The characteristics and distribution of emergency medical services in Saudi Arabia.

BACKGROUND: Emergency medical services (EMS) play an essential role in treating and transporting patients to hospitals or between hospitals. EMS providers must be distributed wisely across all regions of the country to meet healthcare needs during normal times and disasters. No previous study has investigated the characteristics and distribution of the EMS workforce in Saudi Arabia. OBJECTIVES: Examine the characteristics and distribution of the EMS workforce in Saudi Arabia to identify gaps and areas in need of improvement. Also, explore the sociodemographic and educational characteristics of licensed EMS providers in Saudi Arabia. DESIGN: Cross-sectional SETTINGS: EMS in Saudi Arabia METHODS: We included all licensed EMS providers in Saudi Arabia as of 23 December 2020 who were registered in the Saudi Commission for Health Specialties (SCFHS) database. Sociodemographics, where they earned certification, and their job affiliations were collected and categorized. MAIN OUTCOME MEASURES: EMS workforce distribution, gender, and EMS provider-to-population ratio. SAMPLE SIZE: 18 336 EMS providers; 8812 (48.1%) with documented job affiliations. RESULTS: The EMS provider-to-population ratio is very low. In Saudi Arabia, in general, the ratio is 1:3871 (based on n=8812 providers), which is low compared to the 1:1400 ratio for Australian EMS provider-to-population, for example. That makes it a challenge for EMS providers to meet the population's needs, especially in times of disaster. The low ratio may have contributed to the delayed response time in Saudi Arabia (13 minutes for critical cases) which does not meet the international standard response time (8 minutes maximum). Also, only 3.5% of the total EMS providers registered were females, and the clear majority of all EMS providers were technicians. CONCLUSIONS: The growth in the EMS workforce, including the recruitment of more females into the workforce and more EMS specialists compared to EMS technicians and health assistants, is critical to reaching a satisfactory EMS provider-to-population ratio. LIMITATIONS: Most noteworthy of the limitations of this research are the insufficient statistics describing EMS distribution in Saudi Arabia, the lack of previous studies on the research topic in Saudi Arabia, and job affiliation not accurately recorded in the SCFHS database. CONFLICT OF INTEREST: None.

Exploring the opportunities and challenges to implementing interprofessional education in Saudi Arabia: a qualitative study among faculty.

Interprofessional education (IPE) has potential benefits for improving the quality of patient care, but its implementation is challenged with multiple barriers. The primary objectives of this study were to explore the challenges, benefits, and incentives to establishing IPE from the perspective of healthcare faculty at King Saud University. Forty-five faculty members attended six focus groups, each consisting of 6-8 faculty members representing the five colleges. The focus group interview guide included the benefits of and barriers to establishing IPE in this academic institution, curricular design, and the feasibility of support from the colleges and University administration. A SWOC (Strengths, Weaknesses, Opportunities, Challenges) frame work was utilized to guide the focus group discussions, and the data were analyzed inductively using thematic analysis. Three main themes emerged and were related to (i) barriers, (ii) benefits, (iii) opportunities to facilitate the introduction of IPE, and (iv) suggestions on how to implement IPE and overcome challenges to establish an IPE curriculum. Participants were generally supportive of IPE and aware of the constraints that might impede its implementation. Moreover, they identified potential barriers and incentives to promote IPE. Although participants appreciated the long-term benefits of IPE, creating a supportive environment will require the involvement of the academic community, including students, faculty members, and the University's top management.

Saudi Arabian Community Perceptions on Saudi Female Paramedics: A Cross-Sectional Study.

INTRODUCTION: Although emergency medical services (EMS) stakeholders acknowledge the need for both male and female paramedics in the EMS field, the Saudi EMS system is currently only staffed by male paramedics and emergency medical technicians (EMTs) working in EMS organisations. AIM: To understand and explore the Saudi Arabian community's perceptions on engaging Saudi female paramedics in the EMS workforce. MATERIAL AND METHODS: This was a cross-sectional survey design using convenience sampling of the public in Riyadh city by self-administered English and Arabic language questionnaires. Questionnaire validity was assessed by face and content validity. RESULTS: Of the 3603 surveys distributed, 3132 were returned (87% completion response rate). Most respondents were aged between 18 and 29 years (n = 1308, 41%), and the sex distribution was (n = 1646, 52.6%) male and (n = 1486, 47.4%) female. Overall, 77% (n = 2412) of the respondents supported the need for female paramedics in Saudi Arabian ambulance services, and 74.8% (n = 2343) preferred that female paramedics treated female patients. CONCLUSION: This is the first public study to explore Saudi public perceptions about female paramedics in EMS in the Riyadh region, Saudi Arabia. The Saudi public is supportive of female paramedics being employed as paramedics in the country. Moreover, significant differences in perceptions were evidenced in the sex groups over any other factors.

