Priority setting in the Brazilian emergency medical service: a multi-criteria decision analysis (MCDA)

Ana F A Dos Santos,Ricardo P De Souza,Deyse G G Camilo,João Florêncio Da Costa Júnior,Talita D C Frazão

doi:10.1186/s12911-021-01503-z

Abstract

BackgroundDespite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, EMS. With this, and knowing that the decision maker needs a direction on which choice may be the most appropriate, based on different and often conflicting criteria. The current work developed a new model for prioritizing victims of SAMU/192, based on the multicriteria decision methodology, taking into account the scarcity of resources.MethodsAn expert panel and a discussion group were formed, which defined the limits of the problem, and identified the evaluation criteria for choosing a victim, amongst four alternatives illustrated from hypothetical scenarios of emergency situations—clinical and traumatic diseases of absolute priority. For prioritization, an additive mathematical method was used that aggregates criteria in a flexible and interactive version, FITradeoff.ResultsThe structuring of the problem led the researchers to identify twenty-five evaluation criteria, amongst which ten were essential to guide decisions. As a result, in the simulation of prioritization of four requesting victims in view of the availability of only one ambulance, the proposed model supported the decision by suggesting the prioritization of one of the victims.ConclusionsThis work contributed to the prioritization of victims using multicriteria decision support methodology. Selecting and weighing the criteria in this study indicated that the protocols that guide regulatory physicians do not consider all the criteria for prioritizing victims in an environment of scarcity of resources. Finally, the proposed model can support crucial decision based on a rational and transparent decision-making process that can be applied in other EMS.

Highlights

Despite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, Emergency medical services (EMS)
Structuring the decision problem Problem, objective and the Multicriteria decision analysis (MCDA) model alternatives Based on the objective of prioritizing victims, the main issue is the choice of which victim to attend first
The alternatives presented were illustrated based on four occurrence scenarios that brought physicians the main points of pre-hospital care in emergency situations and clinical and traumatic emergencies, these classified as emergencies of absolute priority

Summary

Introduction

Despite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, EMS. Despite the proven value of MCDA’s support in the health field, no models were found that used a multicriteria method to assist in prioritizing victims’ decisions at Emergency Medical Services, EMS. This is one of the most important health services, as it plays a vital role in saving people’s lives and reducing the rate of mortality and morbidity [17]. Carvalho et al [24] presents two generic approaches to optimize dispatch; and Belanger et al [25] relocation decisions and thereby maximize the preparation of the system and a recursive simulation-optimization framework; it does not take into account fundamental criteria for the ambulance dispatch decision, such as those related to the victim’s severity and conditions, leaving a gap in the literature

Methods

Results

Discussion

Conclusion