Exploring Saudi Paramedics’ Experiences in Managing Adult Trauma Cases: A Qualitative Study

Exploring Saudi Paramedics’ Experiences in Managing Adult Trauma Cases: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Saudi Paramedics’ Experiences in Managing Adult Trauma Cases: A Qualitative Study Ateeq Almuwallad, Naif Harthi, Hussain Albargi, Bahja Siddig, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5142899/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Dec, 2024 Read the published version in BMC Emergency Medicine → Version 1 posted 14 You are reading this latest preprint version Abstract Background Saudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges. Methods A qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method. Results A total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, They also stressed the importance of raising public awareness to enhance trauma care. Conclusion This study explored Saudi paramedics' experiences in managing adult trauma patients. Key needs include more staff, standardized handovers, and greater public awareness. Addressing these challenges through increased staffing, improved coordination during handovers, and raising public awareness is crucial for improving trauma care outcomes trauma patients prehospital care perceptions paramedics Background Trauma is one of the leading causes of death worldwide, accounting for 10% of global mortality ( 1 ). In Saudi Arabia, trauma is a significant concern, particularly road traffic collisions (RTCs), which result in around nine thousand deaths annually ( 2 ). Many RTCs and other forms of trauma can be fatal without timely life-saving interventions ( 3 ). The first hour after injury is critical in treating trauma patients and significantly reducing mortality ( 4 ). Prehospital clinicians including paramedics play a crucial role in this process ( 5 ). However, paramedics often encounter varied experiences when responding to trauma calls, and external factors that can impact their ability to provide effective care ( 6 ). Individuals and other authorities, such as the police or civil defense, can create obstacles that impact the response and treatment of trauma patients, ultimately affecting patient outcomes ( 7 ). This study aims to: 1) explore how Saudi paramedics respond to trauma calls, 2) how they acquire their relevant knowledge, and 3) what are the factors that influence application of knowledge when responding to trauma patients. Methods Study design and setting This study utilized a qualitative approach, conducting interviews with paramedics from the Saudi Red Crescent Authority (SRCA) across various cities in the country. Founded in 1934 and funded by the government, the SRCA serves the public and also provides humanitarian aid internationally (8). Recruitment and sample The study participants were primarily Saudi paramedics with bachelor's degrees earned either domestically or abroad. A purposive sampling method was used to recruit paramedics from various cities, including Riyadh, Makkah, Jeddah, Abha, and Jazan. Efforts were made to select senior paramedics with extensive service experience and to achieve gender balance, though only one female paramedic was ultimately recruited. Data collection procedures The interviews were conducted online using a semi-structured format with open-ended questions via Zoom, each lasting 30 to 60 minutes. Data were collected from March to July 2024. Three recorded pilot interviews were conducted before the actual interviews to refine interviewing techniques and assess the effectiveness of the questions. After each interview, reflective notes were taken to evaluate which questions worked well, identify any unexpected findings, and assess whether data saturation had been reached. The initial questions were based on the professional experiences of AA and NH, who observed prehospital staff managing trauma patients. The first interview was carefully reviewed by NH to finalize the questions for the remaining participants. Further steps were taken to involve the academics HA, BS, and RA, from our EMS Emergency Medical Services program, and the participants after each interview to improve the interview guide. The finalized interview guide used in the study is provided in Supplementary File 1 . Use of Arabic Language The interviews were conducted and transcribed in Arabic to ensure detailed insights from participants. Following this, the transcripts were coded, and themes and subthemes were created in English. Key quotations were translated from Arabic to English and categorized under the relevant themes. This translation after data analysis allowed for a deeper understanding of the participants' experiences. We used a forward-translation technique to convert codes, themes, and quotes into English, followed by a back-translation by NH, who acted as a bilingual reviewer. Key documents, such as the interview guide, information sheet, and consent form, were translated from English to Arabic before the interviews. During translation, we faced challenges with certain words that couldn’t be directly translated. To address this, we applied a transliteration technique, using equivalent words while preserving the intended meaning. Data analysis The data were analyzed using the framework analysis approach, which involves familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation (9,10). This method provided a structured and logical way to present the descriptive data (11). The initial framework, developed from the first interviews, addressed the research questions and was expanded as new themes and subthemes emerged from later interviews. Data matrices were created, and emerging ideas were categorized, with relevant quotations placed under each theme. This process ensured transparency, reflexivity, and rigor (12). MAXQDA software was used due to its compatibility with the Arabic language (13,14). Ethical statement The study was approved by Jazan University Institutional Review Board (IRB), reference number REC-45/08/985. Participants were recruited via phone and email and provided informed consent after reviewing the information sheet. Interviews were scheduled at a convenient time, and participants' identities, as well as their ambulance stations, were anonymized using code names for confidentiality. Interview recordings and participant information were securely stored on Jazan University’s encrypted, password-protected system. Results A total of 20 paramedics participated in the interviews, including 19 males and 1 female. This reflects the continued male dominance in prehospital care in Saudi Arabia. Table 1 demonstrate the details of the participants: All participants explained how they respond to trauma patients, how they acquire relevant knowledge, and highlighted the factors that influence the application of this knowledge during trauma responses. These topics are summarized below, with the structured themes detailed in Supplementary file 2 Table. 1. How do Saudi paramedics respond to trauma patients? The participants identified several challenges when responding to trauma patients, including the coordination of the response, the accuracy and accessibility of patient information, difficulties in providing care, and the confidence and readiness of paramedics. 1.1 Challenges in Coordination When Responding to Trauma Patients Participants acknowledged challenges in coordination during trauma responses. Most reported a lack of coordination between the SRCA and other authorities, such as the police and civil defence, which can create obstacles in providing care at the scene. Some participants highlighted the crucial role of the police in managing the public, allowing paramedics to focus on patient care. Two participants specifically noted that securing the scene is difficult without police presence. A7: “if there are no police in the scene, bad consequences may occur”. A9: “I have been to a number of trauma calls and there are no police or civil defense in the scene, and we requested them many times”. A11: “I believe when the ambulance called, police and civil defence should also requested and dispatched, I remember one case that someone drowned in a well and we waited two hours for the divers to arrive although it was mentioned clearly when they asked for help”. Some participants also mentioned a lack of clear coordination between the paramedics and receiving facilities, which can lead to increased wait times due to multiple ambulances crowding the entrance of the emergency room. Additionally, some participants reported arriving at the facility only to find no available beds, resulting in long waits until a bed becomes free. A6: “too many ambulances by the entrance with no coordination… we have to wait for device being used on the patients until they gave it back”. A9: “sometimes we arrive to hospital, and we surprised that there is no bed available for the patient, so we have to wait with our equipment being used on the patients”. Several participants expressed concerns about having to wait for their equipment at the receiving facility, sometimes for hours. They feared that if they left without it, the equipment might be lost, and there would be no replacement available at their station. Some participants noted that in critical situations, paramedics often have to wait a long time for their equipment, either until it's no longer needed or until the patient has completed procedures like a CT scan. A4: “sometimes we use long back board or splints and there is no alternatives in the hospital so we have to wait for that long time”. A7: “if you leave without having all equipment in the hospital, it’s impossible to get them later”. 