Search

INTRODUCTION:Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data (Nielsen 2012). A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.AIM:To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess suitability, strengths, and limitations for future use in assessing prehospital ambulance performance.METHOD:With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We assessed the feasibility of this strategy for collecting patient encounter data when weighed against the investment of time, personnel, and financial resources.RESULTS:Over a 2-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance travelled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter. DISCUSSION:Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols.Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal implications, and observer training must be considered.REFERENCES:Katie Nielsen, Charles Mock, Manjul Joshipura, Andres M. Rubiano, Ahmed Zakariah & Frederick Rivara (2012) Assessment of the Status of Prehospital Care in 13 Low- and Middle-Income Countries, Prehospital Emergency Care, 16:3, 381-389.

INTRODUCTIONMultiple barriers can potentially limit the quality of formal systems of prehospital care, including deficits in training, equipment, funding, and organizational structure.No widely accepted strategy exists to assess the availability of essential medical equipment for managing traumatic injury by advanced life support (ALS) ambulances within a national public ambulance system.METHODSWe employed a published matrix of essential equipment for prehospital providers developed for international use by an expert panel from the World Health Organization, adapted it for current use, and performed a representative sampling of public ALS ambulances in substations across Ukraine.We evaluated the findings to inform an overall assessment of prehospital capability based on the availability of essential equipment in managing urgent injuries that may pose a threat to life and limb in trauma patients.RESULTSWe inventoried 48 ALS ambulances across the country against our developed checklist. These ambulances generally had sufficient medical supplies to perform patient assessment, to control hemorrhage, and to immobilize suspected fractures, but deficits were identified in tools for airway management and for the diagnosis and treatment of hypoxia.CONCLUSIONThe use of a tailored checklist to assess for the availability of essential medical equipment on ambulances can provide valuable insights into both the capabilities and limitations of the ambulance network. This checklist can be updated to incorporate new research and new standards of care, and can contribute to improving the delivery of prehospital trauma care across a national public ambulance system.