Abstract
BackgroundOut-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement.MethodsWe distributed an anonymous, self-administered Knowledge and Attitudes survey to a convenience sample of out-of-hospital EPs in the capital, Yerevan, from August to September 2012.ResultsWith a response rate of 80%, the majority (89.7%) of respondents failed a 10-question knowledge test (with a pre-defined passing score of ≥7) with a mean score of 4.17 ± 1.99 SD. Answers regarding the relationship between pediatric cardiac arrest and respiratory issues, compression-to-ventilation ratio in neonates, definition of hypotension, and recognition of shock were most frequently incorrect. None of the participants had attended pediatric-specific continuing medical education (CME) activities within the preceding 5 years. χ2 analysis demonstrated no statistically significant association between physician age, length of EMS experience, type of ambulance (general vs. resuscitation/critical care), or CME attendance and pass/fail status. The majority of participants agreed that PEC education in Armenia needs improvement (98%), that there is a need for pediatric-specific CME (98%), and that national out-of-hospital PEC guidelines would increase PEC safety, efficiency, and effectiveness (96%).ConclusionsOut-of-hospital emergency physicians in Yerevan, Armenia are deficient in pediatric-specific emergency assessment and resuscitation knowledge and training, but express a clear desire for improvement. There is a need to support additional PEC training and CME within the EMS system in Armenia.
Highlights
Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses
In Armenia, out-of-hospital EPs are not part of a separate specialty; instead, they are often trained in other specialties or begin work immediately after completing a post-medical school internship year. They generally do not have pediatric-specific training and there are no nationally accepted or widely used EMS guidelines or protocols to guide the care of pediatric patients in the country. This is significantly different compared to the “Anglo-American” or “Specialty” model of emergency medicine whereby pre-hospital care is delivered by non-physicians with the goal of rapid transport to a hospital-based emergency department where a trained EP delivers patient care
A majority of respondents (79.4%) estimated the proportion of their pediatric calls to be consistent with the range documented in the literature and reported by the EMS director for 2012 [6,7]
Summary
Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. The emergency medical services (EMS) system in Armenia is based on the “Franco-German” model of emergency medical care wherein physicians work on ambulances along with nurses. Consistent with this model, Armenian emergency physicians (EPs) provide patient care at the significantly different compared to the “Anglo-American” or “Specialty” model of emergency medicine whereby pre-hospital care is delivered by non-physicians with the goal of rapid transport to a hospital-based emergency department where a trained EP delivers patient care. While the training center continues to function, few additional updates have been made to the EMS system or provider education in Armenia
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