Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.

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Outpatient Care in Acute and Prehospital Emergency Medicine by Emergency Medical and Patient Transport Service Over a 10-year Period: A Retrospective Study Based on Dispatch Data From a German Emergency Medical Control Center (OFF-RESCUE)

10.21203/rs.3.rs-80121/v1 ◽

2020 ◽

Author(s):

Marc S. Schehadat ◽

Guido Scherer ◽

David A. Groneberg ◽

Manfred Kaps ◽

Michael H.K. Bendels

Keyword(s):

Emergency Medical Service ◽

Rural Areas ◽

Urban Areas ◽

Medical Service ◽

Transport Service ◽

Economic Point ◽

Control Center ◽

Patient Transport ◽

Medical Control ◽

Emergency Medical

Abstract Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380 % in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types.Methods This analysis examined N=819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical control center (EMCC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p<.01).Results 53.4 % of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7 % are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 % and 85.8 % are triaged or dispatched for the EMS. 74 % of all ON-Missions are located in urban areas, 26 % in rural areas; 81.3 % of rural operations are performed by the EMS. 66 % of OFF-Missions are in cities. 93.2 % of the remaining 34 % of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95 % CI 3.21-3.30; OROFF 3.18, 95 % CI 3.04-3.32). OFF-Missions last 47.2 minutes (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 minutes on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million.Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.

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Polish Medical Air Rescue Crew Interventions Concerning Neonatal Patients

Children ◽

10.3390/children8070557 ◽

2021 ◽

Vol 8 (7) ◽

pp. 557

Author(s):

Ewa Rzońca ◽

Grażyna Bączek ◽

Marcin Podgórski ◽

Robert Gałązkowski

Keyword(s):

Emergency Medical Service ◽

Urban Areas ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Air Rescue ◽

Medical Emergency ◽

Emergency Procedures ◽

Emergency Medical ◽

Common Diagnosis ◽

Medical Air

The purpose of the study was to present the characteristics of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) interventions concerning newborns in Poland. The study involved a retrospective analysis of missions by Polish Medical Air Rescue crews concerning newborns, carried out in Poland between January 2011 and December 2020. Polish Medical Air Rescue crews were most commonly dispatched to urban areas (86.83%), for patient transfer (59.67%), using an airplane (65.43%), between 7 AM and 6:59 PM (93.14%), and in the summer (28.67%). Further management involved handing over the neonatal patient to a ground neonatal ambulance team. Most of the patients studied were male (58.02%), and the most common diagnosis requiring the HEMS or EMS intervention was a congenital heart defect (31.41%). The most common medical emergency procedure performed by Polish Medical Air Rescue crew members for the neonatal patients was intravenous cannulation (43.07%). The odds ratio for congenital malformations was higher in male newborns. The type of Polish Medical Air Rescue mission was associated with the location of the call, time of the call, ICD-10 diagnosis associated with the dispatch, selected clinical findings, most commonly performed medical emergency procedures, and mission duration and distance covered.

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Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE)

BMC Emergency Medicine ◽

10.1186/s12873-021-00424-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marc S. Schehadat ◽

Guido Scherer ◽

David A. Groneberg ◽

Manfred Kaps ◽

Michael H. K. Bendels

Keyword(s):

Emergency Medical Service ◽

Rural Areas ◽

Urban Areas ◽

Medical Service ◽

Transport Service ◽

Emergency Medical Dispatch ◽

Economic Point ◽

Patient Transport ◽

Emergency Medical ◽

Dispatch Centre

Abstract Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. Methods This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). Results 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21–3.30; OROFF 3.18, 95% CI 3.04–3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9–47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6–79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.

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Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical control center (OFF-RESCUE)

10.21203/rs.3.rs-103683/v1 ◽

2020 ◽

Author(s):

Marc S. Schehadat ◽

Guido Scherer ◽

David A. Groneberg ◽

Manfred Kaps ◽

Michael H.K. Bendels

Keyword(s):

Emergency Medical Service ◽

Rural Areas ◽

Urban Areas ◽

Medical Service ◽

Transport Service ◽

Economic Point ◽

Control Center ◽

Patient Transport ◽

Medical Control ◽

Emergency Medical

Abstract BackgroundThe number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380 % in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types.MethodsThis analysis examined N=819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical control center (EMCC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p<.01).Results53.4 % of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7 % are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 % and 85.8 % are triaged or dispatched for the EMS. 74 % of all ON-Missions are located in urban areas, 26 % in rural areas; 81.3 % of rural operations are performed by the EMS. 66 % of OFF-Missions are in cities. 93.2 % of the remaining 34 % of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95 % CI 3.21-3.30; OROFF 3.18, 95 % CI 3.04-3.32). OFF-Missions last 47.2 minutes (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 minutes on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million.ConclusionsThis study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.

