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Prehospital Emergency Care Volume 16, 2012 - Issue 4
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International EMS

Comparison of Emergency Medical Services Systems Across Pan-Asian Countries: A Web-based Survey

Sang Do ShinFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.Correspondence[email protected]
, MD, PhD,
Marcus Eng Hock OngFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MBBS, MPH,
Hideharu TanakaFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Matthew Huei-Ming MaFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD, PhD,
Tatsuya NishiuchiFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Omer AlsakafFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Sarah Abdul KarimFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Nalinas KhunkhlaiFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Chih-Hao LinFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Kyoung Jun SongFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Hyun Wook RyooFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Hyun Ho RyuFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD,
Lai Peng ThamFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MBBS (S'pore), MMed (Paediatrics) &
David C. ConeFrom the Department of Emergency Medicine, Seoul National University College of Medicine (SDS), Seoul, Republic of Korea; the Children's Emergency Department, KK Women's and Children's Hospital (LPT), Singapore; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (KJS), Seoul, Republic of Korea; the Department of Emergency Medicine, Kyoungpook National University Hospital (HWR), Daegu, Republic of Korea; the Department of Emergency Medicine, Chonnam National University Hospital (HHR), Gwangju, Republic of Korea; the Section of Emergency Medicine, Yale University School of Medicine (DCC), New Haven, Connecticut; the Department of Emergency Medicine, Singapore General Hospital (MEHO), Singapore; the Department of Emergency System, Kokushikan University Graduate School of Sport System (HT), Tokyo, Japan; the Department of Emergency Medicine, National Taiwan University (MH-MM), Taipei, Taiwan; the Department of Critical Care and Emergency Medicine, Osaka City University Hospital (TN), Osaka, Japan; the Technical Support Department, Dubai Corporation for Ambulance Services (OA), Dubai, United Arab Emirates; the Department of Emergency Medicine, Hospital Kuala Lumpur (SAK), Kuala Lumpur, Malaysia; the Department of Emergency Medicine, Rajavithi Hospital (NK), Bangkok, Thailand; and the Department of Emergency Medicine, National Cheng Kung University Hospital (C-HL), Tainan, Taiwan.
, MD show all
Pages 477-496 | Received 20 Apr 2012, Accepted 20 Apr 2012, Published online: 03 Aug 2012
 
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Abstract

Background. There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported. Methods. This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight. Results. Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur). Conclusion. We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.

Notice of Correction: The version of this article published online ahead of print on 03 August 2012 contained an error on the first page. Author's name Omer Alsakaf should have been Omer Al Sakaf. The corrected version is shown in this issue.

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