Abstract
Since 2016, Thailand has initiated the decentralization of its emergency medical
services (EMS) system, transferring emergency medical dispatch centers from hospitals to
provincial administrative organizations (PAOs) to better serve local populations. Currently,
15 provinces have successfully transferred these centers.
This study uses a concurrent mixed-methods research design, combining
quantitative analysis of secondary data from the Information Technology for Emergency
Medical Systems (ITEMS) database and patient surveys, with qualitative studies involving
in-depth interviews and focus group discussions with central policymakers and local
practitioners.
Key findings 1. Performance Comparison:
1.1 Provinces with transferred dispatch centers show lower performance in telephone
triage accuracy, use of high-level emergency response units, and response times.
However, there is no difference in out-of-hospital cardiac arrest mortality between
transferred and non-transferred provinces.
1.2 Access to EMS has increased in transferred provinces, but the usage rate of the 1669
emergency hotline is lower in these provinces compared to non-transferred ones,
though still higher than the national average. Critical emergency patients prefer
going to hospitals directly due to convenience.
2. Systemic Evolution:
2.1 Coverage Expansion: Limited due to local readiness and willingness, with no plan
for decentralizing EMS to local organizations.
2.2 Quality Standards: NIEMS focuses on setting standards, but lacks sufficient support
for local areas, particularly in budget and training.
2.3 Digital Information System: Significant gaps in implementing D1669, including lack
of readiness assessments and insufficient support. The new ITEMS4.0 system has
reduced data integrity compared to ITEMS3.0.
2.4 Budget and Compensation: Decreased budgets for NIEMS, inadequate compensation
rates for emergency services, and financial strain on hospitals.
2.5 Human Resource Management: Contractual employment hinders capacity
building and retention.
2.6 Health System Science: Crucial for networked operations, including leadership,
systemic thinking, and change management.
3. Bangkok's EMS Gap:
3.1 The main issue in Bangkok is finding hospitals to receive critical emergency patients,
differing from other provinces where coverage and quality standards are the primary
concerns.
