Abstract
BackgroundThere 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 methodsThe 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.ResultsThe 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.ConclusionThe 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.
Highlights
There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world
An urban EMS Manager (15 years experience) noted: “Sometimes we need more time in the rush hour for example, we can reach a location in 4 mins at 3 AM but we need more than 20 mins in the rush hours due to traffic”
This study reports on interviews conducted with 20 Red Crescent EMS personnel from across rural and urban areas of Riyadh region in Saudi Arabia
Summary
There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. There is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. Urban locations with well-established road networks and health infrastructure hubs are not surprisingly associated with better prehospital EMS outcomes when compared to more isolated and remote rural areas [12]. While it has been known for many years that living in a rural area in many developed countries will affect EMS outcomes e.g. There is a scarcity of research that has directly asked EMS staff in both rural and urban areas their perspectives on how EMS delivery could be improved
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