Role of mHealth applications for emergency medical system activation in reducing mortality in low-income and middle-income countries: a systematic review protocol

INTRODUCTION: Prehospital care is an essential component in reducing mortality for patients presenting with emergency medical conditions. Prehospital systems tend to be underdeveloped or non-existent in these areas, with less than 1% of low-income and middle-income country (LMIC) populations served by an organised prehospital system. Mobile health apps for activation of Emergency Medical System (EMS) have been shown to decrease mortality, but there has yet to be a systematic review and meta-analysis performed to clarify the role that these apps play in reducing mortality in LMICs. The objective of this review is to evaluate the effectiveness of mobile health apps for EMS activation versus traditional EMS dispatches in survival and transport time in patients with emergency medical conditions. METHODS AND ANALYSIS: The proposed systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. MEDLINE, CINAHL, Web of Science, Cochrane Library, EMBASE and EBSCO will be searched from January 2005 to March 2021. The search results will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Primary outcomes will include mortality and transport time. Critical appraisal will be assessed using the JBI SUMARI Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomised Studies tool for NRCTs. A narrative synthesis will be conducted for all included studies. If sufficient data are available, a meta-analysis will be conducted. I(2) statistics will be used to assess heterogeneity and identify their potential sources. ETHICS AND DISSEMINATION: No ethical approval will be required, as this review is based on already published data and does not involve interaction with human subjects. The plan for dissemination, however, is to publish the findings of the review in a peer-reviewed journal and present findings at high-level international conferences that engage the most pertinent stakeholders. Any amendments to this protocol will be documented in the final review. PROSPERO REGISTRATION NUMBER: CRD42021243041.