1.2 Accuracy of information and accessibility of the patients Several participants believed that controlling crowds at the scene is challenging, as they can sometimes become angry and agitated. Two participants noted that crowds can create dangerous situations at the scene. Many felt that paramedics often face added pressure due to the presence of crowds. Additionally, two participants reported that crowds may delay ambulance access to the scene, negatively affecting prehospital care. One participant mentioned that crowds can distract paramedics from their duties, further delaying the care provided to patients. A1: “sometimes the crowd were agitated, and they might be aggressive towards you”. A6: “sometime family of the patient can be aggressive and demanding”. A8: “the problem with crowding is sometimes may delay ambulance to reach to the scene and obstacle paramedics from performing their job”. Several participants reported that trauma scenes are often unsafe upon arrival, particularly when the police are not present. Three participants noted that the scene can be dangerous for both paramedics and patients, especially in highway accidents. One participant mentioned that securing the scene took a long time, which negatively impacted patient treatment. Additionally, two participants highlighted the risk of a secondary accident occurring if the scene is not properly secured by the police upon arrival. A2: “we normally check if the scene is safe or not for us to approach the patient”. A4: “we want to approach the scene without any concern on our personal safety”. Most participants reported that the information they received about calls was often inaccurate. Several noted that it was frequently incomplete, insufficient, or unclear. Three participants added that the scene location they were given sometimes differed from the actual location. Two participants expressed that the information from the 911 dispatch system was often less accurate or complete compared to the 997 system. One participant mentioned that upon arriving at the scene, they often realized that more than one ambulance was needed. A5: “Location can be completely different from the information we received initially”. A6: “maybe the information were not clear so you do not know what to prepare for”. A10: “most of the time when we received the information from 911 were not complete or accurate compared to 997”. 1.3 Handover issues Most participants reported several issues when handing over patient care to the receiving facility. Some noted that the handover was not always properly received by the facility's staff, often depending on the individuals involved. Many participants mentioned encountering ignorance, lack of professionalism, and a lack of respect during the handover process. Three participants expressed that the handover could take a long time due to staff unavailability, even when notified in advance. One participant highlighted the absence of a standardized handover system across facilities, and another mentioned that paramedics sometimes had to give handover to multiple staff members at the receiving facility. A9: “might be lack of professionalism and medical respects in handover process”. A10: “sometimes when I start talking and give handover, some hospital staff are not interested in my handover” A12: “it depends on the situation, sometimes, in critical cases, hospital staff relay on our vital signs and sometimes they do not” 1.4 Care difficulties when treating trauma patients Several participants reported that treating trauma patients at the scene can be challenging, especially in critical cases. Some noted that there are often multiple casualties in severe conditions, requiring additional assistance. Three participants emphasized the need for a cautious approach in special cases to prevent further injury, particularly with patients suffering from severe head trauma or other serious injuries. Two participants mentioned difficulties caused by language barriers when dealing with trauma patients. One participant highlighted the challenge of persuading patients who refuse transport, and another noted that sometimes they respond to calls where an ambulance is unnecessary, as the patients have only minor or no injuries. A2: “sometimes I arrive to the scene and notice that there are more than one patient need immediate care”. A3: “I made the response to trauma case and when I approach the scene there are at least four critical patients need rapid transport”. Several participants mentioned encountering multiple emergencies simultaneously, receiving numerous calls at once. Three participants reported that there are often too many cases and not enough ambulances or teams to cover them all. One participant noted that paramedics sometimes have to handle different types of injuries, such as burns or injuries from fights. Two participants expressed that managing various types of injuries, along with multiple patients at the same time, can be particularly challenging. A15: “there are a number of calls and there is no enough teams to cover all cases and sometimes the respond can take long time because the caller is far from the station”. A20: “by focusing on calls, we can see some of them do not need the whole ambulance service, and some of them are critical and need immediate intervention”. 1.5 Confidence and readiness Several participants expressed their levels of confidence when dealing with trauma patients. Many reported that working on a variety of trauma cases helps build a high level of confidence. Two participants mentioned that confidence stems from mastering skills and knowledge, which can lead to more accurate diagnoses. Additionally, two participants noted that having supportive colleagues helps reduce stress and boosts confidence when managing trauma patients. A1: “in the beginning it was difficult, with more exposure and responding to trauma calls, the confidence start to build up” A8: “the most important thing is that it reducing the stress and with practice, confidence can be build up slowly”. Several participants emphasized that paramedics must be physically and mentally prepared before responding to trauma calls. Many highlighted the importance of conducting routine checks and preparing trauma equipment before starting their shifts. Additionally, several participants stressed that medication bags and fluids should be protected from heat exposure. One participant noted that paramedics should personally prepare their tools to enhance their level of readiness. “A3: when I receive the trauma call, I hope the best and prepare for the worse”. A7: “I normally keep the medication bag by myside because the ambulance can get very hot especially in the summer”. 2. How Saudi paramedics acquire their relevant knowledge? Participants recognized the importance of independent methods for acquiring knowledge, such as attending specialized courses and conferences, engaging in simulation training, reviewing protocols, and discussing cases with colleagues afterward. 2.1 Independent approaches to acquire knowledge Several participants noted that attending specialized trauma courses or conferences is helpful for staying updated on how to manage trauma patients. Most participants mentioned that courses like Prehospital Trauma Life Support (PHTLS) are effective in keeping their knowledge current. Two participants highlighted that mandatory courses provided by SRCA also help in maintaining updated information. Additionally, two participants emphasized that continuous learning in general enhances and refreshes their knowledge in dealing with trauma patients. A4: “mandatory courses can help update our knowledge” A6: “mini courses and specialized courses are important to update our trauma knowledge”. Three participants mentioned that reading books—especially primary resources like Mosby's Paramedic Textbook or Nancy Caroline's Emergency Care in the Streets—and journals helps them stay informed. One participant specifically noted that consulting academic journals provides additional information on trauma patients. Another participant reported that reviewing websites or watching instructional videos on YouTube can be very helpful for refreshing information and skills. A18: “I think reading textbooks with practice can be very helpful”. A19: “reading and watching some YouTube videos can improve practice”. Several participants stated that simulation training is valuable for mastering skills and gaining more knowledge about managing trauma patients. Two participants specifically noted that simulation and scenario-based training on various trauma situations can be particularly helpful in acquiring additional information. A11: “where I work, occasionally, I have to spend around 30 minutes of simulation based on real scenarios to improve my skills and information”. A13: “for example, like in hospital, they have simulation and the trauma team responding like the real case”. Several participants mentioned that practicing and learning techniques from colleagues is useful for gaining trauma-related knowledge. Three participants specifically noted that increased practice and responding to trauma calls help build confidence and improve their skill mastery. A7: “I remember there was a new device that I didn’t receive the training related to it and I learn how to use through a colleague of mine”. A18: “practice with information that I had can be very helpful”. Several participants highlighted that reviewing the SRCA trauma protocol is essential for gaining more information. Some noted that the protocol should be regularly reviewed alongside practice to ensure their knowledge remains up-to-date. One participant described the SRCA trauma protocol as detailed, well-organized, and comprehensive, covering everything needed for managing trauma patients. A4: “of course, reviewing the protocol can be help effectively”. A6: “the protocol is detailed and mentioned different cases in an expanded information”. Several participants mentioned that debriefing trauma cases with colleagues is useful for acquiring additional knowledge and preparing for future trauma calls. Some participants noted that these discussions can last up to 45 minutes and are valuable for gaining further insights. Two participants also stated that reviewing and discussing cases with colleagues helps recover important information related to trauma patients. A7: “debriefing and discussion after the case can last to 45 minutes which can be very helpful sometimes”. A9: “sometimes I feel like it’s not enough to discuss the case, I might read some articles and review the protocol”. A20: “it considered very good to discuss the case with your colleagues in order to improve your skills”. 