Performance Evaluation of Pre-hospital Emergency Management in Gaza Governorates:Health Providers' Perspectives
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Date
2009-01-02
Authors
Raed Yousef Sabbah
رائد يوسف عبد الفتاح صباح
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
تقييم أداء إدارة الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى من وجهة نظر مقدمي الخدمات يتناول هذا البحث الوضع الحالي للخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى في محافظات قطاع غزة من وجهة نظر مقدمي تلك الخدمات. ولقد تم إجراء هذا البحث في النصف الثاني من العام 2008.يهدف البحث لإجراء تقييم لأداء إدارة الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى بهدف تحديد فعالية النظام ومواضع قوته وضعفه. وتقييم جاهزية الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى وجوانب التنسيق بين ذوي العلاقة لهذه الخدمات. الدافع الرئيسي لهذه الدراسة هو الخروج بتوصيات تساهم في تطوير الخدمات الصحية للمرضى خارج إطار المستشفى حيث أن محافظات قطاع غزة تتعرض بشكل مستمر لحوادث طارئة تشكل في معظمها سبباً رئيسياً للوفاة بين الأشخاص من مختلف الأعمار. تتمحور تلك الحوادث في السقوط من نقاط عالية على الأرض، الإجتياحات العسكرية من قبل قوات الاحتلال الإسرائيلي، الحوادث الطبيعية المحتملة وحوادث الطرق وحوادث أخرى. وفي سبيل الوصول إلى أفضل النتائج فإن الباحث قد استخدم مزيجاً من الأدوات الوصفية التحليلية والتي تعتمد على كلا المنهجين النوعي والكمي. وقد شملت الأدوات إجراء استبيان يستهدف العاملين في الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى إضافة إلى إجراء مقابلات ومجموعات بؤرية مع عدد من صانعي القرار والذين يعملون أو عملوا في مجال الخدمات الصحية الطارئة. إضافة إلى ذلك فإن الباحث استند على المعلومات المنشورة في الأبحاث الأكاديمية، التقارير المنشورة في المجلات العلمية والكتب ذات العلاقة. الخلاصة الرئيسية لهذا البحث هي أن الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى يقوم بها ستة من مزودي الخدمات الصحية الطارئة. في الوقت الذي تم تكليف الهلال الأحمر الفلسطيني بمهام مرحلة ما قبل الوصول للمستشفى وفقاً لقرار رئاسي. ولكن هذا لم يمنع الاخرين في الاستمرار في تقديم الخدمات الصحية الطارئة لمرحلة ما قبل المستشفى. لقد خلص الباحث إلى أنه لا يوجد أي من التشريعات أو المعايير أو الإجراءات المنظمة التي تنظم عمل الإسعافات، آليات التوظيف، ومعايير التدريب المهنية. إضافة إلى ذلك فقد أشار الباحث إلى عدم وجود وحدة عمليات مشتركة الأمر الذي يعيق الوصول إلى أفضل الممارسات للخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى مما يؤدي إلى تأخر الاستجابة أو توزيع المرضي على المستشفيات. فيما يتعلق بالجانب الفني فإن الباحث خلص إلى أن هناك إلتزام محدود في فحص تجهيزات الإسعافات من الأجهزة والإسعافات إضافة إلى فحصها التقني.
وبالرغم من أداء الخدمة نسبياً مقبول عن أداء الإدارة الحالية للخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى، إلا أن إستمرار الوضع الحالي من غياب التشريعات، وعدم كفاية مؤهلات الطاقم الفنية يساهم بشكل كبير في إضعاف الأداء الإداري العام. وبناءاً على ذلك يختتم الباحث بعدد من التوصيات والتي من شانها تطوير الوضع القائم، ومن أهمها القيام بخطوات عاجلة لمواجهة التحديات لإدارة الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى. لقد شملت التوصيات على تأسيس جهة مركزية واحدة لقيادة الخدمات الصحية الطارئة لمرحلة ما قبل الوصول للمستشفى، وحدة عمليات مشتركة، معهد تدريبي، معايير لتجهيزات الإسعافات، الأجهزة الطبية ومؤهلات الطاقم.
