{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:31:01Z","timestamp":1785753061649,"version":"3.56.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Subject and methods<\/jats:title>\n                <jats:p>The study was undertaken in the Riyadh region of Saudi Arabia. Potential participants were currently employed by Saudi Red Crescent EMS as either a technician, paramedic or an EMS station manager, and had a minimum of five years experience with the EMS. Semi-structured interviews were undertaken between October 2019 and July 2020 with first respondents to a call for participants, and continued until data saturation was reached. All interviews were conducted in Arabic and transcribed verbatim. The Arabic transcript was shared with each participant, and they were asked to confirm their agreement with the transcription. The transcribed interviews were then translated into English; the English versions were shared with bi-lingual participants for validation, while independent certification of the translations were performed for data from participants not fluent in English. A thematic analysis methodological approach was used to examine the data.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The final sample involved 20 participants (10 rural, 10 urban) from Saudi Red Crescent EMS. Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, three changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-06565-3","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T17:03:39Z","timestamp":1623085419000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Organisational factors affecting emergency medical services\u2019 performance in rural and urban areas of Saudi Arabia"],"prefix":"10.1186","volume":"21","author":[{"given":"Ahmed Ramdan M","family":"Alanazy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Wark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"issue":"1","key":"6565_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.5339\/jemtac.2017.4","volume":"2017","author":"T AlShammari","year":"2017","unstructured":"AlShammari T, Jennings P, Williams B. Evolution of emergency medical services in Saudi Arabia. J Emerg Med Trauma Acute Care. 2017;2017(1):4.","journal-title":"J Emerg Med Trauma Acute Care"},{"key":"6565_CR2","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1016\/j.injury.2015.01.008","volume":"46","author":"A Harmsen","year":"2015","unstructured":"Harmsen A, Giannakopolous G, Moerbeek P, et al. The influence of prehospital time on trauma patients outcome: A systematic review. Injury. 2015;46:602\u20139.","journal-title":"Injury"},{"key":"6565_CR3","doi-asserted-by":"publisher","first-page":"135","DOI":"10.5694\/j.1326-5377.2006.tb00498.x","volume":"185","author":"P Jennings","year":"2006","unstructured":"Jennings P, Cameron P, Walker T, et al. Out-of-hospital cardiac arrest in Victoria: Rural and urban outcomes. Med J Aust. 2006;185:135\u20139.","journal-title":"Med J Aust"},{"key":"6565_CR4","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1161\/CIRCOUTCOMES.112.965210","volume":"5","author":"C Lin","year":"2012","unstructured":"Lin C, Peterson E, Smith E. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2012;5:514\u201322.","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"6565_CR5","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12245-018-0207-6","volume":"11","author":"A Mehmood","year":"2018","unstructured":"Mehmood A, Rowther A, Kobusingye O, et al. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med. 2018;11:53.","journal-title":"Int J Emerg Med"},{"key":"6565_CR6","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.injury.2014.08.043","volume":"46","author":"F Rogers","year":"2015","unstructured":"Rogers F, Rittenhouse K, Gross B. The golden hour in trauma: Dogma or medical folklore? Injury. 2015;46:525\u20137.","journal-title":"Injury"},{"key":"6565_CR7","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/1471-227X-10-20","volume":"10","author":"H Haghparast-Bidgoli","year":"2010","unstructured":"Haghparast-Bidgoli H, Hasselberg M, Khankeh H, et al. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach. BMC Emerg Med. 2010;10:20.","journal-title":"BMC Emerg Med"},{"key":"6565_CR8","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12913-018-3091-0","volume":"18","author":"A Kironji","year":"2018","unstructured":"Kironji A, Hodkinson P, de Ramirez S, et al. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC Health Serv Res. 2018;18:291.","journal-title":"BMC Health Serv Res"},{"key":"6565_CR9","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1111\/ajr.12108","volume":"22","author":"A Aftyka","year":"2014","unstructured":"Aftyka A, Rybojad B, Rudnicka-Drozak E. Are there any differences in medical emergency team interventions between rural and urban areas? A single cohort study. Aust. J Rural Health. 2014;22:223\u20138.","journal-title":"J Rural Health"},{"issue":"10","key":"6565_CR10","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.3390\/ijerph16101728","volume":"16","author":"A Alanazy","year":"2019","unstructured":"Alanazy A, Wark S, Fraser J, et al. Factors impacting patient outcomes associated with use of emergency medical services operating in urban versus rural areas: A systematic review. Int J Env Res Pub Health. 2019;16(10):1728.","journal-title":"Int J Env Res Pub Health"},{"issue":"7","key":"6565_CR11","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.resuscitation.2011.02.040","volume":"82","author":"D Fatovich","year":"2011","unstructured":"Fatovich D, Phillips M, Langford S, et al. A comparison of metropolitan vs rural major trauma in Western Australia. Resuscitation. 