3. What are the factors that influence application of knowledge when responding to trauma patients? Participants identified several factors that affect the application of knowledge when responding to trauma patients, including increasing the number of paramedics, maintaining a focus on patients, managing paramedic burnout, avoiding underestimation of patient conditions, regularly reviewing information, and raising public awareness. 3.1 Current needs to improve care for trauma patients Several participants mentioned that the number of prehospital staff is insufficient and needs to be significantly increased. Most participants noted that having only two people—one driver and one treating the patient—is not enough. Two participants pointed out that additional help can be delayed due to a lack of teams and units available to cover calls. One participant added that while air ambulances can be helpful at times, there is a greater need for more ground ambulances. A2: “I think it’s ideal to have someone else in the cabinet since now it’s only two of us, one driving and the other one back in the cabinet looking after the patient by his own”. A5: “air ambulance can help in some situation but we still need more ground ambulance units to cover most of the calls”. Most participants emphasized the need to raise public awareness about the roles and responsibilities of paramedics and ambulance teams. Two participants specifically mentioned that there is a lack of public understanding regarding the capabilities of paramedics and their duties at the scene. A1: “public need to understand what paramedics are capable of and to let them do their job without any interference”. A8: “there is lack of public awareness in terms of emergency medical services system”. Several participants emphasized that paramedics should focus solely on the patient and avoid distractions with unnecessary tasks. Most participants stressed that paramedics should never underestimate the situation and must be prepared to handle the surrounding environment. Three participants highlighted the importance of regularly reviewing their knowledge when dealing with trauma patients. A7: “ignore the noise that surrounding you, and focus on treating your patient, and if you have multiple casualties, you need to request help as soon as possible”. A8: “don’t let outside factors influence your focus on the patients”. Several participants noted that paramedics may experience burnout due to excessive pressure and insufficient staffing to handle the workload. Most participants reported that many of their colleagues suffer from burnout, as they often have to manage a large number of calls within a single shift. A8: “there is sort of burnout among some paramedics to be honest”. A20: “it is easy to get burnout while being a paramedic working in the field, therefore, you have look after yourself and focus on three main things: nutrition, exercise, and sleep”. Discussion This study examines the experiences of Saudi paramedics in managing adult trauma patients. Participants shared their insights across three key areas: responding to trauma patients, acquiring knowledge related to trauma care, and the factors that affect the application of this knowledge. Themes and subthemes were developed based on the participants' responses. Participants highlighted the challenges they faced in coordinating while responding to trauma patients, including obstacles such as scene security and the availability of police and civil defence. The presence of police at the scene is considered crucial for securing the area and ensuring the safety of paramedics (15). One of the key factors in making a scene safe is having police on-site (16). Their presence also helps manage crowds, allowing paramedics to focus on patient care (15). It is suggested that training police officers in basic first aid for trauma patients could significantly improve outcomes (17). Additionally, the timely presence of civil defence at trauma scenes can enhance patient accessibility and potentially lead to better outcomes (18). Effective coordination between prehospital staff and receiving facilities is crucial for improving survival rates among trauma patients (19). Many participants reported that coordination between these groups (pre-hospital staff and receiving facilities staff) is sometimes lacking. It is suggested that improved communication through the dispatch system can strengthen the treatment plan and enhance patient outcomes (19,20). Studies have emphasized the importance of this coordination, noting that advance communication helps facilitate proper triage, directing trauma patients to the appropriate facility and preventing under-triage, which could complicate their care (21–25). In line with the issue of coordination, some participants reported long waits to retrieve their equipment, which can prevent them from responding to other calls. Some receiving facilities lack alternative equipment, leading to extended wait times for prehospital staff and adding strain to ambulance teams, especially during high call volumes (26,27). The shortage of prehospital staff is a common issue in ambulance services worldwide, and waiting for equipment further exacerbates the impact of this staffing shortage (28). Crowds at trauma scenes can pose significant challenges for paramedics in carrying out their duties. Several participants reported difficulties in managing crowds, particularly in the absence of law enforcement to control the situation (29). Uncontrolled crowds at trauma scenes are believed to endanger the safety of individuals, patients, and paramedics (30). Additionally, crowd interference can delay the arrival of ambulances and paramedics, potentially worsening outcomes for trauma patients (30). However, some individuals present at the scene may assist in moving patients smoothly to the ambulance (30). One participant mentioned that the presence of a crowd can help identify the scene and assist in transferring patients to the ambulance. Scene safety is crucial when responding to and treating trauma patients (31). Several participants emphasized that they cannot enter an unsafe scene. As previously mentioned, the presence of police is key to ensuring scene safety. Additionally, it is suggested that individuals at the scene can assist in making it safer for paramedics, as it is difficult for them to perform their duties in an unsafe environment. Unsafe scenes can delay patient care and increase the risk of injury to paramedics (32). The information received from dispatch can significantly impact the response and care provided to trauma patients (33). Several participants in this study reported that the information relayed from the dispatch system is often incomplete, inaccurate, or unclear. This is likely because the caller may lack the knowledge to accurately describe the patient's condition at the time (34). Inaccurate information can confuse paramedics during their response, potentially leading to negative outcomes for the patient (33). The handover process plays a crucial role in the care journey of trauma patients (35). Several participants reported that the handover is sometimes not conducted properly, with hospital staff occasionally bypassing the process to focus directly on the patient. This issue with the handover process can lead to duplicated interventions, which may negatively affect trauma patients (36). Additionally, participants noted the lack of a standardized handover technique across receiving facilities, increasing the risk of miscommunication between paramedics and hospital staff. Poor handover practices are believed to contribute to medical errors (37). Prehospital interventions are critical in the treatment of trauma patients and can significantly improve survival rates (38). Paramedics aim to intervene as early as possible to prevent the situation from worsening and to enhance patient outcomes (39). However, delivering care in the prehospital phase often presents challenges (38,39). Several participants reported difficulties in providing care to trauma patients, such as the severity of the injuries, lack of patient cooperation, and patients refusing transportation. Treating unstable trauma patients at the scene is particularly challenging due to the conditions of the scene and the absence of hospital resources (40). Prehospital staff often feel overwhelmed by the high volume of calls and staffing shortages (41). Many participants noted that there are too many calls and not enough personnel to handle them all. This shortage of staff may be inherent in the design of the EMS system, which prioritizes responding to all calls, including stable cases, rather than focusing solely on the most critical situations (42). It is estimated that only 8% of ambulance calls are for critical cases, while the rest involve stable patients (43). This strain on the EMS system can delay responses to critical cases, potentially having serious consequences (44). Trauma scenes can be chaotic, adding to the challenges paramedics face (45). Several participants emphasized that paramedics must be physically and mentally prepared to effectively respond and treat trauma patients. It has been suggested that paramedics should adopt a healthy lifestyle, including sufficient sleep and proper nutrition, to boost their readiness and confidence in handling trauma situations (46,47). Additionally, meditation is believed to help mentally prepare paramedics, enhancing their confidence when responding to trauma