Sriram Veena M, Naseer Rizwan, Hyder Adnan A
Department of International Health and Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Punjab Emergency Service, Lahore, Pakistan.
Surgery. 2017 Dec;162(6S):S12-S23. doi: 10.1016/j.surg.2017.02.015. Epub 2017 May 15.
The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore.
We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization.
Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization.
Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting.
包括巴基斯坦在内的低收入和中等收入国家的紧急医疗服务的可及性和质量极其有限。近期，多个部门出现了院前紧急医疗服务提供的新模式，迫切需要对这些模式进行研究，以为资源匮乏地区当前和未来的紧急医疗服务系统提供参考。本案例研究的目的是全面描述巴基斯坦旁遮普省的一家公共部门急救机构——救援1122的组织结构和服务提供模式，重点是拉合尔的运营情况。
我们采用案例研究方法系统地描述救援1122的组织模式。2013年6月对拉合尔进行实地考察期间收集了定性数据。利用了三个来源——半结构化深度访谈、文件审查和非参与观察。根据世界卫生组织提出的卫生系统“构件”对数据进行了分析。
救援1122基于一个为紧急医疗服务提供公共资金的法律框架，从而实现了该服务的财务稳定。据报道，该组织在与社区互动以及在紧急医疗服务、消防和救援之间进行协调方面也采取了积极措施。我们注意到在将该服务扩展到旁遮普省所有地区时存在的益处和挑战。最后，一些需要改进的方面包括供应链管理和扩大数据利用。
我们的案例研究突出了该模式的关键组成部分、需要加强的领域以及进一步研究的机会。救援1122为资源匮乏地区由政府资助和运营的紧急医疗系统提供了一个范例。
