Public perceptions of a rural emergency medical services system

Public awareness of the EMS system in Western Saudi Arabia: identifying the weakest link

Background

The City of Jeddah is the major and largest city in the Western Region of the Kingdom of Saudi Arabia (KSA). Covering a total area of 748 km2. The Saudi Red Crescent Organization (SRC) makes up the major bulk of the Emergency Medical Service (EMS) system in the Kingdom. We have set out to investigate the level of public awareness of the EMS system in place in Western KSA.

Method

This study was an observational cross-sectional study that was done by interviewing the general public in public venues. The survey consisted of a two part questionnaire. The first part was completed for all subjects. The second part was completed only for those subjects that had previous experience with the SRC service.

Result

A total of 1534 subjects were interviewed by 5 data collectors. 33% of people did not know the emergency dispatcher number to call in case of a medical emergency. The majority estimated the ETA of an ambulance response to their home to be about 30 minutes or more. 94 % said that MEDEVAC is needed. 17.7 % of people still find it unacceptable for male paramedics to respond to a female emergency unescorted by a male family member.

Conclusion

It is clear that the general public is aware of the deficit in EMS coverage that is present. To improve the public awareness of the EMS system, municipal, legislative, public guidance, as well as religious support, are needed to be utilized to improve the community’s satisfaction and quality of care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12245-015-0070-7) contains supplementary material, which is available to authorized users.

A Self-Assessment of Wisconsin Prehospital Provider Needs

Introduction:

The pressures facing emergency medical services (EMS) in Wisconsin and their effects on the delivery of prehospital emergency medical care were not known by the Wisconsin EMS Board. In an effort to assess these pressures and the needs of the emergency medical services in the State as perceived by the services, the Board undertook a survey of the EMS providers in Wisconsin.

Methods:

A survey instrument was developed and approved by the EMS Board and distributed to all of the licensed emergency medical services in Wisconsin.

Results:

Of the 453 survey instruments distributed, 323 (71.3%) were completed and returned. Intermediate- and paramedic-level services were more likely to respond than were the basic services, but 235 (72.8%) of the respondents identified their service levels as basic. In addition to providing information about the service characteristics, each responding service also rated the importance of their perceived needs. Lack of medical direction was perceived as the greatest need by all levels of service. However, the second greatest area of need for basic and intermediate services related to difficulty in recruiting new staff. For paramedic services, the second greastest need was associated with dispatching. When comparing services by rural versus urban, difficulty in recruiting new staff and collecting ambulance fees were seen as second and third to lack of a medical director by rural services, whereas urban services noted local training to be in the top three. In the assessment of educational needs, patient-care issues dominated. A review of written comments also demonstrated a difference between rural and urban services, but both noted Medicare and Medicaid reimbursement issues more commonly than any other problem.

Conclusion:

In the restructuring of health care, it will be important to consider the various needs of prehospital providers and recognize that such needs may be unique to the providers' location and level of service.

Paramedic determinations of medical necessity: a meta-analysis

INTRODUCTION

Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport.

METHODS

PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were searched using Cochrane Prehospital and Emergency Care Field search terms combined with the Medical Subject Headings (MeSH) terms "triage"; "utilization review"; "health services misuse"; "severity of illness index," and "trauma severity indices." Two reviewers independently evaluated each title to identify relevant studies; each abstract then underwent independent review to identify studies requiring full appraisal. Inclusion criteria were original research; emergency responses; determinations of medical necessity by U.S. paramedics; and a reference standard comparison. The primary outcome measure of interest was the negative predictive value (NPV) of paramedic determinations. For studies reporting sufficient data, agreement between paramedic and reference standard determinations was measured using kappa; sensitivity, specificity, and positive predictive value (PPV) were also calculated.

RESULTS

From 9,752 identified titles, 214 abstracts were evaluated, with 61 studies selected for full review. Five studies met the inclusion criteria (interrater reliability, kappa = 0.75). Reference standards included physician opinion (n = 3), hospital admission (n = 1), and a composite of physician opinion and patient clinical circumstances (n = 1). The NPV ranged from 0.610 to 0.997. Results lacked homogeneity across studies; meta-analysis using a random-effects model produced an aggregate NPV of 0.912 (95% confidence interval: 0.707-0.978). Only two studies reported complete 2 x 2 data: kappa was 0.105 and 0.427; sensitivity was 0.992 and 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

CONCLUSION

The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.