PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
METHODS: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目标：在2023年，澳大利亚政府紧急医疗服务（EMS）响应了超过400万消费者，其中超过56%的人没有被归类为“紧急情况”，耗资55亿澳元。我们探讨了政治家的观点，政策制定者，临床医生和消费者如何管理这些非紧急请求。
方法：采用了现实主义框架；多学科团队（包括辅助医学，医学和护理)形成；数据是通过半结构化焦点小组或访谈收集的，并进行了专题分析。
方法：有目的地并通过公开广告选择了56名参与者：国家和州议员（n=3）；政府医疗保健学科负责人（n=3）；政府决策者（n=5）；急诊医学行业决策者，全科医学和辅助医学(n=6)；EMS首席执行官，医疗主管和经理(n=7)；学者(n=8)，一线临床医生，护理和辅助医疗（n=8）；和消费者（n=16）。
结果：出现了三个主题：第一，EMS工作负载的现实(主题为“面对现实”)；第二，对政策应该采取什么方向来管理这一点的看法(“没有银弹”)，最后，EMS在社会中的未来角色应该是什么(“找到合适的空间”)。与会者提供了16条政策建议，其中10项得到广泛支持：提高公共卫生素养，移除医疗优先调度系统,支持多学科团队，增加24小时虚拟急诊部门，修改本科护理人员大学教育，以反映当代角色的现实，越来越多地为频繁的消费者使用管理计划，护理人员与医疗保健系统更好地整合，通过提供估计的等待时间来赋予呼叫者权力，减少无效的媒体活动，以“为紧急情况保存EMS”，并将EMS从医院转诊转向社区护理。
结论：有必要就EMS在社会中的作用达成共识，特别是,关于范围是否应该继续扩大到紧急护理之外。这项研究报告了16种可能的想法，每一项都可能需要考虑，并将它们映射到标准的患者旅程上。
方法：采用了现实主义框架；多学科团队（包括辅助医学，医学和护理)形成；数据是通过半结构化焦点小组或访谈收集的，并进行了专题分析。
方法：有目的地并通过公开广告选择了56名参与者：国家和州议员（n=3）；政府医疗保健学科负责人（n=3）；政府决策者（n=5）；急诊医学行业决策者，全科医学和辅助医学(n=6)；EMS首席执行官，医疗主管和经理(n=7)；学者(n=8)，一线临床医生，护理和辅助医疗（n=8）；和消费者（n=16）。
结果：出现了三个主题：第一，EMS工作负载的现实(主题为“面对现实”)；第二，对政策应该采取什么方向来管理这一点的看法(“没有银弹”)，最后，EMS在社会中的未来角色应该是什么(“找到合适的空间”)。与会者提供了16条政策建议，其中10项得到广泛支持：提高公共卫生素养，移除医疗优先调度系统,支持多学科团队，增加24小时虚拟急诊部门，修改本科护理人员大学教育，以反映当代角色的现实，越来越多地为频繁的消费者使用管理计划，护理人员与医疗保健系统更好地整合，通过提供估计的等待时间来赋予呼叫者权力，减少无效的媒体活动，以“为紧急情况保存EMS”，并将EMS从医院转诊转向社区护理。
结论：有必要就EMS在社会中的作用达成共识，特别是,关于范围是否应该继续扩大到紧急护理之外。这项研究报告了16种可能的想法，每一项都可能需要考虑，并将它们映射到标准的患者旅程上。
