Page 15 - Hassan Nasser Moafa
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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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