patients (48). In terms of preparation, training and practice can greatly improve paramedics' performance when responding to trauma patients (49). Several participants highlighted various ways they update their knowledge and skills, including attending specialized courses, academic lectures, conferences, simulation training, reading books and journals, reviewing SRCA protocols, and debriefing cases with colleagues (50). Simulation training, in particular, is believed to significantly enhance specific skills, while debriefing with colleagues offers a valuable opportunity to gain knowledge and learn from peers (51). Strengths and limitations of the study: In terms of strengths, this study was conducted across various Saudi cities, revealing consistent themes and subthemes that reflect similar responses, challenges, and obstacles. Further, although the interviews and analyses were conducted in Arabic, a bilingual checker with expertise in qualitative research and paramedicine performed a back-translation to confirm the accuracy of the forward-translation. This study also had several limitations, which may be linked to its design. Firstly, it only interviewed paramedics with advanced knowledge and skills, excluding EMTs, which could have provided a broader perspective of EMS clinicians' experiences in handling trauma patients. Secondly, the study included only one female paramedic, potentially introducing gender bias and limiting a comprehensive understanding of female paramedics' experiences with trauma patients. Thirdly, the study did not include interviews with patients, which could have offered a more complete view of the trauma experience from both the clinicians' and patients' perspectives. Fourthly, other methods, such as patient interviews or direct observation of practice, may yield different results, as interviews provide insight into what participants believe is happening, rather than what is actually occurring. Lastly, this study may be limited by participant selection, as those with strong opinions or interest in the topic might be more likely to participate. This could result in missing important perspectives, especially from individuals with less knowledge or interest in trauma care and patient management. Implication of the study for policy and practice: This study offers several important implications, particularly in addressing the challenges paramedics face when managing trauma patients. Many participants emphasized the need to increase prehospital staff to better meet the high demand for calls. Additionally, it is suggested that implementing a triage system would enable ambulance units to prioritize and respond primarily to the most critical cases. Currently, in Saudi Arabia, some non-life-threatening calls are dispatched to general practitioners. Raising public awareness about which cases require ambulance services and which do not could help redirect resources toward critical, life-threatening cases (52). Furthermore, educating the public on how to behave at trauma scenes, and how individuals can assist rather than hinder, could significantly improve trauma care. Lastly, the handover process should be standardized across receiving facilities to streamline communication between paramedics and hospital staff, ultimately enhancing patient care. Conclusion Few studies have explored the challenges and obstacles paramedics encounter when responding to and caring for trauma patients. This study addressed these gaps by examining the experiences of Saudi paramedics in managing trauma patients, identifying key challenges such as trauma response coordination, information accuracy, handover issues, care provision, and paramedic confidence. It also highlighted the various methods paramedics use to acquire knowledge, including training courses, simulations, and case reviews. The main outcomes emphasize the need for public awareness, increased prehospital staffing, and a standardized handover process. Additionally, future research should consider incorporating practice observation methods with Saudi paramedics and interviews with trauma patients or their relatives to capture a broader range of perspectives and ensure a comprehensive understanding of the challenges in trauma care. Abbreviations EMS Emergency Medical Services PHTLS prehospital trauma life support SRCA Saudi Red Crescent Authority KSA Kingdom of Saudi Arabia. Declarations Acknowledgment The authors gratefully acknowledge the funding of the Deanship of Graduate Studies and Scientific Research, Jazan University, Saudi Arabia, through Project Number: GSSRD-24 Author contributions AA designed the study, NH, developed the plan and methodology, AA conducted the interviews with the participants, NH confirmed and back translated the transcripts, HA & BS & RA reviewed and approved the initial questions of interview guide, and later reviewed the final draft of manuscript. Funding This study was funded by the Jazan University, Saudi Arabia. Ethical approval and informed consent to participate This study received approval from the Jazan University Institutional Review Board (IRB), under reference number REC-45/08/985 (HAPO-10-001). It was conducted in compliance with local laws and institutional guidelines. Participants reviewed the study's information sheet, confirmed their understanding, and provided signed informed consent before participating. Consent for publication Not applicable. Availability of data and materials The data generated and analyzed during this study (audio files and transcripts) are not publicly available due to ethical considerations. Reasonable data requests can be directed to the corresponding author. Only the corresponding author has access to the data, and all findings are presented anonymously in accordance with the informed consent form. Competing interests The authors declare that they have no competing interests. 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The trend of change in the role of pre-hospital emergency medical services in Iran’s healthcare system: a situational analysis. BMC Emerg Med. 2023;23(1). Alruqi F, Aglago EK, Cole E, Brohi K. Factors Associated with Delayed Pre-Hospital Times during Trauma-Related Mass Casualty Incidents: A Systematic Review. Volume 17. Disaster Medicine and Public Health Preparedness: Cambridge University Press; 2023. Ricciardelli R, Czarnuch S, Afifi TO, Taillieu T, Carleton RN. Public safety personnel’s interpretations of potentially traumatic events. Occup Med (Chic Ill). 2020;70(3):155–61. Nasser AAH, Nederpelt C, El Hechi M, Mendoza A, Saillant N, Fagenholz P, et al. Every minute counts: The impact of pre-hospital response time and scene time on mortality of penetrating trauma patients. Am J Surg. 2020;220(1):240–4. Lamb T, Tran A, Lampron J, Shorr R, Taljaard M, Vaillancourt C. The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review. Journal of Trauma and Acute Care Surgery. Volume 95. Lippincott Williams and Wilkins; 2023. pp. 267–75. Waalwijk JF, Lokerman RD, van der Sluijs R, Fiddelers AAA, Leenen LPH, van Heijl M, et al. Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study. Eur J Trauma Emerg Surg. 2022;48(2):1111–20. Bashekah KA, Alqahtani R, Aljifri AM, Ashram SY, Alghamdi E, Khallaf AM et al. The Knowledge, Attitudes, and Associated Factors Regarding First Aid Among the General Public in Saudi Arabia. Cureus. 2023. O’Neill K, Powell M, Lovell T, Brown D, Walsham J, Calleja P, et al. Improving the handover of complex trauma patients by implementing a standardised process. Australian Crit Care. 2023;36(5):799–805. Cowan S, Murphy P, Kim M, Mador B, Chang E, Kabaroff A, et al. Paramedic to trauma team verbal handover optimization - a complex interaction. Can J Surg. 2023;66(3):E290–7. Sarkarsi R, Syed Elias SM, Lee SP. Experience of Patients with Breast Cancer at Home During Chemotherapy Treatment: A Qualitative Approach. Int J CARE SCHOLARS. 2023;6(1):47–58. Maegele M, Lier H, Hossfeld B. Pre-Hospital Blood Products for the Care of Bleeding Trauma Patients. Deutsches Arzteblatt International. Volume 120. Deutscher Arzte-Verlag GmbH; 2023. pp. 670–6. Duc CN, Tuan AT, Manh HD, Thuy HN, Quynh Dinh Van, An Le Vu Khanh. The situation of pre-hospital emergency care through traumatic patients have been admitted to emergency department of Viet Duc University Hospital in 2023. GSC Adv Res Reviews. 2024;19(1):033–41. Isgrò S, Giani M, Antolini L, Giudici R, Valsecchi MG, Bellani G et al. Identifying Trauma Patients in Need for Emergency Surgery in the Prehospital Setting: The Prehospital Prediction of In-Hospital Emergency Treatment (PROPHET) Study. J Clin Med. 2023;12(20). Alruwaili A, Alanazy A, Alanazi TM, Alobaidi N, Almamary AS, Faqihi BM, et al. Managing High Frequency of Ambulance Calls in Hospitals: A Systematic Review. Risk Management and Healthcare Policy. Volume 17. Dove Medical Press Ltd; 2024. pp. 287–96. Colla M, Santos GD, Oliveira GA, de Vasconcelos RBB. Ambulance response time in a Brazilian emergency medical service. Socioecon Plann Sci. 2023;85. Eastwood K, Johnson M, Williams J, Batt AM, Tavares W. Paramedicine: An evolving identity. Vol. 20, Paramedicine. SAGE Publications Inc.; 2023. pp. 177–80. Friesen J, Kharel R, Delaney PG. Emergency medical dispatch technologies: Addressing communication challenges and coordinating emergency response in low and middle-income countries. Surg (United States). 2024;176(1):223–5. Breeding T, Rosander A, Abella M, Martinez B, Maka P, Elkbuli A. Retrospective Study of EMS Scene Times and Mortality in Penetrating Trauma Patients: Improving Transport Standards and Patient Outcomes. Am Surg. 2024;90(1):46–54. Kosydar-Bochenek J, Religa D, Iwanicka K, Szczupak M, Krupa-Nurcek S. Burnout among Polish paramedics: insights from the Oldenburg Burnout Inventory. Front Public Health. 