Perception and Attitude of Medical Staff in the Saudi Red Crescent Authority Toward their Preparedness for Disaster Management and Response.

OBJECTIVE: The Saudi Red Crescent Authority (SRCA) plays a major role in the event of disasters and crisis, as it is the main pre-hospital health-care provider. This study reports on the attitude and perceptions of SRCA medical staff concerning their knowledge of disaster management and response. METHOD: This is a descriptive cross-sectional study performed in Riyadh, Saudi Arabia. An Arabic version of the Disaster Preparedness Evaluation Tool (DPET), a self-administered Likert-scale survey, was used to obtain data from SRCA medical staff to evaluate the current status of disaster preparedness. RESULTS: The population surveyed consisted of 302 participants; 20.9% had participated in a drill exercise or practical application of a regular disaster or emergency plan in their workplaces. Most of participants (85.3%) had incentives to extend their education regarding their role, scope of practice, and skills as medical staff in disaster situations. CONCLUSION: Results indicate a lack of regular disaster drills available to prehospital care providers, although most of them are willing to participate in more training and education programs regarding preparedness for disaster management, especially concerning their role in a disaster situation.

Potential of Community Volunteers in Flood Early Warning Dissemination: A Case Study of Bangladesh.

Flood early warning (FEW) is a vital component of disaster risk management and is particularly important for saving lives, developing a sustainable agro-based economy, economic stability, and the overall development of the people of Bangladesh as well as others. This study was conducted in a northern, flood-prone area of Bangladesh to investigate the potential of incorporating volunteers of the community to the Union Councils (UCs) to disseminate FEW alongside the top-down approach. Several studies have found that despite having a sophisticated flood forecasting technology, local communities are not reaping the benefits of it, as the existing dissemination system is inaccessible to most local people. Since risk communication takes place in a social context, this study investigated and thereby proposed that volunteerism, as a form of social capital or communal virtue, can potentially assist the community-based disaster management (CBDM) institutions in enhancing their capacity to reach the maximum population at times of flood risk. Therefore, it was confirmed that the trained volunteers need to be integrated into and endorsed by the national policy. In addition, this study also provides a number of recommendations connecting literature with policy documents of Bangladesh.

High flow nasal oxygen for acute type two respiratory failure: a systematic review.

Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO 2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO 2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO 2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL  (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO 2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 - 7.7 vs NIV median 7.6, IQR 6.3 - 9.3) and no significant difference at  24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO 2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.

Knowledge, Attitude, and Practice (KAP) toward the Novel Coronavirus (COVID-19) Pandemic in a Saudi Population-Based Survey.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) outbreak has affected all regions and countries with varying impacts based on infection rates and the associated fatalities. This study aimed to assess knowledge, attitude, and practices (KAP) toward the COVID-19 pandemic among Saudi Arabians. METHODS: The study utilized a cross-sectional research design. Web-based questionnaires' link was sent via emails and social media and sample was 5483 respondents. Purposive sampling ensured only those participants that met the inclusion criteria. Validity and reliability were checked. RESULTS: Most respondents, 67.9%, were aged between 18 and 35 years and highest level of education university. The findings based on the study objectives indicated a high level of knowledge about COVID-19, which indicated early detection can improve treatment by 4701 (85.7%), the disease can be treated at home 84.6%, the disease can be prevented and avoided when precautions are taken 96.8%. Moreover, 37.2% of the respondents still used herbal products to prevent and treat the disease, and 72.1% indicating immediate visit the physician when there are symptoms. CONCLUSION: Promoting public knowledge about COVID-19 by the Ministry of Health is paramount in defeating this disease. Providing more education and awareness for public to comply with WHO's recommendation is recommended.

A Cross-Sectional Study on the Flood Emergency Preparedness among Healthcare Providers in Saudi Arabia.

