The Knowledge and Expectation of the Public in Saudi Arabia in Terms of Emergency Medical Services

Abstract

The study aims to assess the knowledge and awareness of the public regarding emergency medical services in the Jazan region of Saudi Arabia.

Method

In this paper, we used a cross-sectional observational study. We conducted a survey to collect data among all residents of the Jazan region for the unaffiliated category in the field of medicine, distributed over 21 different governorates. We designed a questionnaire and distributed it via an electronic link.

Result

Six hundred and eighty-five individuals participated in the project, and the main findings is that only 42.6% of the participants knew the emergency call number, while 75.8% did not have pre-training or background about cardio-pulmonary resuscitation. A total of 64.7% of the community members believe that the process of transporting the deceased is mandatory for the Red Crescent (58.2%) consider that not to refuse to transfer non-emergency cases by a paramedic. On the other side, 37% of the people decided to search for courses and applications in order to improve their knowledge regarding emergency medical service system after the end of the survey.

Conclusion

There is lack of EMS system knowledge in the Jazan region among public as well as the vast majority of individuals are not familiar with EMS duties and responsibilities.

Background

This study has taken place in Jazan region, located in the southwest in the Kingdom of Saudi Arabia. This area is serviced by the Saudi Red Crescent (SRC) organization which makes up the major bulk of the emergency medical service (EMS) system in the Kingdom.1 The Jazan area contains 17 Red Crescent centers.2

By looking at most of the studies, we concluded that most systems consist of some divided steps from certain components, in addition to the fact that the (EMS) system has its own components. The structure of the EMS takes the form of a chain. These components are accident identification, access 977, and dispatcher, and first responder, basic life support, advanced life support, transportation, emergency department, specialized care, patient rehabilitation, preventative outreach and general education.3 This study will assess the knowledge and expectation of public regarding EMS.

There is a study that has been published that has measured public awareness of the EMS system Jeddah. In that study, they have explained and show up figures regarding how many people can access to EMs system, and they have demonstrated that lack of public awareness regarding (EMS) system.1

Methods

We used an observational tomographic scan in this research. By conducting a survey and collecting data via a two-part questionnaire, the first is for demographic data (age, gender, location, etc.). The second part contained a set of questions extracted from a previous study entitled “Emergency Medical Services Conducted in 2002.” In addition to some other questions, we added to assess public health awareness toward EMS system (Table 1). The original language of the questionnaire is Arabic. We obtained ethical approval from the Standing Committee for Scientific Research at Jazan University, No. REC-43/03/048, Date of decision: October 25, 2021. Additionally, we obtained the ethical consent of the respondents by agreeing to share their personal data in the demographic section of the survey. The study included a number of inclusion and exclusion criteria, so that the participant must be a resident of the Jazan region, and the exclusion criteria included excluding everyone who lives outside the Jazan region. We also excluded all participants in the health field (nurses, doctors, paramedics, etc.). Between October 26, 2021, and November 13, 2021, the survey was answered by 685 participants through a link shared within the district’s counties.

Table1. Sample survey form

Table 2. Descriptive statistics of demographic of Participant (n = 685)

Results

Sample size analysis showed that 685 participants were sufficient to reveal the level of awareness of the region’s population by a 4% error margin at 98% of the degree of confidence.

As shown in Table 2 above, the majority of the sample is in the 15-29 age groups, out of the total sample, 24% had previously called the SRC.

At first, we asked them for the SRC emergency call number. The results were as follows: 42.6% (n = 292) had their answers correct, while 57.4% (n = 393) did not know the correct number (Fig. 1).

Regarding the (SRCA) system, we asked them: Do you think (SRCA) works with other agencies like (hospital – police…etc) or does it work on its own? (73.3%) (n = 502) said that it works with others and 9.6% (n = 66) said that it works alone and 17.1% (n = 117) choose I do not know (Fig. 2).

We asked the participants whether it was true that the paramedic should transport the deceased. 64.7% (N = 443) said this is true, while 35.3% (N = 242) said that this is incorrect (Fig. 3).

We also asked whether the paramedic has the right to refuse to transfer non-emergency cases after arriving at the scene of an accident, such as transferring a patient to an appointment or a review day. The results were 41.8% (n = 286) who answered yes and on the contrary 58.2% (n = 399) said no (Fig. 4).

With regard to the public’s opinion about several obstacles related to the Red Crescent system, we asked them at the beginning if it is acceptable for a male paramedic to come to treat a patient without the presence of her guardian. A total of 73.6% (n = 504) said it was acceptable, compared to 26.4% (n = 181) who said it was unacceptable (Fig. 5).

In addition, we asked another question, how do they act in an emergency? (72%) (n = 493) chose to go directly to the hospital while 28% (n = 192) preferred to contact the Red Crescent (Fig. 6).

Furthermore, when we asked what is your opinion of the Red Crescent’s performance, the results were as follows: Twenty-two point eight percent (n = 156) said excellent, 30.5% (n = 209) good, 29.8% (n = 204) average, 9.8% (n = 67) less than average and 7.2% (n = 49) stating that performance is weak (Fig. 7).

