| The objective of this research was to evaluate the Ubon Ratchathani emergency medical service system (EMSS) in the topics of input, process, output and outcome, following the guidelines of the handbook of emergency medical service 2005. The data were collected during January–April 2007, and were obtained from ambulance units, emergency practice records and medical records of patient admitted in Sappasitthiprasong Hospital as well as personnel who worked in ambulances. The ambulatory technicians were 193 registered nurses, 18 intermediate-emergency medical technicians, 258 basic-emergency medical technicians, 140 first responders and 62 ambulance chiefs. Created questionnaires, ambulance surveyed forms and interviews were used in this research. Data were statistically analyzed by description and Chi square.
From man-input results, it was found that only 28.7% nurses were trained according to the required program. The average scores of their knowledge were 72.3%, and the topic of their lowest scores was scene size up. In additions, the average-knowledge scores of intermediate-emergency medical technicians were 82.3%. Moreover, all of basic-emergency medical technicians were trained. In this group, 64.7% was the average knowledge scores and the lowest-score topic was continuous care in ambulance. Furthermore, first responders were mostly trained (94.3%), with 69.9 % average-knowledge scores. From money-material-management input results, the chief of each advanced ambulance unit was the registered nurse who set up the unit policy. Materials, equipments and medicines in the ambulance unit were to be shared in the emergency room due to the inappropriate location of the ambulance unit. The ambulance for EMSS service was only 5.9% and the operation of ambulance technicians could be done only in festival periods. In the basic ambulance unit, the unit was 92.1% appropriately located, with 87.9% required equipments. However, most equipment was not functionally used.
For process results, the appropriate first-aid treatment in trauma patients was splint, stop bleeding and airway management (60.6%, 54% and 22.5% respectively). The response time (measured by the standard guideline) for the distance less than 10 and 10-20 kilometer was 70.1% and 70.5% respectively. When the distance was more than 20 kilometer, the response time was decreased to 58.8%. The total time within 30 minutes for the distance less than 20, 10-20 and 21-30 kilometer was 95.7%, 80.1% and 40.4% respectively.
For output results, the EMSS coverage at the emergency room in this province was 10.4%. For outcome results, the mortality rate in EMSS patients was more than that of trauma patients who came to the hospital by other means (5.0% and 1.6%, respectively, p< 0.001). Additionally, in patients with high degree of survival probability (Ps>0.75), there was not statistically significant (3.5% and 1.3%, respectively, p= 0.102). By comparison with EMSS patients recorded in National Injury Surveillance Thailand (2006) data, the mortality rate in patients at the same degree of survival probability who arrived at the hospital less than and more than 2 hours, was insignificantly different. |