2024;12. Khan HNA, Hasmi N, Arvind Chitra S, Sudarshan Doshi S, Mahesh S. R, Rescuing the Rescuers: Combating Burnout in the Emergency Medicine Department. Mathews J Emerg Med. 2023;8(3). Kaplan GR, Frith T, Hubble MW. Quantifying the prevalence and predictors of burnout in emergency medical services personnel. Ir J Med Sci. 2024;193(3):1545–56. Bienstock J, Heuer A, Zhang Y. Simulation-Based Training and Its Use Amongst Practicing Paramedics and Emergency Medical Technicians: An Evidence-Based Systematic Review. Int J Paramedicine. 2022;(1):12–28. Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. Int J Environ Res Public Health. 2023;20(5). Jadzinski M, Jack E, Darby I. Journal of Paramedic Practice What value does peer-assisted learning have in the training of student paramedics? Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. Luo J, Zheng K, Hong W. Public first aid education model design study based on user experience. Front Public Health. 2023;11. Tables Table 1: Participants’ criteria for the analysis study No. ID Demographics (position, city, and experience years) No. ID Demographics (position, city, and experience years) 1 A1 Paramedic, Makkah, 3 years 11 A11 Paramedic, Riyadh, 4 years – 5 months 2 A2 Paramedic, Abha, 2 years 12 A12 Paramedic, Jeddah, 2 years 3 A3 Paramedic, Makkah, 9 years 13 A13 Paramedic, Riyadh, 2 years – 9 months 4 A4 Paramedic, Makkah, 3 years 14 A14 Paramedic, Makkah, 2 years – 5 months 5 A5 Paramedic, Makkah, 2 year - 2 months 15 A15 Paramedic, Makkah, 2 years 6 A6 Paramedic, Riyadh, 1 years – 8 months 16 A16 Paramedic, Makkah, 2 years – 5 months 7 A7 Paramedic, Riyadh, 7 years 17 A17 Paramedic, Abha, 1 year - 8 months 8 A8 Paramedic, Riyadh, 2 years 18 A18 Paramedic, Jeddah, 1 year – 4 months 9 A9 Paramedic, Riyadh, 6 years 19 A19 Paramedic, Jazan, 3 years 10 A10 Paramedic, Riyadh, 9 years 20 A20 Paramedic, Riyadh, 2 years – 5 months Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1READY.pdf Additional file 1 Format: .PDF Title: The versions of interview guide Description: a file shows two versions of interview guide used to interview the participants. Supplementaryfile2READY.pdf Additional file 2 Format: .PDF Title: Three matrices of each study question of the qualitative study Description: a file shows three matrices reflecting how the questions of this qualitative study were addressed. Cite Share Download PDF Status: Published Journal Publication published 04 Dec, 2024 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 04 Nov, 2024 Reviewers agreed at journal 13 Oct, 2024 Reviews received at journal 10 Oct, 2024 Reviewers agreed at journal 09 Oct, 2024 Reviewers agreed at journal 08 Oct, 2024 Reviewers agreed at journal 08 Oct, 2024 Reviewers agreed at journal 08 Oct, 2024 Reviews received at journal 03 Oct, 2024 Reviewers agreed at journal 26 Sep, 2024 Reviewers invited by journal 26 Sep, 2024 Editor invited by journal 26 Sep, 2024 Editor assigned by journal 24 Sep, 2024 Submission checks completed at journal 24 Sep, 2024 First submitted to journal 24 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Almuwallad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYDADfoYDMGYCkVokG0jWYgDXQUgL/7TDzz7+qLCR3Xzw8OMPP3ccZuBnzzFg/FGDW4vE7TTjGRJn0oy3HThmYNh75jCDZM8bA2aeY3isuZ1gzGDYdjhx24EDBgm8bYcZDG7kGDAzsOHWIX87/TNDIlDL5objHw7+BWqxvwFy2D/cWgxu5xgzHARq2cBwxrAZbItEjgEDbxtuLYa3c4oZG4B+mXHgTDGzbFs6j8SZZwWHeftwa5G7nb6ZERRi/TOOb/74ts1ajr89eePDH9/weB8KGBskDoAZPCDiAGENIC38DcSoGwWjYBSMgpEIABZFWPaT33yVAAAAAElFTkSuQmCC","orcid":"","institution":"Jazan University","correspondingAuthor":true,"prefix":"","firstName":"Ateeq","middleName":"","lastName":"Almuwallad","suffix":""},{"id":374147269,"identity":"2dc8221f-c83e-4dc9-967e-d9363109443d","order_by":1,"name":"Naif Harthi","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Naif","middleName":"","lastName":"Harthi","suffix":""},{"id":374147270,"identity":"2559e753-5edc-4fc8-b43b-dc0813735bbd","order_by":2,"name":"Hussain Albargi","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Hussain","middleName":"","lastName":"Albargi","suffix":""},{"id":374147271,"identity":"41910162-57a0-4e38-9202-96041d55482d","order_by":3,"name":"Bahja Siddig","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Bahja","middleName":"","lastName":"Siddig","suffix":""},{"id":374147272,"identity":"e2658d95-0a98-418e-96c2-a83afd25c3b0","order_by":4,"name":"Rayan Jafnan Alharbi","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Rayan","middleName":"Jafnan","lastName":"Alharbi","suffix":""}],"badges":[],"createdAt":"2024-09-24 07:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5142899/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5142899/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-024-01145-0","type":"published","date":"2024-12-04T15:58:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70965520,"identity":"33b08831-5de9-4b48-8ec1-7395b54f3029","added_by":"auto","created_at":"2024-12-09 16:20:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":399143,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5142899/v1/a44153db-c434-4288-b254-b89415e7d9a8.pdf"},{"id":69321184,"identity":"6fc62bad-b4c4-4cf9-bb8a-a8026904bd2c","added_by":"auto","created_at":"2024-11-19 07:02:24","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":44315,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1\u003c/p\u003e\n\u003cp\u003eFormat: .PDF\u003c/p\u003e\n\u003cp\u003eTitle: The versions of interview guide\u003c/p\u003e\n\u003cp\u003eDescription: a file shows two versions of interview guide used to interview the participants.\u003c/p\u003e","description":"","filename":"Supplementaryfile1READY.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5142899/v1/68c001e140e16347369e2511.pdf"},{"id":69321185,"identity":"604820ce-ef3f-408c-a013-c0c2ab1770f1","added_by":"auto","created_at":"2024-11-19 07:02:24","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":100172,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2\u003c/p\u003e\n\u003cp\u003eFormat: .PDF\u003c/p\u003e\n\u003cp\u003eTitle: Three matrices of each study question of the qualitative study\u003c/p\u003e\n\u003cp\u003eDescription: a file shows three matrices reflecting how the questions of this qualitative study were addressed.\u003c/p\u003e","description":"","filename":"Supplementaryfile2READY.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5142899/v1/0f60ae07653ccd9e94c8cdcc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring Saudi Paramedics’ Experiences in Managing Adult Trauma Cases: A Qualitative Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eTrauma is one of the leading causes of death worldwide, accounting for 10% of global mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Saudi Arabia, trauma is a significant concern, particularly road traffic collisions (RTCs), which result in around nine thousand deaths annually (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Many RTCs and other forms of trauma can be fatal without timely life-saving interventions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The first hour after injury is critical in treating trauma patients and significantly reducing mortality (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Prehospital clinicians including paramedics play a crucial role in this process (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, paramedics often encounter varied experiences when responding to trauma calls, and external factors that can impact their ability to provide effective care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Individuals and other authorities, such as the police or civil defense, can create obstacles that impact the response and treatment of trauma patients, ultimately affecting patient outcomes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This study aims to: 1) explore how Saudi paramedics respond to trauma calls, 2) how they acquire their relevant knowledge, and 3) what are the factors that influence application of knowledge when responding to trauma patients.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy design and setting\u003c/p\u003e\n\u003cp\u003eThis study utilized a qualitative approach, conducting interviews with paramedics from the Saudi Red Crescent Authority (SRCA) across various cities in the country. Founded in 1934 and funded by the government, the SRCA serves the public and also provides humanitarian aid internationally (8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecruitment and sample\u003c/p\u003e\n\u003cp\u003eThe study participants were primarily Saudi paramedics with bachelor\u0026apos;s degrees earned either domestically or abroad. A purposive sampling method was used to recruit paramedics from various cities, including Riyadh, Makkah, Jeddah, Abha, and Jazan. Efforts were made to select senior paramedics with extensive service experience and to achieve gender balance, though only one female paramedic was ultimately recruited.