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Obstacles to emergency medical services system design and operational features

02 December 2015
Volume 5 · Issue 3



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.


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.


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.


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.

The US Institute of Medicine report, Emergences Medical Services: At the Crossroads, and the National EMS Research Agenda sponsored by the US National Highway Traffic Administration, both cite a paucity of peer-reviewed research on EMS systems and how little remains known about system features that make a difference (National Highway Traffic Safety Administration, 2001; Institute of Medicine, 2006). Published research frequently focuses on a single feature: not taking a systems view, and are not designed to look at the complexity of EMS systems (Spaite et al, 1995). Professional organisations have made the case for design concepts like competitive procurement or a preferred ambulance provider model, but evidence is absent to support or refute their advocacy (Williams, 2006; International Association of Firefighters, 2007; American Ambulance Association, 2008). More needs to be understood about EMS systems.

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