Healthcare in transition in the Republic of Armenia: A longitudinal mixed-method study of emergency medical systems

2020 ◽  
Author(s):  
Sharon Chekijian ◽  
Nune Truzyan
Keyword(s):  
Emergency Care ◽  
Mixed Method ◽  
Systems Development ◽  
Mixed Method Study ◽  
Medical Systems ◽  
Emergency Medical ◽  
Emergency Care Systems ◽  
Care Systems ◽  
Emergency Systems ◽  
Emergency Medical Systems

Abstract Background Acute life-threatening illness such as trauma, myocardial infarction, and stroke depend on timely recognition and treatment. There is a shift in interest by international agencies and funders in recent years towards the development of emergency care systems (EMS) in low and middle-income countries. Armenia, ex-Soviet Republic in transition since independence in 1991, has made remarkable progress but the healthcare sector, emergency systems development and education have lagged behind the overall development of the nation.Methods This manuscript describes a mixed method study used to derive a comprehensive picture of the state of EMS in Armenia. The quantitative component consists of a survey administered at three intervals over a 5-year period in 2005, 2009 and 2010 to gauge issues with the emergency medical system (EMS). A qualitative assessment of EMS was also performed using focus groups discussion and in-depth interviews.Results The quantitative questionnaire showed a positive trend in trust placed in EMS via the results of two questions “the ambulance team will respond in a timely manner”, and “the ambulance dispatcher will not request payment for services before deciding to respond to the call” (p = 0.04). These positive changes led to a statistically significant systematic increase in the percent of people who will decide to wait for the ambulance rather than to take the patient directly to the hospital in a medical emergency (p = 0.01). In-depth interviews and focus group discussions identified issues with training, timeliness of care and shortages of medications and equipment.Conclusion Nations and communities rely on emergency medical systems to care for conditions that require timely and skilled interventions. There are vital problems with emergency medical systems in Armenia related to both confidence in emergency systems from the public and physicians especially related to timeliness of care provided, training, equipment and medications. Emergency care systems development provides a comprehensive way to efficiently address multiple critical conditions. Armenia benefits from an organized emergency system as well as from the Franco-German model of care with physicians deployed in the field. An investment in training as well as critical medications and updated equipment will be key to improvement in services.

scholarly journals National evaluation program for emergency medical center

2020 ◽  
Vol 63 (4) ◽  
pp. 184-186
Author(s):  
Sung Woo Lee
Keyword(s):  
Emergency Care ◽  
Evaluation System ◽  
Medical Center ◽  
Medical Systems ◽  
Emergency Rooms ◽  
Evaluation Program ◽  
Emergency Medical ◽  
Final Treatment ◽  
Medical Person ◽  
Emergency Medical Systems

Since 2003, the national evaluation program for emergency medical centers (EMCs) has been managed by the Central Emergency Medical center which is controlled by the Ministry of Health and Welfare. Although the evaluation system for EMC has contributed to the development of the structure of emergency centers and the expansion of emergency resources (emergency medical person and equipment), it has some limitations in terms of quality control for both EMCs and emergency medical systems. One of the purposes of the evaluation program is to assess the performance of EMC in different levels. However, both regional and local emergency centers have same role that is offering of final treatment to severe emergency patients. There is no role for local emergency rooms in the emergency care of patients. In addition, the national evaluation program does not have outcome indicators that assess the performance of the EMC in emergency care. The improvement of the national evaluation system for EMC is required for the appropriate assessment of the performance of EMCs in the future.

scholarly journals Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study: Table 1

BMJ Open ◽  
2015 ◽  
Vol 5 (11) ◽  
pp. e009208 ◽  
Author(s):  
Morgan C Broccoli ◽  
Emilie J B Calvello ◽  
Alexander P Skog ◽  
Benjamin Wachira ◽  
Lee A Wallis
Keyword(s):  
Qualitative Study ◽  
Emergency Care ◽  
Medical Systems ◽  
Emergency Medical ◽  
Emergency Medical Systems

Abstract WP303: Laying the Groundwork for Stroke Care in Armenia. Assessment of Ambulance Services in the Republic of Armenia: Current State of Care, Public Perception and Opportunities for Strengthening the Emergency Medical System

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sharon Chekijian ◽  
Nune Truzyan ◽  
Mikayel Grigoryan ◽  
Viken Babikian
Keyword(s):  
Emergency Care ◽  
Public Perception ◽  
Emergency Services ◽  
Early Recognition ◽  
Stroke Care ◽  
The State ◽  
Medical Systems ◽  
Emergency Medical ◽  
Chain Of Survival ◽  
Emergency Medical Systems