\u003c/p\u003e\n\u003cp\u003eData collection procedures\u003c/p\u003e\n\u003cp\u003eThe interviews were conducted online using a semi-structured format with open-ended questions via Zoom, each lasting 30 to 60 minutes. Data were collected from March to July 2024. Three recorded pilot interviews were conducted before the actual interviews to refine interviewing techniques and assess the effectiveness of the questions. After each interview, reflective notes were taken to evaluate which questions worked well, identify any unexpected findings, and assess whether data saturation had been reached. The initial questions were based on the professional experiences of AA and NH, who observed prehospital staff managing trauma patients. The first interview was carefully reviewed by NH to finalize the questions for the remaining participants. Further steps were taken to involve the academics HA, BS, and RA, from our EMS Emergency Medical Services program, and the participants after each interview to improve the interview guide. The finalized interview guide used in the study is provided in \u003cstrong\u003eSupplementary File 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eUse of Arabic Language\u003c/p\u003e\n\u003cp\u003eThe interviews were conducted and transcribed in Arabic to ensure detailed insights from participants. Following this, the transcripts were coded, and themes and subthemes were created in English. Key quotations were translated from Arabic to English and categorized under the relevant themes. This translation after data analysis allowed for a deeper understanding of the participants\u0026apos; experiences. We used a forward-translation technique to convert codes, themes, and quotes into English, followed by a back-translation by NH, who acted as a bilingual reviewer. Key documents, such as the interview guide, information sheet, and consent form, were translated from English to Arabic before the interviews. During translation, we faced challenges with certain words that couldn\u0026rsquo;t be directly translated. To address this, we applied a transliteration technique, using equivalent words while preserving the intended meaning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using the framework analysis approach, which involves familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation (9,10). This method provided a structured and logical way to present the descriptive data (11). The initial framework, developed from the first interviews, addressed the research questions and was expanded as new themes and subthemes emerged from later interviews. Data matrices were created, and emerging ideas were categorized, with relevant quotations placed under each theme. This process ensured transparency, reflexivity, and rigor (12). MAXQDA software was used due to its compatibility with the Arabic language (13,14).\u003c/p\u003e\n\u003cp\u003eEthical statement\u003c/p\u003e\n\u003cp\u003eThe study was approved by Jazan University Institutional Review Board (IRB), reference number REC-45/08/985. Participants were recruited via phone and email and provided informed consent after reviewing the information sheet. Interviews were scheduled at a convenient time, and participants\u0026apos; identities, as well as their ambulance stations, were anonymized using code names for confidentiality. Interview recordings and participant information were securely stored on Jazan University\u0026rsquo;s encrypted, password-protected system.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 20 paramedics participated in the interviews, including 19 males and 1 female. This reflects the continued male dominance in prehospital care in Saudi Arabia. Table 1 demonstrate the details of the participants:\u003c/p\u003e\n\u003cp\u003eAll participants explained how they respond to trauma patients, how they acquire relevant knowledge, and highlighted the factors that influence the application of this knowledge during trauma responses. These topics are summarized below, with the structured themes detailed in \u003cstrong\u003eSupplementary file 2\u003c/strong\u003e Table.\u003c/p\u003e\n\u003cp\u003e1. How do Saudi paramedics respond to trauma patients?\u003c/p\u003e\n\u003cp\u003eThe participants identified several challenges when responding to trauma patients, including the coordination of the response, the accuracy and accessibility of patient information, difficulties in providing care, and the confidence and readiness of paramedics.\u003c/p\u003e\n\u003cp\u003e1.1\u0026nbsp;Challenges in Coordination When Responding to Trauma Patients\u003c/p\u003e\n\u003cp\u003eParticipants acknowledged challenges in coordination during trauma responses. Most reported a lack of coordination between the SRCA and other authorities, such as the police and civil defence, which can create obstacles in providing care at the scene. Some participants highlighted the crucial role of the police in managing the public, allowing paramedics to focus on patient care. Two participants specifically noted that securing the scene is difficult without police presence.\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;if there are no police in the scene, bad consequences may occur\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA9: \u0026ldquo;I have been to a number of trauma calls and there are no police or civil defense in the scene, and we requested them many times\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA11: \u0026ldquo;I believe when the ambulance called, police and civil defence should also requested and dispatched, I remember one case that someone drowned in a well and we waited two hours for the divers to arrive although it was mentioned clearly when they asked for help\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSome participants also mentioned a lack of clear coordination between the paramedics and receiving facilities, which can lead to increased wait times due to multiple ambulances crowding the entrance of the emergency room. Additionally, some participants reported arriving at the facility only to find no available beds, resulting in long waits until a bed becomes free.\u003c/p\u003e\n\u003cp\u003eA6: \u0026ldquo;too many ambulances by the entrance with no coordination\u0026hellip; we have to wait for device being used on the patients until they gave it back\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA9: \u0026ldquo;sometimes we arrive to hospital, and we surprised that there is no bed available for the patient, so we have to wait with our equipment being used on the patients\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants expressed concerns about having to wait for their equipment at the receiving facility, sometimes for hours. They feared that if they left without it, the equipment might be lost, and there would be no replacement available at their station. Some participants noted that in critical situations, paramedics often have to wait a long time for their equipment, either until it\u0026apos;s no longer needed or until the patient has completed procedures like a CT scan.\u003c/p\u003e\n\u003cp\u003eA4: \u0026ldquo;sometimes we use long back board or splints and there is no alternatives in the hospital so we have to wait for that long time\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;if you leave without having all equipment in the hospital, it\u0026rsquo;s impossible to get them later\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e1.2\u0026nbsp;Accuracy of information and accessibility of the patients\u003c/p\u003e\n\u003cp\u003eSeveral participants believed that controlling crowds at the scene is challenging, as they can sometimes become angry and agitated. Two participants noted that crowds can create dangerous situations at the scene. Many felt that paramedics often face added pressure due to the presence of crowds. Additionally, two participants reported that crowds may delay ambulance access to the scene, negatively affecting prehospital care. One participant mentioned that crowds can distract paramedics from their duties, further delaying the care provided to patients.\u003c/p\u003e\n\u003cp\u003eA1: \u0026ldquo;sometimes the crowd were agitated, and they might be aggressive towards you\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA6: \u0026ldquo;sometime family of the patient can be aggressive and demanding\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA8: \u0026ldquo;the problem with crowding is sometimes may delay ambulance to reach to the scene and obstacle paramedics from performing their job\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants reported that trauma scenes are often unsafe upon arrival, particularly when the police are not present. Three participants noted that the scene can be dangerous for both paramedics and patients, especially in highway accidents. One participant mentioned that securing the scene took a long time, which negatively impacted patient treatment. Additionally, two participants highlighted the risk of a secondary accident occurring if the scene is not properly secured by the police upon arrival.\u003c/p\u003e\n\u003cp\u003eA2: \u0026ldquo;we normally check if the scene is safe or not for us to approach the patient\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA4: \u0026ldquo;we want to approach the scene without any concern on our personal safety\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eMost participants reported that the information they received about calls was often inaccurate. Several noted that it was frequently incomplete, insufficient, or unclear. Three participants added that the scene location they were given sometimes differed from the actual location. Two participants expressed that the information from the 911 dispatch system was often less accurate or complete compared to the 997 system. One participant mentioned that upon arriving at the scene, they often realized that more than one ambulance was needed.\u003c/p\u003e\n\u003cp\u003eA5: \u0026ldquo;Location can be completely different from the information we received initially\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA6: \u0026ldquo;maybe the information were not clear so you do not know what to prepare for\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA10: \u0026ldquo;most of the time when we received the information from 911 were not complete or accurate compared to 997\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e1.3\u0026nbsp;Handover issues\u003c/p\u003e\n\u003cp\u003eMost participants reported several issues when handing over patient care to the receiving facility. Some noted that the handover was not always properly received by the facility\u0026apos;s staff, often depending on the individuals involved. Many participants mentioned encountering ignorance, lack of professionalism, and a lack of respect during the handover process. Three participants expressed that the handover could take a long time due to staff unavailability, even when notified in advance. One participant highlighted the absence of a standardized handover system across facilities, and another mentioned that paramedics sometimes had to give handover to multiple staff members at the receiving facility.