A mixed methodology study covering both quantitative and qualitative data is suggested to identify the supply and demand side barriers to access to prehospital emergency medical services. The study will be conducted in Trauma Care institutions in three districts of Kerala in three stages. The first stage would consist of assessing the existing systems to understand the utilization pattern; factors influencing the response time as well as 108 ambulance utilization and design of an intervention strategy based on the learnings. The second stage would include technical support to the Government of Kerala in delivery of the strategic options in the selected regions followed by assessment of the treatment outcomes of this intervention as the third stage. The IR will encompass the following activities: 1. A comprehensive assessment of the utilization of 108 services: This assessment will be carried out to understand the reasons for low utilization of the 108 system with a specific focus on factors related to its involvement in the post-crash response:¡¤ Surveys of patients and/or families who are presented at hospitals following vehicle crash; including both those who used the 108 system and those who arrived by other means.¡¤ Community surveys determine their perceptions of constraints to utilizing the 108 system. 2. Development of communications and public information strategy: The strategy will focus on the identified constraints from the assessment (described above) and seek to address any misconceptions that the public may have with respect to the 108 service and inform them regarding when and how to contact this service for assistance. As an outcome; this will enhance the use of 108 system for post-crash response.3. Technical support in the application of the strategic options for Enhancing Post-Crash Response Services: District specific implementation plans for the technical support will be prepared and it will include the roll out of the communications strategy in the select districts. 4. Develop measurement tools and data to define baseline indicators of post-crash response: Systematically track the data on "Increased use of pre-hospital emergency care services for post-crash response¡± in the selected districts.