National research guideline for prehospital emergency medical care: A prospective Delphi-study

Abdulrhman S. Alghamdi; Ahmed M. Alotaibi; Khaled J. Alshammari; Abdulrahman J. Alharbi; Rayyan S. Alrabiah; Abdulmohsen Y. Hadadi; Mohammed M. Albloushi; Abdullah A. Alabdali

doi:10.15537/smj.2022.43.11.20220570

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Figure 1
- Flow chart of the study process.

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Table 1

- Participants’ demographics.

Variables	Round I	Round II	Round III
Role	47	34	39
Emergency medicine physician	9 (19.1)	2 (5.9)	7 (17.9)
Paramedic	22 (46.8)	20 (58.8)	18 (46.2)
Pre-hospital academic or researcher	14 (29.8)	11 (32.4)	12 (30.8)
Emergency nurse	2 (4.3)	1 (2.9)	2 (5.1)
Years of experience
3-5	15 (31.9)	13 (38.2)	11 (28.2)
6-10	11 (23.4)	9 (26.5)	9 (23.1)
11-15	15 (31.9)	8 (23.5)	13 (33.3)
16-20	4 (8.5)	4 (11.8)	6 (15.4)
>21	2 (4.3)	0 (0.0)	0 (0.0)

Values are presented as a number and percentage (%).

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Table 2

- Research priorities met, including criteria from round II and III.

No.	Suggestions	Round II agreement (%)	Round III agreement (%)
1	Reliability of emergency medical services records	97.1	89.7
2	Pediatric care	82.4	89.7
3	Epidemiology of out-of-hospital cardiac arrest	85.3	87.2
4	Level of crew training impact on patient outcome	91.2	84.6
5	Effectiveness of prehospital critical care	88.2	84.6
6	Dispatch pre-arrival assistance	85.3	84.6
7	Prehospital pain management	82.4	84.6
8	Clinical protocols and guidelines improvement and implementation	91.2	82.1
9	Survival rate following out-of-hospital cardiac arrest	82.4	82.1
10	Emergency medical services response to stroke	82.4	82.1
11	Integration and telecommunication between prehospital systems and hospitals	91.2	79.5
12	The role of home health care in reducing emergency medical services calls	88.2	79.5
13	Prehospital response and scene time	85.3	79.5
14	The efficiency of prehospital systems	82.4	79.5
15	The outcome of dispatcher-assisted cardiopulmonary resuscitation	79.4	79.5
16	Challenges in providing care for special population groups (bariatric, geriatrics, pediatric, and mental health patients)	88.2	76.9
17	Obstetrics and gynecologyand neonatal care in prehospital	85.3	76.9
18	Awareness for the public on when to call for an ambulance	82.4	76.9
19	Workforce psychological stress and anxiety	79.4	76.9
20	Impact of COVID-19 pandemic on emergency medical services	76.5	76.9
21	Cardiopulmonary resuscitation quality	70.6	76.9
22	Continuous education and training	82.4	74.4
23	Prehospital safety measures	82.4	74.4
24	Time of response and transportation of critically ill patients	79.4	74.4
25	Epidemiology of traumatic brain injury	79.4	74.4
26	Role and importance of air ambulance in transportation	79.4	74.4
27	Accessibility to an automated external defibrillator	76.5	74.4
28	Occupational burnout	76.5	74.4
29	Trauma registry	82.4	71.8
30	Physical fitness among prehospital care providers	82.4	71.8
31	Infection in prehospital settings	79.4	71.8
32	Patient’s safety	76.5	71.8

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Table 3

- Research priorities excluded after round III.

No.	Suggestions	Round II agreement (%)	Round III agreement (%)
1	Occupational health and risk of physical injuries prevention	82.4	69.2
2	Dispatch role in crises	76.5	69.2
3	Readiness and training level among emergency medical services specialists to respond to mass casualty incidents	73.5	69.2
4	Post-traumatic stress disorder	73.5	69.2
5	Innovations in emergency medical services curriculum: what did we learn from the pandemic?	73.5	69.2
6	Emergency medical services simulation integrated curriculum	82.4	66.7
7	Workforce anxiety	76.5	66.7
8	The impact of new paramedic decisions on patients’ safety	76.5	66.7
9	Fluid resuscitation in pre-hospital trauma patients	73.5	66.7
10	Barriers and consequences of delaying delivery	82.4	64.1
11	Identification and management of sepsis	79.4	64.1
12	Preparedness of emergency medical services to deal with multi-casualty accidents	79.4	64.1
13	The access, quality, and costs of pre-hospital care	73.5	64.1
14	Workforce mental health and wellbeing	73.5	64.1
15	Successful intubation and patient outcome	70.6	64.1
16	Epidemiology of myocardial infarction	76.5	59.0
17	Helicopter emergency medical services utilization	76.5	56.4
18	Emergency medical services role in hospital-based emergency medical services stations	70.6	56.4
19	Workforce sleep disorder	73.5	51.3