A comparison of pre-hospital emergency medical services’ response and duration times in urban versus rural areas of Saudi Arabia
pdf
html

Keywords

Emergency Medical Service
response
time
duration
rural
urban
Saudi Arabia

How to Cite

1.
Alanazy ARM, Wark S, Fraser J, Nagle A. A comparison of pre-hospital emergency medical services’ response and duration times in urban versus rural areas of Saudi Arabia. Australasian Journal of Paramedicine [Internet]. 2020Jul.23 [cited 2020Aug.9];17. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/805

Abstract

Background

Response impacts on treatment outcomes, particularly for time-sensitive illnesses, including trauma. This study compares key outcome measures for emergency medical services (EMS) operating in urban versus rural areas in the Riyadh region of Saudi Arabia.

Methods

A cross-sectional study of EMS users was conducted using a random sampling method. Primary outcome measures were response time, on-scene time, transport time interval and survival rates. Secondary outcomes were the length of stay in the intensive care unit and hospital. Data were compared between the urban and rural groups using the t-test and chi-square test.

Results

Eight-hundred patients (n=400 urban, n=400 rural) were included in the final analysis. Cases in rural areas had significantly higher response times and duration times (median response 15 vs. 22 minutes, median duration 43 vs. 62 minutes). Response times were significantly longer for rural areas for MVC, industrial accidents, medical incidents and trauma, but there was no significant difference in duration time for industrial accidents. While urban areas had significantly shorter response times for all incident types, there was no difference with rural areas in duration time for chest injury, gastrointestinal, neurological or respiratory problems.

Conclusion

The findings indicate that response time and duration differs between urban and rural locations in a number of key areas. The factors underlying these differences need to be the subject of specific follow-up research in order to make recommendations as to the best way to improve EMS in Saudi Arabia and to close the gap in rural and urban service delivery.

https://doi.org/10.33151/ajp.17.805
pdf
html

References

Kobusingye O, Guwatudde D, Owor G, Lett R. Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev 2002;8:133-6. doi: 10.1136/ip.8.2.133

Mehmood A, Rowther A, Kobusingye O, Hyder A. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med 2018;11:53. doi.org/10.1186/s12245-018-0207-6

Gosselin R, Spiegel D, Coughlin R, Zirkle L. Injuries: the neglected burden in developing countries. Bull World Health Organ 2009;87:246. doi: 10.2471/BLT.08.052290

Harmsen A, Giannakopoulos G, Moerbeek P, et al. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46:602-9. doi: 10.1016/j.injury.2015.01.008

Levine A, Presser D, Rosborough S, et al. Understanding barriers to emergency care in low-income countries: view from the front line. Prehosp Disaster Med 2007;22:467-70. doi: 10.1017/s1049023x00005240

Henry J, Reingold A. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg 2012;73:261-8. doi: 10.1097/TA.0b013e31824bde1e

Norris R. Fatality outside hospital from acute coronary events in three British health districts, 1994-5. BMJ 1998;316:1065. doi.org/10.1136/bmj.316.7137.1065

Lin C, Peterson E, Smith E. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes 2012;5:514-22.

Studnek J, Artho M, Garner C, Jones A. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med 2012;30:51-6. doi: 10.1016/j.ajem.2010.09.015

MacFarlane C, Van Loggerenberg C, Kloeck W. International EMS systems in South Africa: past, present, and future. Resuscitation 2005;64:145-8. doi: 10.1016/j.resuscitation.2004.11.003.

Razzak J, Hyder A, Akhtar T, Khan M, Khan U. Assessing emergency medical care in low income countries: a pilot study from Pakistan. BMC Emerg Med 2008;8:8. doi: 10.1186/1471-227X-8-8

Calvello E, Broccoli M, Risko N, et al. Emergency care and health systems: consensus‐based recommendations and future research priorities. Acad Emerg Med 2013;20:1278-88. doi: 10.1111/acem.12266

Alanazy A, Wark S, Fraser J, Nagle A. Factors impacting patient outcomes associated with use of emergency medical services operating in urban versus rural Areas: a systematic review. Int J Environ Res Public Health 2019;16:1728. doi: 10.3390/ijerph16101728

Strobe-statement. STROBE checklist for cohort, case-control, and cross-sectional studies (combined). 2019. Available at: www.strobe-statement.org/index.php?id=available-checklists [Accessed 30 March 2020].

AlShammari T, Jennings P, Williams B. Evolution of emergency medical services in Saudi Arabia. J Emerg Med Trauma Acute Care 2017;1:4. doi.org/10.5339/jemtac.2017.4

General Authority for Statistics. Saudi Arabia Health Statistics 2017. Available at: www.stats.gov.sa/en/868 [Accessed 20 January 2020].

Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res 2010;1:55. doi: 10.4103/0974-7788.59946

Sariyer G, Ataman M, Sofuoğlu T, Sofuoğlu Z. Does ambulance utilization differ between urban and rural regions: a study of 112 services in a populated city, Izmir. J Public Health 2017;25:379-85. doi.org/10.1007/s10389-017-0802-7

General Authority for Statistics. Population in Saudi Arabia by gender, age, nationality. 2016. Available at: www.stats.gov.sa/en/5305 [Accessed 1 June 2020].

Gonzalez R, Cummings G, Mulekar M, Rodning C. Increased mortality in rural vehicular trauma: identifying contributing factors through data linkage. J Trauma Acute Care Surg 2006;61:404-9. doi: 10.1097/01.ta.0000229816.16305.94

Aftyka A, Rybojad B, Rudnicka‐Drozak E. Are there any differences in medical emergency team interventions between rural and urban areas? A single‐centre cohort study. Aust J Rural Health 2014;22:223-8. doi: 10.1111/ajr.12108

Sørensen J, Terkelsen, C, Nørgaard B, et al. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur Heart J 2011;32:430-6. doi: 10.1093/eurheartj/ehq437

Masterson S, Wright P, O’Donnell C, et al. Urban and rural differences in out-of-hospital cardiac arrest in Ireland. Resuscitation 2015;91:42-7. doi: doi.org/10.1016/j.resuscitation.2015.03.012

Fleischmann T, Fulde G. Emergency medicine in modern Europe. Emerg Med Australas 2007;19:300-2. doi: 10.1111/j.1742-6723.2007.00991.x

Schwartz J, Dreyer R, Murugiah K, Ranasinghe I. Contemporary prehospital emergency medical services response times for suspected stroke in the United States. Prehosp Emerg Care 2016;20:560-5. doi: 10.3109/10903127.2016.1139219

Carter A, Keane P, Dreyer J. Transport refusal by hypoglycemic patients after on‐scene intravenous dextrose. Acad Emerg Med 2002;9:855-57. doi: 10.1111/j.1553-2712.2002.tb02179.x

Ro Y, Shin S, Song K, et al. A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea. Resuscitation 2013;84:547-57. doi: 10.1016/j.resuscitation.2012.12.020