Background: The recent creation of the Armenian National Stroke Program has stipulated that all links in the Stroke Chain of Survival are examined and remediated including Emergency Medical Systems (EMS). EMS forms the second link in the chain of survival after early recognition of stroke symptoms by the general public. This study describes the perception of and performance of EMS in Armenia’s capital, Yerevan, and provides the groundwork for nascent stroke care in Armenia. Methods: We used mixed methods to derive a comprehensive picture of the state of Emergency Medical Systems. We administered a survey using random digit telephone number generator to 384 households at three intervals over a 5 year period in 2005, 2009 and 2010. A trend analysis was performed for six questions regarding EMS. We queried knowledge of the 911-equivalent access number, perception of accessibility of emergency services, perception of anticipated care, and financial concerns. The surveys had a 96% response rate. We also performed key stakeholder interviews and focus groups to describe the state and evolution of emergency care in Armenia. Results and Discussion: Appropriate and timely stroke care relies on activation of EMS. EMS in Armenia remains an ambulance-based service following the Franco-German model where ambulances are staffed by a physician, nurse and driver. Utilization of EMS in Armenia is one of the highest in the world. Eighty percent of calls are treated on scene and 20% are transported to surrounding hospitals. There is currently minimal hospital-based emergency care. Over the three survey periods there was a trend towards increased trust in the EMS system. The idea that the ambulance will respond in a timely manner and not request payment before accepting the call (p=0.04) gained traction. Increased trust means more people will wait for the ambulance than drive the patient to the hospital themselves (p=0.01), a key factor for prompt stroke care. Since February of 2019, stroke patients are transferred to two stroke referral centers in Yerevan. EMS systems strengthening starting with public education and trust-building, emergency medicine residency, ambulance and helicopter protocols and tele-stroke development is key in providing timely and quality stroke care.

A Call to Action: The Institute of Medicine Report on Emergency Medical Services for Children

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 173-174
Author(s):  
Jane F. Knapp
Keyword(s):  
Emergency Medical Services ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Institute Of Medicine ◽  
Medical Systems ◽  
Call To Action ◽  
Emergency Medical ◽  
Grant Program ◽  
Public Responsibility ◽  
Emergency Medical Systems

Emergency Medical Services for Chi (EMS-C) must be recognized as a public responsibility; the "market" cannot be relied on to produce the kind of planning and cooperation required to make services available to all who need them.1 The Institute of Medicine (IOM) Report on Emergency Medical Services For Children. Each year millions of American chi become seriously ill or injured. If you have ever encountered a child who did not receive the medical care they needed or deserved under these circumstances you understand what EMS-C is all about. The familiar adage, "Children are not small adults," emphasizes that their care must be an integral part of a system not an afterthought once the adults have been addressed. The achievement of the desired level of competence for EMS-C in the larger system is hampered by many factors. These include lack of organization, equipment, training, and a tack of understanding of the child's unique problems and needs. In response to these needs, Congress approved a demonstration grant program in 1984. The purpose of the program was threefold: to expand access to EMS-C, to improve the quality available through existing Emergency Medical Systems (EMS), and to generate knowledge and experience that would be of use to all states and localities seeking to improve their system. Continuing interest prompted the formation of the Committee on Pediatric Emergency Medical Services by the IOM. This 19-member committee Chaired by Dr Donald N. Medearis, Jr released their report in the summer of 1993. The IOM report entitled Emergency Medical Services for Chi is available in both a soft cover 25-page summary and the full text (see Appendix).

Emergency Medical Services for Children: What Is the Pediatric Surgeon's Role?

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 576-581
Author(s):  
J. ALEX HALLER
Keyword(s):  
Emergency Care ◽  
Emergency Services ◽  
Pediatric Emergency ◽  
State Funding ◽  
Adolescent And Young Adult ◽  
Emergency Medical ◽  
Emergency Care System ◽  
Pediatric Emergency Care ◽  
Emergency Systems ◽  
The One

Comprehensive pediatric emergency care should be integrated into an overall emergency care system and organized regionally to address the special needs of children. Some pediatric voices have suggested that emergency care for children be organized separately in a parallel system with adult emergency systems, but this plan would put children in competition with adults for federal and state funding. Equally important is the natural overlap of many emergency services with obstetric, perinatal, adolescent, and young adult programs, all of which will be strengthened by integration, not by separation. The one non-negotiable principle must be that any emergency medical system that includes children must use the best and most experienced pediatric specialists available in the area.

Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met?

PEDIATRICS ◽  
1984 ◽  
Vol 73 (6) ◽  
pp. 769-772
Author(s):  
James S. Seidel ◽  
Mark Hornbein ◽  
Kathy Yoshiyama ◽  
Dorothy Kuznets ◽  
Jerry Z. Finklestein ◽  
...  
Keyword(s):  
Los Angeles ◽  
Death Rate ◽  
The United States ◽  
Base Station ◽  
Medical Systems ◽  
Medical Problems ◽  
Emergency Medical ◽  
Mobile Intensive Care Unit ◽  
Critically Ill Child ◽  
Emergency Medical Systems

Emergency medical systems are being developed throughout the United States primarily to deal with myocardial infarction and trauma. These programs often fail to recognize the special needs of the critically ill child. Data collected in Los Angeles County from the LA County Trauma Surveys, Mobile Intensive Care Unit Rescue Reports, and Base Station Hospitals demonstrate that children represent approximately 10% of the paramedic calls. The calls are for medical problems as well as trauma. These data suggest that children have a higher death rate in the field than adults, and deaths occur more commonly in areas where there are no pediatric centers. Children are often secondarily transferred from emergency departments to other centers for definitive care. This study suggests that the needs of children in the prehospital setting are not being met.

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