Who Calls for Help? Lower Female Utilization of Prehospital Emergency Medical Services in Punjab, Pakistan

Global evidence suggests that women have delays in seeking health care including lower utilization of emergency medical services (EMS). While these disparities have been documented in high-income countries, data from low- and middle-income countries (LMIC) is limited. This study assessed gender disparities in pre-hospital care utilization in Punjab, the largest province of Pakistan, an LMIC.

This was a retrospective secondary data analysis of Punjab EMS Data (Rescue 1122) from January 2022 to June 2025. The primary exposure was gender (female and male) and outcome was EMS utilization rate (number of activations per 100,000 population per ambulance). On-scene mortality was considered a secondary outcome. Descriptive, Inferential analysis, and negative binomial model were performed by using R version 4.2.2.

Of 6,872,833 EMS activations, 39% were for females. The overall EMS utilization rate in Punjab was 5.05 in females as compared to 7.46 per 100000 per ambulance in males, respectively. Approximately 95% of the districts had statistically significant differences in EMS activations between females and males. The median age of female patients was 37 years (IQR: 25–55) and of males 35 years (IQR: 23-52). A lower proportion of females had no formal education compared with males (46% vs 54%). Females were predominantly housewives (94.2%), whereas males were largely employed, most commonly as laborers (97.8%). Most female EMS calls originated from the school and home (55% & 53%), whereas male calls were more evenly distributed from workspace, roads, and mass events (91%, 88% & 79%). The mean EMS response time was significantly longer for females (8.65 minutes; IQR: 5.70-13.27) compared with males (7.93 minutes; IQR: 5.13- 12.33). Females were less likely to receive on-scene first aid (35% vs 65%) and to be dead on arrival (35% vs 65%) compared with males.

This study highlights lower EMS utilization by females from an LMIC, underscoring the need for further studies to identify the drivers of these disparities and develop context-specific interventions to address gender- and district-level disparities in access to and use of EMS services.