Rural and urban Emergency Medical Services in Saudi Arabia: A comparison of barriers and facilitators of effective pre-hospital care

Abstract

<p>Around the world, Emergency Medical Services (EMS) are a vital component of the wider health system, and contribute to the effective, timely and well-coordinated delivery of medical services to people in the community affected by sudden ill health or injuries. </p> <p>However, studies conducted in developed countries, such as the USA, UK and Australia, have shown differences in patient outcomes and key service measures between the rural and urban EMS. In spite of this knowledge, limited research has so far focussed on these rural/urban differences in developing countries, such as Saudi Arabia, where such disparities may be even more significant due to cultural, social, political and economic differences when compared to developed countries. The over-arching aim of this Thesis was to comparatively examine the provision of EMS in both rural and urban locations within the Riyadh region of Saudi Arabia, with the goal of identifying barriers and impediments to effective and efficient service delivery. Through the identification of these issues, recommendations were able to be developed for both Government and EMS services providers to facilitate changes to practice that may improve the delivery of pre-hospital emergency healthcare support.</p> <p>This study utilized an explanatory sequential mixed methods design. In accordance with this approach, data collection was done in consecutive stages; stage one was a retrospective crosssectional quantitative analysis of 800 (400 rural and 400 urban) hard copy emergency patient records from The Saudi Red Crescent Authority EMS. The results from this analysis informed the development of a semi-structured interview guide for collection of qualitative data in stage two. This was undertaken through 20 (10 rural and 10 urban) in-depth interviews with EMS personnel from both rural and urban areas of Riyadh region in Saudi Arabia. The first stage involved examination and comparison of patient records across rural and urban EMS for key operational and on-scene characteristics, as well as short term patient outcomes. This allowed for the identification of areas of concern, both generally and comparatively, which in turn became key foci questions for the second stage of qualitative interviews with experienced (5 years minimum) frontline EMS personnel selected through purposive sampling. Both the interviewing methods and analyses of the arising data were performed in line with the principles of a hermeneutic phenomenological approach. </p> <p>The analysis of the patient record data showed significant differences were evident between rural and urban EMS services in Saudi Arabia across a number of key performance areas, including response and duration time, as well as the overall length of stay in hospital or intensive care unit following transportation. There was also a major disparity in the total number of male versus female cases for both rural and urban locations, with another variation observed in the ratio of medical versus trauma cases between the two areas. In-depth interviews allowed further interrogation of the quantitative results, with differences in the equipment, training and skill-sets of EMS staff being noted as factors contributing to these findings. There was also a belief that the general community sometimes lacked a clear understanding of the role and responsibilities of the Saudi Red Crescent EMS, which could culminate in threats to on-scene staff and increased risk for patients associated with nontransportation outcomes. In addition, the lack of female EMS staff across both rural and urban areas was considered a reason for the observed sex difference in call-out and transportation rates.</p> <p>The combined findings from the qualitative and quantitative components of this Thesis facilitated the development of a number of recommendations for improvement for EMS delivery in both rural and urban areas of Riyadh region in Saudi Arabia. Specifically, it is suggested that a review of all equipment is performed to ensure that the performance of EMS staff, particularly in rural areas, is not being limited through a lack of vital infrastructure. It is also recommended that localized skills training and career advancement opportunities for rural EMS could assist to redress some of the observed differences in patient outcomes. A strategy of supplementing existing EMS teams with female registered nurses from local hospitals is suggested as a means to overcome the current lack of female paramedics, and may be appropriate until sufficient female EMS staff can be trained and brought into the system. Widespread national public health campaigns that promote and explain the exact functions of the Saudi Red Crescent EMS may also be beneficial in overcoming perceived misunderstandings by the general public.</p>