This study used a descriptive cross-sectional methodology to measure healthcare workers' knowledge, attitudes, perceptions, and willingness to respond to a flood scenario in Saudi Arabia. A validated survey was distributed to collect data using a convenience sampling technique through multiple social media platforms. A total of 227 participants were included in this study: 52% of them were aged between 26 to 34 years, 74% were residents from Riyadh, and 52.4% worked in nursing divisions. A significant number of respondents (73.2%) had positive perceptions towards their hospitals' ability to provide an effective response to a flood, 89% were willing to report to work following a flood, and 90% of participants reported the need to develop both guidelines and training for flood disaster preparedness. Preparation and successful flood mitigation in the hospital setting requires staff that have both knowledge and training in emergency management. One way to obtain such readiness is through competency-based training, including both table-top and full-scale live exercises. Although the willingness to respond to such a flooding emergency was high among staff, the development of guidelines and educational programs is needed in order to develop the competencies and skills sets to improve disaster preparedness response and preparedness efforts.

High-flow nasal cannula therapy for initial oxygen administration in acute hypercapnic respiratory failure: study protocol of randomised controlled unblinded trial.

INTRODUCTION: Acute respiratory failure is a common clinical condition accounting for nearly 116 000 admissions in the UK hospitals. Acute type 2 respiratory failure is also called acute hypercapnic respiratory failure (AHRF) and characterised by an elevated arterial CO2 level of >6 kPa due to pump failure. Acute exacerbation of chronic obstructive pulmonary disease is the most common cause of AHRF. High-flow nasal therapy (HFNT) is a new oxygen delivery system that uses an oxygen-air blender to deliver flow rates of up to 60 L/min. The gas is delivered humidified and heated to the patient via wide-bore nasal cannula. METHODS AND ANALYSIS: We hypothesised that HFNC as the initial oxygen administration method will reduce the number of patients with AHRF requiring non-invasive ventilation in patients at 6 hours post intervention when compared with low-flow nasal oxygen (LFO). A randomised single-centre unblinded controlled trial is designed to test our hypothesis. The trial will compare two oxygen administration methods, HFNT versus LFO. Patients will be randomised to one of the two arms if they fulfil the eligibility criteria. The sample size is 82 adult patients (41 HFNT and 41 LFO) presenting to the emergency department. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Office for Research Ethics Committees Northern Ireland (REC reference: 20/NI/0049). Dissemination will be achieved in several ways: (1) the findings will be presented at national and international meetings with open-access abstracts online and (2) in accordance with the open-access policies proposed by the leading research funding bodies we aim to publish the findings in high-quality peer-reviewed open-access journals. TRIAL REGISTRATION NUMBER: The trial was prospectively registered at the clinicaltrials.gov registry (NCT04640948) on 20 November 2020.

Using gel for difficult mask ventilation on the bearded patients: a simulation-based study.

The beard is a well-known cause of difficult mask ventilation due to excessive air leaks. Various techniques have been proposed to overcome this difficulty, such as applying a gel on the mask edge. Our objective was to determine whether the gel technique will improve ventilation and to assess the comfort of the provider. A randomized crossover design was conducted to assess the efficacy of gel in a bearded simulation model. Respiratory therapists (RT) were recruited by convenience sampling to hold the mask using a two-handed technique for a two-minute ventilation session. During the session, the ventilator provided a fixed Tidal Volume (TV) of 550 mL and a respiratory rate of 12 per minute, and the simulated model measured the received volumes. We compared the median TV and number of failed ventilation attempts with or without the gel. The comfort level while using the gel was assessed with constructed questions. We recruited 74 respiratory therapists working in Riyadh city. More than half of the participants had more than 5 years experience. The median tidal volume for standard mask ventilation without the gel was 283 mL [interquartile range (IQR) 224, 327], whereas that with the gel was 467 mL [451, 478], respectively (p < 0.01). The number of successful ventilations was recorded out of 24 breaths during the 2-min ventilation period for each technique; the proportion of successful ventilations increased significantly by 65% (95% CI 51-75%, p < 0.01) with the gel. In addition, only nine participants believed the technique was not comfortable, while the remaining individuals found it comfortable or natural. In our bearded simulation model, applying the gel significantly improved ventilation without negatively affecting comfort. Further studies and education are encouraged in the field of basic airway management.

Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study.

The impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January-29 February 2020), during COVID-19 (1 March-23 April 2020), and during the Holy Month of Ramadan (24 April-23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.

Electrocardiogram Interpretation Competency Among Paramedic Students.

