Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom

摘要

Design: A Delphi questionnaire design with two rounds to gain a consensus of opinion. Investigation of four aspects of EMS design is reported—type of response to a priority based dispatch category, transportation options, enhancement of paramedic skills, and structure of a first responder system. Subjects: Chief executives, directors of operations, and medical directors of Ambulance Trusts in the United Kingdom. Outcome measures: Likert scales (0–9) to score opinion on a series of statements with achievement of inter-round consistency. A median score of 0–4 was classified as disagreement and 6–9 as agreement. Results: A 65% response to the first questionnaire and with iteration, 52% response to the second questionnaire was attained. A tiered response (paramedics, technicians, and basic life support first responders) with technicians responding to selected category A and B calls and all category C calls (median score (MS) 7.5, interquartile range (IQR) 4), was recommended. Inter-unit handover of selected calls to maintain paramedic availablity ( MS 7.5, IQR 3.75) and enhancement of paramedic skills (MS 7.0, IQR 4.0) was also proposed. Finally, the development of a first responder system fully integrated into the EMS (MS 8.0, IQR 2.75) involving other agencies including the police force, fire service, and trained members of the local community was agreed. Conclusions: Senior expert staff from Ambulance Trusts in the UK achieved consensus on certain design characteristics of EMS systems. These are significantly different from the present EMS model.