2011;82(7):886\u201390.","journal-title":"Resuscitation"},{"issue":"2","key":"6565_CR12","first-page":"9","volume":"2020","author":"A Alanazy","year":"2020","unstructured":"Alanazy A, Wark S, Fraser J, et al. Utilization of prehospital emergency medical services in Saudi Arabia: An urban versus rural comparison. J Emerg Med Trauma Acute Care. 2020;2020(2):9.","journal-title":"J Emerg Med Trauma Acute Care"},{"issue":"1","key":"6565_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-018-2017-x","volume":"22","author":"W Mathiesen","year":"2018","unstructured":"Mathiesen W, Bj\u00f8rshol C, Kval\u00f8y J, et al. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. Crit Care. 2018;22(1):1\u20139.","journal-title":"Crit Care"},{"key":"6565_CR14","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1097\/00005373-199704000-00024","volume":"42","author":"D Grossman","year":"1997","unstructured":"Grossman D, Kim A, Macdonald S, et al. Urban-rural differences in prehospital care of major trauma. J Trauma. 1997;42:723\u20139.","journal-title":"J Trauma"},{"key":"6565_CR15","first-page":"1","volume":"17","author":"A Alanazy","year":"2020","unstructured":"Alanazy A, Wark S, Fraser J, et al. A comparison of pre-hospital emergency medical services\u2019 response and duration times in urban versus rural areas of Saudi Arabia. Aus J Paramed. 2020;17:1\u20137.","journal-title":"Aus J Paramed"},{"issue":"1","key":"6565_CR16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.4103\/sjmms.sjmms_560_20","volume":"9","author":"A Alanazy","year":"2021","unstructured":"Alanazy A, Wark S, Fraser J, et al. Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region. Saudi J Med Med Sci. 2021;9(1):38\u201344.","journal-title":"Saudi J Med Med Sci"},{"issue":"1","key":"6565_CR17","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12245-018-0217-4","volume":"11","author":"N Alharthy","year":"2018","unstructured":"Alharthy N, Alswaes S, Almaziad A, et al. Public perception of female paramedics at King Abdulaziz Medical City, Saudi Arabia. Int J Emerg Med. 2018;11(1):57.","journal-title":"Int J Emerg Med"},{"key":"6565_CR18","doi-asserted-by":"crossref","unstructured":"AlShammari T, Jennings P, Williams B. (2019) National study of Saudi Arabian emergency medical services professional profiles: An inferential analysis. Aust J Paramed 2019:16.","DOI":"10.33151\/ajp.16.729"},{"key":"6565_CR19","doi-asserted-by":"publisher","DOI":"10.4135\/9781412985000","volume-title":"Meta-ethnography: Synthesizing qualitative studies","author":"G Noblit","year":"1988","unstructured":"Noblit G, Hare R. Meta-ethnography: Synthesizing qualitative studies. Newbury Park: Sage; 1988."},{"key":"6565_CR20","unstructured":"Polit D, Beck C. (2020) Nursing research: Generating and assessing evidence for nursing practice 11th Edition. Lippincott, Williams & Wilkins, USA."},{"key":"6565_CR21","volume-title":"Interpreting qualitative data","author":"D Silverman","year":"2015","unstructured":"Silverman D. Interpreting qualitative data. Great Britain: Sage; 2015."},{"issue":"2","key":"6565_CR22","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res in Psych. 2006;3(2):77\u2013101.","journal-title":"Qual Res in Psych"},{"key":"6565_CR23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13049-016-0247-y","volume":"24","author":"F-X Ageron","year":"2016","unstructured":"Ageron F-X, Debaty G, Gayet-Ageron A, et al. Impact of an emergency medical dispatch system on survival from out-of-hospital cardiac arrest: a population-based study. Scand J Trauma Resusc Emerg Med. 2016;24:53.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"3","key":"6565_CR24","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/00063110-199509000-00009","volume":"2","author":"B Nemitz","year":"1995","unstructured":"Nemitz B. Advantages and limitations of medical dispatching: the French view. Eur J Emerg Med. 1995;2(3):153\u20139.","journal-title":"Eur J Emerg Med"},{"key":"6565_CR25","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1046\/j.1440-1584.2002.00409.x","volume":"10","author":"P O\u2019Meara","year":"2002","unstructured":"O\u2019Meara P, Burley M, Kelly H. Rural urgent care models: What are they made of? Aust J Rural Health. 2002;10:45\u201350.","journal-title":"Aust J Rural Health"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-06565-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-021-06565-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-021-06565-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T17:05:25Z","timestamp":1623085525000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-021-06565-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,7]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6565"],"URL":"https:\/\/doi.org\/10.1186\/s12913-021-06565-3","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,7]]},"assertion":[{"value":"17 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Research ethics approval was granted by the University of New England\u2019s Human Research Ethics Committee, the Saudi Arabia Ministry of Health Ethical Committee, The King Abdelaziz Medical Cities Ethical Committee, and the Saudi Red Crescent Authority. All participants signed consent forms prior to data collection commencing.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Nil to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"562"}}