emergency medical services by suwan samrit

Journal of Public Health and Development Vol. 7 No. 2 May - August 2009

The Performance Indicators Development in operational level for pre-hospital EMS in Thailand Napisporn Memongkol Runchana Sinthavalai Nattapong Seneeratanaprayune Weerawat Ounsaneha Chanisada Choosuk

ABSTRACT The objective of this research is to develop the performance indicators (PIS) in operational level for the Pre-hospital Emergency Medical Service (EMS) system in Thailand. Nevertheless, Success Factor (SF) was identified by Strategic Map (SM), which was analyzed from main objective in National Strategy Plan of developing EMS (2008 - 2012) of Emergency Medical Institute of Thailand (EMIT). Then, PIS were developed from SF and SM. The results showed that only the first strategy of Infrastructure and information technology development was suited for developing PISin operational level. Besides, the success factor was the development of various infrastructure (people can received standard and efficient EMS thoroughly both in regulation and disaster conditions). Finally, twenty-eight performance indicators in operational level were developed using the analysis of strategy map and success factors. Those PIScan be used as a guideline to improve operational work.

Keyword Emergency medical services Performance indicators Success factor

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Journal of Public Health and Development May August 2009 Vol. 7 No. 2

Table1 Procedure of standard and weight determination Procedure

Validity

Easily understood Success ability Availability and Accuracy of data Comparability of KPI Quantitative Cause & Effect Linkage Tmly

Meaning

Weight Score (=I) To evaluate real operation ability 0.30 To evaluate meaning or description 0.20 communication for easily understanding To evaluate application and success 0.10 possibility To evaluate completion and sufficiency 0.10 in data collection To evaluate comparability of KPI with 0.10 other provinces or in the past To evaluate type of data in operation 0.10 data collection To evaluate cause and result relation 0.05 with goal of strategy plan To evaluate suitability of frequency in 0.05 data collection

Reference

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Figure 1 Success factor analysis diagram

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Journal of Public Health and Development Vol. 7 No. 2 May - August 2009

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Table 2 KPIs evaluation of Khon Kaen Province Criterion

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1 . Ratio of service (FR : ALSI-BLS) 2. Percentage of informing on EMS number (1669) 3. Percentage of patient satisfaction ofthe service provided by community EMS

4. I n f m - Dspatdung s 2 minutes 5 . Dispatching - Depart from ambulance station s 60 seconds 6. From ambulance station to the scene r 10 minutes 7. Response Time at the scene care s 10 minute 8. Fromthescene tonearathospital s 10 minute 9. Percentage of successibility of cardiopulmonary resuscitation 10. Ratio of number of service compare with popul ati on 1 1. Percentage ofnon-appropnable care (air way protection, bleeding control, immobilization, TV fluid catheterizations) 12. Percentage of urban patient delivered to Emergency Room ~ t EMS h 13. Percentage of local administration cooperation with EMS

Journal of Public Health and Development May - August 2009 Vol. 7 No. 2

Strategic dimensions

I . Infrastructure and information technolocy development T o develop infrastructure that people can receive a standard emergency medical service -b throughout and efficiency both in normal and disaster situation and emergency medical information system

Develop emergency room

-b Develop E M S

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Develop disaster m a n a g e m e n t Develop data base system 8: IT

b 2 . Develop m a n a g e m e n t mechanism and financial system

T o develop a n d reinforce m a n a g e m e n t mechanism o f standard emergency medical and efficiency T o develop financial mechanism to m a n a g e a emergency medical thoroughly and efficiency

3. Staff develnpment T o dislrihute e m e r z e n c y medical staff throughoul and

-b sufficient T o improve the capability o f the emergency medical

-b supporting staffs to take care the emergency patient

4. K n o w l e d ~ econstruct and management

T o get a k n o w l e d g e that harmonize with Thailand context to m a k e decision in the policy level. administrative level and practical le\'el of the E M S system using clearly evident and systematic collected knowledge that u p to date a n d consistent with social surrounding of the country a n d locality

Y T o develop the network a m o n g research institutes, researchers, and knowledge managers o f the E M S continuity

b 5. Develop networks and promote the participants role

T o develop network and promote the related partner to design, develop and e \ ~ a l u a t ethe E M S syslem for a standard and efficiency both in normal and disaster situations

Figure 2 National strategy plan of developing EMS in 2008 - 2012 B.C.

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Journal of Public Health and Development Vol. 7 No. 2 May - August 2009

Table 3 Minor objectives of infrastructureand information technology development Components

Minor ob-jectives

Pre-Hospital EMS

To develop the staff by training and evaluation for increasing the number of staff to cover all local administration To develop the knowledge revision mechanism for staff To develop the tool and vehicle in order to have efficiency and safety standard To develop the system of efficiency revision of tool and vehicle To make the organization chart and job description of staff To satisfy staff To reduce the time to the scene according to the topography To develop the standard operation procedure To develop communication equipment, data collection and evaluation program To develop the easily calling number and the reserved network for informing To increase the number of people acknowledgmentand accept the EMS system To develop the capability of people can evaluate and inform the situation To increase the number of doctor in command control center for controlling the staff and operational unit To develop the motivation mechanism for all hospitals to be the EMS network Management system in disaster condition

Management system in disaster condition

To develop the staff for making the acknowledgment about disaster management, related law and operation obligation To prepare the material, tool and vehicle ready for disaster condition operation To develop the operation and obligation approach for disaster condition To promote the hospitals and related organizations making the mitigation plan for disaster in each area To increase the training for operation in disaster condition To develop the communication system for help support in each area To set up the operation network system in disaster condition

Table 4 Performance indicators in operational level for EMS

T ~ e s

Dimensions

Perfarmance Indic abrs (d

1. Percentge oflocal administration organizati on s m&ng staE for training and passed standard training course 2. Percentge ofregisteredlocal operati anal units 3 . Percentge of operati onal unit having operaion results 4 . Percentge of operational units hming motivation system 5. Percentge of operation of local operational units aâ&#x201A;Źter informedfrom command control center 6. Percentge of operational unit h wing standard welfare system 7. Percentge of satisfiedstaffs in operation 8. Percentge of operational units passing the equipment and vehicle stm dard evaluation system 9. Percentge of operational units using equipment and vehicle standard manual 1 0. Percentage of operati ma1 unit having prepar;tion procedure 11. Percentage of operation having standard time to scene on the topography standard 1 2. Percentage of operation h wing standard time at scene according to injury level 1 3. Number of D ead Case conference 14. Percentage of ABC standard operati on

Journal of Public Health and Development Vol. 7 No. 2 May - August 2009

Table 4 Performance indicators in operational level for EMS (Cont.) Types

Dimensions Q)

Per farmance Indicators rn

15. Percentage of operation using standard time to definite c are 16. Percentage of reporting to emergency room before arriving the hospital 17. Percentage of operational unit and command control c enter having organization ch art 18. Number of 1ate response calling fiom random check 19. Number of no response calling fiorn command control center 20. Number of EMSpublic relitionsplan 2 1. Percentage of people in province recogniz dEMS 22. Percentage of emergency call (1669) 23. Percentage of EMS in total medical s ervi ces 24. Percentage of people remember EMS number (1669) 25. Percentage of reporting using provincial standard time 2 6. Percentage of command passing the standard (under triag e/over tri age) 27. Percentage of command using provincial standard time 2 8. Responding by rad o receiver ritio -

Remark : A = Provincial public he dth off1ce B = Local admmstration C = Command control center D = Operational unit

Journal of Public Health and Development Vol. 7 No. 2 May - August 2009

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