BACKGROUND: Electrocardiography is an essential emergency tool used in the pre-hospital setting. However, no studies have yet assessed electrocardiogram (ECG) interpretation among emergency medical services (EMS) students in Saudi Arabia. This study aimed to determine the ECG interpretation competency of paramedic students. METHODOLOGY: Cross-sectional, single-center study, a pre-validated, self-administered, two-part questionnaire first created by Coll-Badell et al was used to assess the ECG interpretation competency of paramedic students at Prince Sultan College for Emergency Medical Services (PSCEMS) in King Saud University. Participant data were collected and analyzed to identify factors associated with improved competency. RESULTS: All students of PSCEMS were included, and 137 of 248 paramedic students completed the questionnaire (55% response rate); 88 students (64.2%) scored >7.5 points, indicating competency in (ECG) interpretation. Factors such as grade point average (GPA) (>3.5) and enrollment in cardiology and advanced cardiac life support courses were found to be significantly associated with competency (p<0.001). CONCLUSION: The majority of paramedic students were found to be competent in ECG interpretation. GPA and enrollment in cardiology and advanced cardiac life support courses were significantly associated with improved competency.

Knowledge, Attitudes, and Beliefs Regarding Drug Abuse and Misuse among Community Pharmacists in Saudi Arabia.

Background and Objective: Several over-the-counter drugs have been documented as an essential issue in the community pharmacy setting owing to their liability to abuse. Pharmacists act as a critical monitor for these concerns and evaluate the seriousness of the patients' condition. Therefore, this study aimed to assess the knowledge, attitudes, and beliefs regarding drug abuse and misuse among pharmacists at a community pharmacy in Riyadh city, Saudi Arabia. Methods: A cross-sectional study using a validated self-administered questionnaire was carried out among community pharmacists over three months April to June 2019. The survey had 25 items on the experience, knowledge, attitudes, beliefs, strategies, and opinions of participants toward drug abuse and misuse. Results: A total of 239 community pharmacists responded to the survey. About 84% of them had received training on drug misuse or abuse. The majority of community pharmacists (85.8%) would like to be provided educational programs on drug abuse in the future. Nearly all the pharmacists (94.9%) reported providing suitable advice to suspected drug misusers either in written or oral form at their pharmacies. Approximately 31% agreed or strongly agreed to dispense controlled drugs through a pharmacy. Regarding the ethical matter of selling misusers controlled drugs, 93.7% of the respondents believed that it is deceptive to offer misusers controlled medications. A comparison of knowledge and beliefs (univariate analysis) showed that the results were significant only for respondents who had graduated from Yemen (p = 0.007) and respondents who had an experience of four to six years or more (p < 0.01). Conclusion: The findings revealed that the majority of community pharmacists had been trained in recognizing drug abuse or dependence during their pharmacy college education. In addition, majority of them reported that they warned or counseled patients about the occurrence of adverse drug reactions to specific medications. However, majority of them agreed that selling controlled drugs is unethical in a community pharmacy. Thus, effective implementation of pharmaceutical rules and laws is a fundamental need in the Saudi Arabian health care system and we suggest stringent execution of the regulations by the Saudi health care authorities.

Epidemiology of non-transported emergency medical services calls in Saudi Arabia.

OBJECTIVES: To determine the epidemiology of non- transported emergency medical services (EMS) calls within the EMS system at Riyadh, Saudi Arabia, to identify factors that contributes to non-transport of patients by EMS provider, and to recommend suggestions for reduction in number of non-transported calls.  METHODS: Retrospective analysis of 1390 patient care reports (PCR) of non-transported cases responded to, and documented by the Saudi Red Crescent Authority (SRCA) emergency medical technicians (EMTs). All PCRs of non-transported cases from 10 EMS stations, in 3 consecutive months were examined. The SRCA EMTs management in Riyadh allocated all non-transported PCRs for 3 months (March-May 2014). Constructive data that includes patients demographics, scene characteristics, trip and timing information, length of stay, clinical and assessment data, and physician contact, or presence status were extracted from those PCRs.  RESULTS: Twenty-five percent of calls made during the study period were reported as non-transported calls. Seventy percent of non-transported calls were related to refusal by patient. Approximately 22.4% of non-transported calls were canceled by dispatch. Approximately 50% of non-transported patient were in the young age group (16-30 years). In 26% of non-transported calls, the field time was restricted to 15 minutes.  CONCLUSION: More than half of the non-transported emergency calls were reported as refused by patient/relative, while approximately one quarter were reported as  cancelled calls.