Obstacles to emergency medical services system design and operational features

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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