This thesis is looking at the current situation of the pre-hospital emergency medical services in the Gaza governorates. The research has been conducted over the second half of the year 2008 targeting pre-hospital emergency services in the Gaza governorates. The research has examined the performance of the Pre-hospital Emergency Management from the health providers perspectives aiming at assessing the current performance of pre-hospital services to identify its effectiveness as well as its areas of strengths and weaknesses, in the process of assessing the accessibility of the preparedness of the pre-hospital emergency health services as well as the coordination aspects among the different providers of the pre-hospital emergency medical services. The major rationale of this research is to bring out recommendations that contribute to advance the care of patients in the out-of-hospital locale. As Gaza Governorates are significantly subject to intentional and non-intentional injuries as a leading cause of death among persons at different ages due to falling down from higher points to the ground, ongoing military activities, potential natural disasters and the traffic accidents. The need to evaluate the performance management is to carry out best practices of Pre-hospital emergency medical services is a major concern of this research that would provide vital knowledge to the decision makers of where the pre-hospital emergency medical services are standing for the time being. The research has followed a cross-sectional hybrid with follow-up analysis of descriptive data based on triangulation of research tools as integrating both qualitative and quantitative approaches. The process included interviewing several key people working in the Emergency Health Sector, observations against available data collected from relevant literature of journal articles, news reports, and materials from senior health and research organizations. In addition, the researcher tackled a questionnaire for pre-hospital emergency medical services staff as well as conducted focus groups that gather senior and junior pre-hospital emergency personnel. The main result that the research brought up is that the current pre-hospital Emergency Medical services are fragmented among six providers. In the time it has been formally mandated to the Palestinian Red Crescent Society according to presidential decree, other providers continue in providing pre-hospital emergency medical services. Then, the researcher found out that there are no effective regulations, standards, or legalizations that govern the work of the ambulance services, recruitment and qualifications of staff. Additionally, the researcher found out that the absence of one Command Room hinders best practices of pre-hospital Emergency Medical services which might lead to delay in response time or allocations of patients to hospitals. On the technical level, the researcher found out a relevant commitment of the daily-check of ambulances in terms of technical inspection or checking the availability of medical equipment and consumables. The researcher concluded that the existing management performance of the Pre-hospital EMS is relatively adequate with a strong infrastructure. Yet, the disintegration of the pre-hospital EMS providers, deficiency of standards and legislations, insufficient capabilities of workforce are undermining the overall management performance. Thus, the researcher strongly concludes with the recommendation that rapid steps should be undertaken to meet the challenges of the of Pre-hospital Emergency Medical services management. Recommendations have included, but not limited to, an establishment of a leading agency, one command room, a training institutes and a standards for ambulances, pre-hospital equipments, and qualifications of staff
This thesis is looking at the current situation of the pre-hospital emergency medical services in the Gaza governorates. The research has been conducted over the second half of the year 2008 targeting pre-hospital emergency services in the Gaza governorates. The research has examined the performance of the Pre-hospital Emergency Management from the health providers perspectives aiming at assessing the current performance of pre-hospital services to identify its effectiveness as well as its areas of strengths and weaknesses, in the process of assessing the accessibility of the preparedness of the pre-hospital emergency health services as well as the coordination aspects among the different providers of the pre-hospital emergency medical services. The major rationale of this research is to bring out recommendations that contribute to advance the care of patients in the out-of-hospital locale. As Gaza Governorates are significantly subject to intentional and non-intentional injuries as a leading cause of death among persons at different ages due to falling down from higher points to the ground, ongoing military activities, potential natural disasters and the traffic accidents. The need to evaluate the performance management is to carry out best practices of Pre-hospital emergency medical services is a major concern of this research that would provide vital knowledge to the decision makers of where the pre-hospital emergency medical services are standing for the time being. The research has followed a cross-sectional hybrid with follow-up analysis of descriptive data based on triangulation of research tools as integrating both qualitative and quantitative approaches. The process included interviewing several key people working in the Emergency Health Sector, observations against available data collected from relevant literature of journal articles, news reports, and materials from senior health and research organizations. In addition, the researcher tackled a questionnaire for pre-hospital emergency medical services staff as well as conducted focus groups that gather senior and junior pre-hospital emergency personnel. The main result that the research brought up is that the current pre-hospital Emergency Medical services are fragmented among six providers. In the time it has been formally mandated to the Palestinian Red Crescent Society according to presidential decree, other providers continue in providing pre-hospital emergency medical services. Then, the researcher found out that there are no effective regulations, standards, or legalizations that govern the work of the ambulance services, recruitment and qualifications of staff. Additionally, the researcher found out that the absence of one Command Room hinders best practices of pre-hospital Emergency Medical services which might lead to delay in response time or allocations of patients to hospitals. On the technical level, the researcher found out a relevant commitment of the daily-check of ambulances in terms of technical inspection or checking the availability of medical equipment and consumables. The researcher concluded that the existing management performance of the Pre-hospital EMS is relatively adequate with a strong infrastructure. Yet, the disintegration of the pre-hospital EMS providers, deficiency of standards and legislations, insufficient capabilities of workforce are undermining the overall management performance. Thus, the researcher strongly concludes with the recommendation that rapid steps should be undertaken to meet the challenges of the of Pre-hospital Emergency Medical services management. Recommendations have included, but not limited to, an establishment of a leading agency, one command room, a training institutes and a standards for ambulances, pre-hospital equipments, and qualifications of staff