Regarding Red Crescent staff, we first asked what kind of healthcare providers work in the emergency care system. Fifty-two percent (n = 356) answered “first aider,” 27.2% (n = 186) said “emergency medical technician/specialist,” 0.9% (n = 6) said “physicians” and 20% (n = 137) who said that I do not know (Fig. 8).

They were also asked whether they are transporting patients without treatment because they are not qualified to deal with the treatments or transport them with treatment because they are qualified to deal with the treatments. The majority, 79.3% (n = 543) said they are transferring patients with treatment, while 20.7% (n = 142) said they are transferring patients without treatment (Fig. 9).

In the same context, we asked the participants whether the paramedics were qualified to deal with childbirth cases specifically or not. Thirty-nine point three percent (n = 269) answered yes, 60.7% (n = 416) answered no (Fig. 10).

Furthermore, participants were asked to rate their background regarding CPR skills. We asked them: have you ever taken a CPR course even if your major is unrelated to the health field? Only 24.2% (n = 166) answered yes, while 59.3% (n = 406) answered no, and 16.5% (n = 113) said they did not know what CPR is. (Figure 11).

To measure the population’s ability to learn first aid skills, we asked that whether everyone should learn first aid skills or not. The great majority, 96.4% (n = 660) answered yes, while 3.6% (n = 25) answered no (Fig. 12).

At the end of the survey, we asked have you ever searched for courses or sessions related to emergency cases, and have you learned how to act to save a life? Only 18.2% (n = 125) said yes, 45.3% (n = 310) said no and 36.5% (n = 250) said they would attend medical sessions after this questionnaire (Fig. 13).

Discussion

In general, the results of the study indicate that the population of Jazan region has little awareness about EMS system. Moreover, another study from Polonia University in Częstochowa, Poland, measured public awareness of particular emergencies such as first aid, sudden cardiac arrest and use of automated external defibrillators (AED).5 The data we collected indicates that 75.8% of participants did not have a prior background on CPR, only 24.2% who knew CPR, and these rates may be vary in urban and rural areas. In an Arizona district, the rate of training was 55.4%, while in rural areas the rate fell to 39.3%.6

As long as the rate of people with a background of CPR is 75.8%, it shows that participants in training courses are much lower than this rate. In a study conducted in Turkey, rates of those who received CPR training were 40.3%, while researchers found that the number of participants in knowledge refresher courses was 2%.7

Most of the studies in different countries have resulted in an average of knowledge and awareness in their communities regarding CPR skills. We obtained a rate of 69.4% in a study conducted in Slovenia. The researchers attributed this to the mandatory CPR training in the country’s driving schools.8

The rates for those who received CPR training in other countries were as follows: 27% in New Zealand, 28% in Ireland, 58% in Australia, 64.1% in Western Australia, 75% in Poland and 79% in Washington.9, 10, 11, 12, 13Providing professional training and medical courses on first aid and emergency skills in different governorates can increase the life-saving rate and reduce deaths by a large percentage. This is especially true because the population’s susceptibility to these skills is very high, as 96.4% of the respondents believe everyone should attend these sessions and be qualified to act in case of emergency. One person per family can make self-rescue and provide first aid. For example, one in four persons in the United States of America has basic knowledge of emergency skills, and one in three in Seattle is a first responder.14

Another issue that appeared in this study was the public’s lack of knowledge of the actual role of the Red Crescent, as 64.7% of the respondents considered that transporting the dead is an obligation on the Red Crescent. In fact, that the Departure of the Dead service operates as a civil service, not the Red Crescent. In addition, 41.3% believed that it was unethical for paramedics to refuse to transport non-emergency cases such as those with an appointment, which would of course delay and disable the emergency ambulance team from performing its primary task. One study in London revealed that 16% of ambulance calls were deemed unnecessary,15 with similar results, 31.7%, found in a study in Taiwan.16

Limitations

This study has some limitations. For example, it is not possible to conduct a paper questionnaire, due to the main purpose of the study, to cover all of Jazan region. Therefore, we worked on sharing the survey through a link and distributed it to a specific area. Another limitation is the collected sample itself. Knowing the questions are restricted, since the participant will not be able to understand them well and as a result, those being questioned will give an undesirable answer. We worked hard to facilitate the questions, and wrote the original questionnaire in Arabic to ensure that participants read and understood the questions to obtain accurate results. The questions and answers were then translated from Arabic to English for this manuscript.

Conclusion

This population-based survey of the public in Jazan aged 15–60 years, based on multiple-choice questions, has shown the expectation of our participant to access to the EMS system is low. Moreover, our study does show a percentage who do not have an obvious idea about EMS responsibilities. The level of awareness of the EMS system must be clear to all citizens in order to identify the main objective of establishing the system and obtain positive results indicating that this system is an important part in the Jazan region.

Acknowledgements

We would like to express our special thanks of gratitude to Dr. Ateeq AL-Muwallad, MSc.

Funding

No funding to declare. ‏

Conflict of Interests

All authors have no conflict of interest to report.

Disclaimer

The results we reached in the questionnaire depend on the opinions of the respondents.

References

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