\u003c/p\u003e\n\u003cp\u003eA9: \u0026ldquo;might be lack of professionalism and medical respects in handover process\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA10: \u0026ldquo;sometimes when I start talking and give handover, some hospital staff are not interested in my handover\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eA12: \u0026ldquo;it depends on the situation, sometimes, in critical cases, hospital staff relay on our vital signs and sometimes they do not\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e1.4\u0026nbsp;Care difficulties when treating trauma patients\u003c/p\u003e\n\u003cp\u003eSeveral participants reported that treating trauma patients at the scene can be challenging, especially in critical cases. Some noted that there are often multiple casualties in severe conditions, requiring additional assistance. Three participants emphasized the need for a cautious approach in special cases to prevent further injury, particularly with patients suffering from severe head trauma or other serious injuries. Two participants mentioned difficulties caused by language barriers when dealing with trauma patients. One participant highlighted the challenge of persuading patients who refuse transport, and another noted that sometimes they respond to calls where an ambulance is unnecessary, as the patients have only minor or no injuries.\u003c/p\u003e\n\u003cp\u003eA2: \u0026ldquo;sometimes I arrive to the scene and notice that there are more than one patient need immediate care\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA3: \u0026ldquo;I made the response to trauma case and when I approach the scene there are at least four critical patients need rapid transport\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants mentioned encountering multiple emergencies simultaneously, receiving numerous calls at once. Three participants reported that there are often too many cases and not enough ambulances or teams to cover them all. One participant noted that paramedics sometimes have to handle different types of injuries, such as burns or injuries from fights. Two participants expressed that managing various types of injuries, along with multiple patients at the same time, can be particularly challenging.\u003c/p\u003e\n\u003cp\u003eA15: \u0026ldquo;there are a number of calls and there is no enough teams to cover all cases and sometimes the respond can take long time because the caller is far from the station\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA20: \u0026ldquo;by focusing on calls, we can see some of them do not need the whole ambulance service, and some of them are critical and need immediate intervention\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e1.5\u0026nbsp;Confidence and readiness\u003c/p\u003e\n\u003cp\u003eSeveral participants expressed their levels of confidence when dealing with trauma patients. Many reported that working on a variety of trauma cases helps build a high level of confidence. Two participants mentioned that confidence stems from mastering skills and knowledge, which can lead to more accurate diagnoses. Additionally, two participants noted that having supportive colleagues helps reduce stress and boosts confidence when managing trauma patients.\u003c/p\u003e\n\u003cp\u003eA1: \u0026ldquo;in the beginning it was difficult, with more exposure and responding to trauma calls, the confidence start to build up\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eA8: \u0026ldquo;the most important thing is that it reducing the stress and with practice, confidence can be build up slowly\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants emphasized that paramedics must be physically and mentally prepared before responding to trauma calls. Many highlighted the importance of conducting routine checks and preparing trauma equipment before starting their shifts. Additionally, several participants stressed that medication bags and fluids should be protected from heat exposure. One participant noted that paramedics should personally prepare their tools to enhance their level of readiness.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;A3: when I receive the trauma call, I hope the best and prepare for the worse\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;I normally keep the medication bag by myside because the ambulance can get very hot especially in the summer\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e2. How Saudi paramedics acquire their relevant knowledge?\u003c/p\u003e\n\u003cp\u003eParticipants recognized the importance of independent methods for acquiring knowledge, such as attending specialized courses and conferences, engaging in simulation training, reviewing protocols, and discussing cases with colleagues afterward.\u003c/p\u003e\n\u003cp\u003e2.1 Independent approaches to acquire knowledge\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral participants noted that attending specialized trauma courses or conferences is helpful for staying updated on how to manage trauma patients. Most participants mentioned that courses like Prehospital Trauma Life Support (PHTLS) are effective in keeping their knowledge current. Two participants highlighted that mandatory courses provided by SRCA also help in maintaining updated information. Additionally, two participants emphasized that continuous learning in general enhances and refreshes their knowledge in dealing with trauma patients.\u003c/p\u003e\n\u003cp\u003eA4: \u0026ldquo;mandatory courses can help update our knowledge\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eA6: \u0026ldquo;mini courses and specialized courses are important to update our trauma knowledge\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eThree participants mentioned that reading books\u0026mdash;especially primary resources like Mosby\u0026apos;s Paramedic Textbook or Nancy Caroline\u0026apos;s Emergency Care in the Streets\u0026mdash;and journals helps them stay informed. One participant specifically noted that consulting academic journals provides additional information on trauma patients. Another participant reported that reviewing websites or watching instructional videos on YouTube can be very helpful for refreshing information and skills.\u003c/p\u003e\n\u003cp\u003eA18: \u0026ldquo;I think reading textbooks with practice can be very helpful\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA19: \u0026ldquo;reading and watching some YouTube videos can improve practice\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants stated that simulation training is valuable for mastering skills and gaining more knowledge about managing trauma patients. Two participants specifically noted that simulation and scenario-based training on various trauma situations can be particularly helpful in acquiring additional information.\u003c/p\u003e\n\u003cp\u003eA11: \u0026ldquo;where I work, occasionally, I have to spend around 30 minutes of simulation based on real scenarios to improve my skills and information\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA13: \u0026ldquo;for example, like in hospital, they have simulation and the trauma team responding like the real case\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants mentioned that practicing and learning techniques from colleagues is useful for gaining trauma-related knowledge. Three participants specifically noted that increased practice and responding to trauma calls help build confidence and improve their skill mastery.\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;I remember there was a new device that I didn\u0026rsquo;t receive the training related to it and I learn how to use through a colleague of mine\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA18: \u0026ldquo;practice with information that I had can be very helpful\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants highlighted that reviewing the SRCA trauma protocol is essential for gaining more information. Some noted that the protocol should be regularly reviewed alongside practice to ensure their knowledge remains up-to-date. One participant described the SRCA trauma protocol as detailed, well-organized, and comprehensive, covering everything needed for managing trauma patients.\u003c/p\u003e\n\u003cp\u003eA4: \u0026ldquo;of course, reviewing the protocol can be help effectively\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA6: \u0026ldquo;the protocol is detailed and mentioned different cases in an expanded information\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants mentioned that debriefing trauma cases with colleagues is useful for acquiring additional knowledge and preparing for future trauma calls. Some participants noted that these discussions can last up to 45 minutes and are valuable for gaining further insights. Two participants also stated that reviewing and discussing cases with colleagues helps recover important information related to trauma patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;debriefing and discussion after the case can last to 45 minutes which can be very helpful sometimes\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA9: \u0026ldquo;sometimes I feel like it\u0026rsquo;s not enough to discuss the case, I might read some articles and review the protocol\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA20: \u0026ldquo;it considered very good to discuss the case with your colleagues in order to improve your skills\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e3. What are the factors that influence application of knowledge when responding to trauma patients?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants identified several factors that affect the application of knowledge when responding to trauma patients, including increasing the number of paramedics, maintaining a focus on patients, managing paramedic burnout, avoiding underestimation of patient conditions, regularly reviewing information, and raising public awareness.