I have recently read a research paper published by J Med Assoc Thailand 2012: 95(1): 111-8, and my summary and comments follow.
In response to patient perspectives not being considered previously, however it was a key performance indicator when looking at ‘quality improvement in public organisations’ and the research paper undertook a satisfaction survey of over 6,400 patients. The purpose of the paper was to look into the patient experience with both EMS and Emergency Departments, with the view to leading to improvements.
It was intriguing that only 7.28% of respondents where conveyed to hospital by an ambulance but also worrying that the satisfaction levels expressed by patients who had been conveyed by volunteer ambulance crews was noticeably lower than that of the paid hospital based ambulance crews. Only 80% of those surveyed said that they felt safe in a volunteer/foundation ambulance and slightly less that 80% where satisfied with the experience.
Of those patients who were conveyed by a paid hospital ambulance, over 97% said that they felt safe and just under 92% were satisfied.
It is of concern that there is such a disparity between volunteer and paid ambulance services. The findings of the paper said:
(the lower satisfaction score of the foundation or volunteer ambulance) indicated a room for capacity building and personnel management of the volunteers.
Further to this, the authors of the paper reported that:
Given a high turnover of volunteers, it is challenging to design a system to ensure sustainable quality of services of the volunteers.
It was interesting to note that 13% of patients identified pain management as an area of concern. This raises the issue of appropriate training for volunteer ambulance crews at EMT level and the question that comes to mind is should EMT’s at a volunteer level receive appropriate training to administer relevant pain relief as and where required? The question becomes more pertinent when the distance from an appropriate receiving hospital is increased in rural and remote areas.
Another issue identified was correct identification of STEMI patients (ST elevated myocardial infarction) and referred to recent lessons learnt from the 29 referral networks stating that reduction in the time taken to reach the treatment centre lead to a decrease in mortality.
The training and role of volunteer EMS crews is in urgent need of reform. The training program that is in place is in need of a complete overhaul and bringing up to date. The scope of practice for volunteer EMS crews needs to be reviewed and reformed. The role of volunteers needs to be reviewed and progression needs to be opened up by removal of the restrictions on entry to courses above EMT level. The AEMT training takes 2 years and having seen the content of the course, this is a vastly excessive period of time to acquire the skills outlined.
Volunteer retention is an issue experienced globally and is definitely not a Thai only issue. We need to remember that 84% of ambulance personnel in Thailand are volunteers and there needs to be not only recognition of the importance of volunteers and service they delivered, but there also needs to be a recognition of volunteers as ‘professionals’ and provide them with the status they deserve. However in order to deliver a professional service, there is a need for NIEMS to support the role of volunteers and foundations. The current funding scheme does not adequately support a foundation, this needs to change otherwise the delivery of EMS is going to suffer.
There is a pressing need for foundations to start working together in a collaborative manner. This is the only identifiable way forward and should be investigated as a matter of urgency.
With this in mind, we are looking to form such a working arrangement in Khonkaen and lead the way in which volunteer pre-hospital care is delivered.