Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

Meysam Safi-Keykaleh; Davoud Khorasani-Zavareh; Zohreh Ghomian; Saeideh Nateghinia; Hamid Safarpour; Reza Mohammadi

doi:10.4103/jehp.jehp_1566_20

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

J Educ Health Promot. 2021 Aug 31:10:312. doi: 10.4103/jehp.jehp_1566_20. eCollection 2021.

Authors

Meysam Safi-Keykaleh¹, Davoud Khorasani-Zavareh², Zohreh Ghomian³, Saeideh Nateghinia⁴, Hamid Safarpour⁵, Reza Mohammadi⁶

Affiliations

¹ Department of Nursing, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
² Professor in Workplace Health Promotion Research Center (WHPRC), Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.
⁶ Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Huddinge, Sweden.

Abstract

Background: To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system.

Materials and methods: To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data.

Results: Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system.

Conclusions: There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.

Keywords: Decision-making; emergency medical services; emergency medical technician; offline protocol; prehospital emergency.