Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2024 Jul 25;14(7):e083866. doi: 10.1136/bmjopen-2024-083866.
In 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an 'emergency', at the cost of AU$5.5 billion. We explored the viewpoints of politicians, policymakers, clinicians and consumers on how these non-emergency requests should be managed.
A realist framework was adopted; a multidisciplinary team (including paramedicine, medicine and nursing) was formed; data were collected via semistructured focus groups or interviews, and thematic analysis was performed.
56 participants were selected purposefully and via open advertisement: national and state parliamentarians (n=3); government heads of healthcare disciplines (n=3); government policymakers (n=5); industry policymakers in emergency medicine, general practice and paramedicine (n=6); EMS chief executive officers, medical directors and managers (n=7); academics (n=8), frontline clinicians in medicine, nursing and paramedicine (n=8); and consumers (n=16).
Three themes emerged: first, the reality of the EMS workload (theme titled 'facing reality'); second, perceptions of what direction policy should take to manage this ('no silver bullet') and finally, what the future role of EMS in society should be ('finding the right space'). Participants provided 16 policy suggestions, of which 10 were widely supported: increasing public health literacy, removing the Medical Priority Dispatch System, supporting multidisciplinary teams, increasing 24-hour virtual emergency departments, revising undergraduate paramedic university education to reflect the reality of the contemporary role, increasing use of management plans for frequent consumers, better paramedic integration with the healthcare system, empowering callers by providing estimated wait times, reducing ineffective media campaigns to 'save EMS for emergencies' and EMS moving away from hospital referrals and towards community care.
There is a need to establish consensus on the role of EMS within society and, particularly, on whether the scope should continue expanding beyond emergency care. This research reports 16 possible ideas, each of which may warrant consideration, and maps them onto the standard patient journey.
2023 年，澳大利亚政府紧急医疗服务（EMS）响应了超过 400 万名消费者，其中超过 56%的人不属于“紧急情况”，费用为 55 亿澳元。我们探讨了政治家、政策制定者、临床医生和消费者对如何管理这些非紧急请求的观点。
采用现实主义框架；成立了一个多学科团队（包括护理人员、医生和护士）；通过半结构化焦点小组或访谈收集数据，并进行主题分析。
通过有目的和公开广告招募了 56 名参与者：国家和州议员（n=3）；医疗保健学科的政府负责人（n=3）；政府政策制定者（n=5）；急诊医学、全科医学和护理人员领域的行业政策制定者（n=6）；EMS 首席执行官、医疗主任和经理（n=7）；学者（n=8），医学、护理和护理人员的一线临床医生（n=8）；和消费者（n=16）。
出现了三个主题：首先，EMS 工作量的现实（主题为“面对现实”）；其次，对管理这一工作应采取的政策方向的看法（“没有银弹”），最后，EMS 在社会中的未来角色（“找到合适的空间”）。参与者提出了 16 项政策建议，其中 10 项得到了广泛支持：提高公众健康素养，取消医疗优先调度系统，支持多学科团队，增加 24 小时虚拟急诊部门，修订大专护理人员大学教育以反映当代角色的现实，更多地使用管理计划来管理频繁就诊者，更好地将护理人员融入医疗系统，通过提供估计的等待时间赋予来电者权力，减少“为急救保留 EMS”的无效媒体宣传活动，以及 EMS 从医院转诊转向社区护理。
需要就 EMS 在社会中的角色达成共识，特别是关于其范围是否应继续扩大到急救护理之外。本研究报告了 16 个可能的想法，每个想法都可能值得考虑，并将它们映射到标准的患者就诊流程上。