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Organisational factors affecting emergency medical services’ performance in rural and urban areas of Saudi Arabia

BMC Health Services Research ◽

10.1186/s12913-021-06565-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Ramdan M Alanazy ◽

John Fraser ◽

Stuart Wark

Keyword(s):

Saudi Arabia ◽

Emergency Medical Services ◽

Rural Areas ◽

Urban Areas ◽

Medical Services ◽

Time Service ◽

Rural And Urban Areas ◽

Emergency Medical ◽

Rural And Urban ◽

Organisational Factors

Abstract Background There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance. Subject and methods The study was undertaken in the Riyadh region of Saudi Arabia. Potential participants were currently employed by Saudi Red Crescent EMS as either a technician, paramedic or an EMS station manager, and had a minimum of five years experience with the EMS. Semi-structured interviews were undertaken between October 2019 and July 2020 with first respondents to a call for participants, and continued until data saturation was reached. All interviews were conducted in Arabic and transcribed verbatim. The Arabic transcript was shared with each participant, and they were asked to confirm their agreement with the transcription. The transcribed interviews were then translated into English; the English versions were shared with bi-lingual participants for validation, while independent certification of the translations were performed for data from participants not fluent in English. A thematic analysis methodological approach was used to examine the data. Results The final sample involved 20 participants (10 rural, 10 urban) from Saudi Red Crescent EMS. Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing. Conclusion The findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, three changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.

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Provision of Emergency Medical Services in Rural and Urban Saudi Arabia: An overview of personnel experiences

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v16i2.559 ◽

2021 ◽

Vol 16 (2) ◽

pp. 148-157

Author(s):

Ahmed Alanazy ◽

John Fraser ◽

Stuart Wark

Keyword(s):

Saudi Arabia ◽

Emergency Medical Services ◽

Urban Areas ◽

Public Awareness ◽

Organizational Factors ◽

Medical Services ◽

Rural And Urban Areas ◽

Awareness Campaigns ◽

Emergency Medical ◽

Rural And Urban

Objective: Pre-hospital emergency medical services (EMS) are a vital component of health management, however there are disparities in the provision of EMS between rural and urban locations. While rural people experience lower levels of pre-hospital care, there has been little examination of the reasons underpinning these differences through discussion with the providers of EMS, and particularly in countries other than the USA, UK and Australia. The purpose of this paper is to provide an overview of the lived experience of EMS personnel in Saudi Arabia regarding the key issues they face in their work practice. Design: This research focussed on frontline workers and middle-level station managers within the Saudi Arabian EMS system and adopted a hermeneutic phenomenology design to better understand the factors contributing to observed disparities between rural and urban areas in Riyadh region in Saudi Arabia. A semi-structured interview approach was used to collect data reflecting realistic experiences of EMS personnel in both urban and rural locations. Results: 20 interviews (10 each with rural and urban personnel) were done. Data analyses identified three primary thematic categories impacting EMS delivery: EMS Personnel Factors; Patient Factors; and, Organisational Factors. Underpinning each category were sub-themes, including Working Conditions, Stress, Education and training, and Resources, amongst others. Conclusions: The quality and efficiency of EMS services, in both rural and urban areas, was affected by a number of over-arching organizational factors. Implementing major policy shifts, such as recruitment of female EMS professionals, will be critical in addressing these challenges, but is acknowledged that this will take time. Quicker changes, such as improving the advanced training options for rural EMS staff, may help to remediate some of the issues. Public awareness campaigns may also be effective in addressing the identified misconceptions about the role of EMS in Saudi Arabia.

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Organisational factors affecting Emergency Medical Services’ performance in rural and urban areas of Saudi Arabia

10.21203/rs.3.rs-279486/v1 ◽

2021 ◽

Author(s):

Ahmed Ramdan M Alanazy ◽

John Fraser ◽

Stuart Wark

Keyword(s):

Developing Countries ◽

Saudi Arabia ◽

Emergency Medical Services ◽

Urban Areas ◽

Medical Services ◽

Time Service ◽

Rural And Urban Areas ◽

Emergency Medical ◽

Rural And Urban ◽

Organisational Factors

Abstract Background:There is a disparity in outcomes between rural and urban emergency medical services (EMS) in both developed and developing countries. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas of developing countries how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance.Subject and Methods:The study was undertaken in the Riyadh region of Saudi Arabia, with 20 participants (10 rural, 10 urban) drawn from Saudi Red Crescent EMS. Semi-structured interviews were undertaken between October 2019 and July 2020. All interviews were conducted in Arabic, transcribed verbatim and translated into English. Results:Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing.Conclusion:The findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.

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Trend Analyses of Emergency Medical Services for Motor Vehicle Crashes: Michigan Case Study

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/2635-07 ◽

2017 ◽

Vol 2635 (1) ◽

pp. 55-61

Author(s):

Anil Kumar ◽

Osama Abudayyeh ◽

Tycho Fredericks ◽

Megan Kuk ◽

Michelle Valente ◽

...

Keyword(s):

Emergency Medical Services ◽

Urban Areas ◽

Motor Vehicle ◽

Medical Services ◽

Vehicle Crashes ◽

Rural And Urban Areas ◽

Emergency Medical ◽

Vehicle Collision ◽

Rural And Urban ◽

Timely Response

The timely response of emergency medical services (EMS) personnel at a crash site may help prevent loss of life and thereby impact the quality of life for an individual at risk. Thus, availability of and access to quantitative data on EMS activities is critical. This study was conducted to review the data collected by the Michigan Department of Community Health, Emergency Medical Services Section, from a five-year period starting in 2010. The intent was to identify current EMS response, treatment, and transport trends. Among the results noted in this paper, it was identified that on average, the total times involved from the dispatch call to the drop-off of a patient from a motor vehicle collision (MVC) in Michigan were approximately 56 and 43 min for rural and urban areas, respectively. The results from this study could be utilized to guide and direct future EMS initiatives relating to MVCs. The analysis might also be beneficial in predicting the types of injuries that occur in specific types of vehicle crashes. Several challenges and recommendations are provided in the paper.

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