David Williams
International Paramedic Practice, Vol. 5, Iss. 3, 22 Dec 2015, pp 68 - 77

Objective: There is a paucity of global research regarding emergency medical
services (EMS) systems. EMS system processes and outcomes vary by model
and jurisdiction. This study explores the individual, organisational, and system
obstacles to 15 features of EMS systems.
Methods: Using a multi-case study, five US EMS systems, representing five
major design models, were studied. Data collection included: i) data metrics, ii)
document review, iii) interviews, and iv) archival records.
Results: EMS system performance and adoption of the 15 features varies. A total
of 582 independent obstacles in 39 distinct categories were identified. The top
obstacles included: cost/funding, measurement, process/outcome focus, systems
view, public information/education, understanding productivity, training, will,
data definitions, and culture/tradition.
Conclusions: Variation in performance exists across EMS system provider
models. Adoption of the 15 features studied was not universal. Reported
obstacles are opportunities for further investigation and action.

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