Page 14 - Hassan Nasser Moafa
P. 14

Chapter 1



                 emergencies. EMS in SA responds to all three levels, but needless to mention, dispatching
                 ambulances for non-emergency cases might be delayed by the system when there are
                 high-acuity cases.


                 Modern EMS systems in the world


                 During the last two-decades, the demand for EMS has increased.[30-34] For example,
                 demand for EMS between 2008 and 2015 has increased by 29% in the US.[35] Nevertheless,
                 this demand requires policymakers to be vigilant to assure that patients can receive
                 medical aid when they need it within a short time. Responding to non-emergency cases is
                 considered one of the obstacles that adds pressure to any EMS system and is considered
                 a waste of resources.[36]  The EMS system needs permanent financial support to avoid
                 system failure and collapse.[37] Reorganizing the EMS system according to patients needs
                 depend on a nation’s geography and the health status of the population.  Therefore,
                 many countries in the world have their own EMS setting compatible with their financial
                                        st
                 possibilities. In the current 21  century, several countries do not have aviation ambulances,
                 while others, such as Australian EMS, have a unique model that does and lets EMS reach
                 patients in any location.[38] Some European countries, such as Denmark, use drones for
                 carrying blood and medical equipment to the crew’s site for particular situations such as
                 a shortage of supply during major incidents.[39]


                 Comparing EMS systems between countries is difficult due to variations in geographical,
                 cultural, political, economic, and medical settings.[40,41] There are two recognized models
                 of EMS systems: the Franco-Germanic model (FGM) known as stay and play and the Anglo-
                 American model (AAM) known as scoop and run.[2,42-44] The FGM brings the doctor to
                 the scene, whereas in the AAM, the patient is brought to the doctor(s) at the ED.[42,44]
                 Several countries in Europe such as France, Germany, Italy, and Spain have implemented
                 the FGM. They assign a specialized emergency physician in the dispatching center to
                 answer all coming calls, and they can dispatch a specialized crew equipped with another
                 emergency physician to the scene for high-acuity cases to provide care at the site.[44]
                 Medical crews in the FGM have a comprehensive scope of practice, and sometimes, based
                 on emergencies, the DC can involve other physicians in the crew. For example, when the
                 patient is a child, the DC can dispatch a pediatrician as well.[42,44] On the other hand,
                 the cornerstone of AAM is to transport patients to hospitals quickly to receive definite
                 healthcare.[42,44]  AAM is widely used in the US, UK, Canada, Australia. In the UK, the
                 level of services depends on the patient’s urgency level, which means high-acuity cases
                 require highly competent personnel like a senior paramedic.[45,46] In the US, each state
                 has its own EMS source of funding. For instance, certain states in the US provided single-
                 tier ambulance runs while others provide double-tier services.[43] Similar to the UK,



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