An International Comparison of Emergency Medical Services DeliverySystems: Which Produces The Optimum Outcome For The Patient?

This thesis was written to address a problem with ambulance service delivery times in Victoria, Australia. For a number of years, ambulance response times have been increasing to unacceptable levels. As a result of the ever-increasing problem it was appropriate to see if the are other alternative solutions producing better results. There are a number of different service delivery models for Emergency Medical Services (EMS) around the world. The main two are the Anglo/American model (also known as scoop and run) and the Franco/German model (also known a stay and play). There are also two major delivery agencies; the British model of a separate third party public sector service as used in UK, Australia and New Zealand or the fire service model where the fire service is the main delivery agency such as most of Asia, Europe and North America. Which model provides the best outcome for the patient? Such research has not been done in the past. The research will also examine if the Metropolitan Fire brigade has capacity to undertake possible EMS roles. A number of case studies were undertaken and explored with key issues of response times, patient outcomes, skills and new technologies compared. The results, particularly of response time show that in Victoria the response time for fire EMS (8.3 minutes) to medical emergencies is similar to that provided by fire services delivering EMS in North America. The MFB in Victoria is providing the equivalent of first responder; the American and Canadian fire services are delivering Advanced Life Support (ALS). The response times for Basic Life Support (BLS) in Victoria provided by ambulance service are over twice as long (8.3 minutes for fire compared to 18.2 minutes for Victorian Ambulance at the 90%). The US and Canadian Fire Services provide EMS response time considerably lower than Ambulance Victoria, some as low as 7.43 minutes. UK Ambulance (on which the Victorian model is based) also provides response time considerably less than Ambulance Victoria. The issue of whether the fire service in Victoria has capacity to undertake further EMS delivery was explored and whilst it has the capacity it is doubtful it could be delivered in the current industrial environment with the union having the capability of vetoing managerial decisions. The research raised fundamental questions regarding the effective use of scarce public sector resources and agencies working across organisational boundaries in the interests of serving the public. Data analysis involved pattern matching, explanation building and time series analysis to identify trends and commonalities across the cases. A number of themes emerged including continued increases in call volumes, challenges meeting response times and the development of proactive programs to reduce the impact of these trends.

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