Barriers and requirements in the off‑line emergency medical protocols implementation in Iranian Pre‑hospital system: A qualitative study
نویسندگان
1 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
2 Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
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4 Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6 Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Huddinge, Sweden
doi
چکیده
BACKGROUND: To avoid making decisions based on the unproven opinions of emergency medicaltechnicians (EMTs), many emergency medical service (EMS) systems rely on emergency medicalprotocols. As protocol‑based on‑scene decision‑making is influenced by many challenges, identifyingthese 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 protocolsimplementation m in the prehospital emergency medical system.MATERIALS AND METHODS: To conduct this study, qualitative content analysis using 10 fieldobservations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration ofinterviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach wasused to analyze the data.RESULTS: Seven categories (15 subcategories) including education and awareness (professionaltraining and education and community‑based education); attitudes (professional attitude andcommunity attitude); interactions and coordination (interpersonal interactions, organizationalinterferences, and community’s interactions); rules and instructions (instructions and supportiverules); control system (monitoring and evaluation and motivational system); accessibility (recoursesand communication); and organization (structure and process) were obtained as the obstacles andchallenges in the offline emergency medical protocol implementation in the prehospital system.CONCLUSIONS: There are many challenges in implementing offline emergency medical protocols inthe prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospitalemergency 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 studycan be useful for EMS systems from national to local levels.
