Page 15 - Hassan Nasser Moafa
P. 15

General Introduction



                 American physicians do not provide emergency services at the scene. The Netherlands
                 also has their specific model. They have a single-tiered ALS of ambulance runs operated   Chapter 1
                 by registered nurses, but they do not have EMTs, paramedics, or emergency physicians in
                 an ambulance.[47,48] The total EMS and on-scene time are longer with FGM compared to
                 others models due to the stay and play approach of this model, i.e., the length of stay for
                 treating patients on-site. [42]

                 EMS in the Arabian Gulf States, including SA, have implemented AAM. The Saudi EMS
                 implements the AAM in cases where the transported patients cannot be admitted to
                 the specialized unit in the hospitals’ wards without passing through the ED for further
                 evaluation. EMS in SA has medical doctors accompanied by paramedics who work in ALS
                 units and respond to high-acuity patients at the scene within a standardized time of 15
                 minutes of on-scene time and decide whether the patient needs to be transported or not.
                 However, medical doctors in the Saudi EMS do not have a broad scope of practice like the
                 doctors in the FGM. Similarly, the time benchmarks for ALS are applied for BLS crews. EMS
                 is provided in SA by an all-male staff and responds to all patients without considering race,
                 color, or ethnicity because SRCA is a member of The International Federation of Red Cross
                 and Red Crescent Societies.[25,49] The EMS system in SA is deemed double-tiered in most
                 large provinces while in other small provinces only single-tiered of BLS. In general, the
                 first level is the BLS crews that usually respond to non-life-threatening cases. The second
                 level is the mobile intensive care unit, called the ALS crew, and is usually dispatched for
                 high-acuity cases. The BLS level of services is available in all locations of KSA. Whereas ALS,
                 to a significant extent, is available in major cities like Riyadh, Jeddah, Dammam, Macca,
                 and Madinah. Recently, Saudi EMS was implemented in other provinces with a limited
                 numbers of ALS crews. ALS level of services is staffed by a medical doctor and sometimes
                 senior paramedics. Both the personnel are licensed to give intravenous medication and
                 endotracheal intubation. 997 is the free-of-charge call number that covers all 13 provinces
                 of the country. Each province has a DC to respond to emergency calls. Patients’ calls to 997
                 can be responded to by any one of the call-takers in dispatching centers, depending on
                 the primary patient site during the call. Call takers and dispatchers are often emergency
                 medical technicians who received further training in the triaging system. They receive
                 the emergency call by utilizing the computerized-aid-dispatching system to identify the
                 urgency level and dispatching the nearest crews to the patient’s location. When there is a
                 life-threatening emergency case, and at the same time, all ALS crews are busy with other
                 patients, then the DC dispatches a BLS crew.

                 Medical doctors work in dispatch centers around the clock inside large provinces of SA.
                 They follow up with EMS providers and provide them with medical consultation when they
                 confront complex cases requiring second opinion. Patients may also travel to ambulance
                 stations or centers and seek emergency help from EMS providers available in the station.



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