\u003c/p\u003e\n\u003cp\u003e3.1 Current needs to improve care for trauma patients\u003c/p\u003e\n\u003cp\u003eSeveral participants mentioned that the number of prehospital staff is insufficient and needs to be significantly increased. Most participants noted that having only two people\u0026mdash;one driver and one treating the patient\u0026mdash;is not enough. Two participants pointed out that additional help can be delayed due to a lack of teams and units available to cover calls. One participant added that while air ambulances can be helpful at times, there is a greater need for more ground ambulances.\u003c/p\u003e\n\u003cp\u003eA2: \u0026ldquo;I think it\u0026rsquo;s ideal to have someone else in the cabinet since now it\u0026rsquo;s only two of us, one driving and the other one back in the cabinet looking after the patient by his own\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA5: \u0026ldquo;air ambulance can help in some situation but we still need more ground ambulance units to cover most of the calls\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eMost participants emphasized the need to raise public awareness about the roles and responsibilities of paramedics and ambulance teams. Two participants specifically mentioned that there is a lack of public understanding regarding the capabilities of paramedics and their duties at the scene.\u003c/p\u003e\n\u003cp\u003eA1: \u0026ldquo;public need to understand what paramedics are capable of and to let them do their job without any interference\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA8: \u0026ldquo;there is lack of public awareness in terms of emergency medical services system\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants emphasized that paramedics should focus solely on the patient and avoid distractions with unnecessary tasks. Most participants stressed that paramedics should never underestimate the situation and must be prepared to handle the surrounding environment. Three participants highlighted the importance of regularly reviewing their knowledge when dealing with trauma patients.\u003c/p\u003e\n\u003cp\u003eA7: \u0026ldquo;ignore the noise that surrounding you, and focus on treating your patient, and if you have multiple casualties, you need to request help as soon as possible\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA8: \u0026ldquo;don\u0026rsquo;t let outside factors influence your focus on the patients\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eSeveral participants noted that paramedics may experience burnout due to excessive pressure and insufficient staffing to handle the workload. Most participants reported that many of their colleagues suffer from burnout, as they often have to manage a large number of calls within a single shift.\u003c/p\u003e\n\u003cp\u003eA8: \u0026ldquo;there is sort of burnout among some paramedics to be honest\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eA20: \u0026ldquo;it is easy to get burnout while being a paramedic working in the field, therefore, you have look after yourself and focus on three main things: nutrition, exercise, and sleep\u0026rdquo;.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examines the experiences of Saudi paramedics in managing adult trauma patients. Participants shared their insights across three key areas: responding to trauma patients, acquiring knowledge related to trauma care, and the factors that affect the application of this knowledge. Themes and subthemes were developed based on the participants\u0026apos; responses.\u003c/p\u003e\n\u003cp\u003eParticipants highlighted the challenges they faced in coordinating while responding to trauma patients, including obstacles such as scene security and the availability of police and civil defence. The presence of police at the scene is considered crucial for securing the area and ensuring the safety of paramedics (15). One of the key factors in making a scene safe is having police on-site (16). Their presence also helps manage crowds, allowing paramedics to focus on patient care (15). It is suggested that training police officers in basic first aid for trauma patients could significantly improve outcomes (17). Additionally, the timely presence of civil defence at trauma scenes can enhance patient accessibility and potentially lead to better outcomes (18).\u003c/p\u003e\n\u003cp\u003eEffective coordination between prehospital staff and receiving facilities is crucial for improving survival rates among trauma patients (19). Many participants reported that coordination between these groups (pre-hospital staff and receiving facilities staff) is sometimes lacking. It is suggested that improved communication through the dispatch system can strengthen the treatment plan and enhance patient outcomes (19,20). Studies have emphasized the importance of this coordination, noting that advance communication helps facilitate proper triage, directing trauma patients to the appropriate facility and preventing under-triage, which could complicate their care (21\u0026ndash;25).\u003c/p\u003e\n\u003cp\u003eIn line with the issue of coordination, some participants reported long waits to retrieve their equipment, which can prevent them from responding to other calls. Some receiving facilities lack alternative equipment, leading to extended wait times for prehospital staff and adding strain to ambulance teams, especially during high call volumes (26,27). The shortage of prehospital staff is a common issue in ambulance services worldwide, and waiting for equipment further exacerbates the impact of this staffing shortage (28).\u003c/p\u003e\n\u003cp\u003eCrowds at trauma scenes can pose significant challenges for paramedics in carrying out their duties. Several participants reported difficulties in managing crowds, particularly in the absence of law enforcement to control the situation (29). Uncontrolled crowds at trauma scenes are believed to endanger the safety of individuals, patients, and paramedics (30). Additionally, crowd interference can delay the arrival of ambulances and paramedics, potentially worsening outcomes for trauma patients (30). However, some individuals present at the scene may assist in moving patients smoothly to the ambulance (30). One participant mentioned that the presence of a crowd can help identify the scene and assist in transferring patients to the ambulance.\u003c/p\u003e\n\u003cp\u003eScene safety is crucial when responding to and treating trauma patients (31). Several participants emphasized that they cannot enter an unsafe scene. As previously mentioned, the presence of police is key to ensuring scene safety. Additionally, it is suggested that individuals at the scene can assist in making it safer for paramedics, as it is difficult for them to perform their duties in an unsafe environment. Unsafe scenes can delay patient care and increase the risk of injury to paramedics (32).\u003c/p\u003e\n\u003cp\u003eThe information received from dispatch can significantly impact the response and care provided to trauma patients (33). Several participants in this study reported that the information relayed from the dispatch system is often incomplete, inaccurate, or unclear. This is likely because the caller may lack the knowledge to accurately describe the patient\u0026apos;s condition at the time (34). Inaccurate information can confuse paramedics during their response, potentially leading to negative outcomes for the patient (33).\u003c/p\u003e\n\u003cp\u003eThe handover process plays a crucial role in the care journey of trauma patients (35). Several participants reported that the handover is sometimes not conducted properly, with hospital staff occasionally bypassing the process to focus directly on the patient. This issue with the handover process can lead to duplicated interventions, which may negatively affect trauma patients (36). Additionally, participants noted the lack of a standardized handover technique across receiving facilities, increasing the risk of miscommunication between paramedics and hospital staff. Poor handover practices are believed to contribute to medical errors (37).\u003c/p\u003e\n\u003cp\u003ePrehospital interventions are critical in the treatment of trauma patients and can significantly improve survival rates (38). Paramedics aim to intervene as early as possible to prevent the situation from worsening and to enhance patient outcomes (39). However, delivering care in the prehospital phase often presents challenges (38,39). Several participants reported difficulties in providing care to trauma patients, such as the severity of the injuries, lack of patient cooperation, and patients refusing transportation. Treating unstable trauma patients at the scene is particularly challenging due to the conditions of the scene and the absence of hospital resources (40).\u003c/p\u003e\n\u003cp\u003ePrehospital staff often feel overwhelmed by the high volume of calls and staffing shortages (41). Many participants noted that there are too many calls and not enough personnel to handle them all. This shortage of staff may be inherent in the design of the EMS system, which prioritizes responding to all calls, including stable cases, rather than focusing solely on the most critical situations (42). It is estimated that only 8% of ambulance calls are for critical cases, while the rest involve stable patients (43). This strain on the EMS system can delay responses to critical cases, potentially having serious consequences (44).\u003c/p\u003e\n\u003cp\u003eTrauma scenes can be chaotic, adding to the challenges paramedics face (45). Several participants emphasized that paramedics must be physically and mentally prepared to effectively respond and treat trauma patients. It has been suggested that paramedics should adopt a healthy lifestyle, including sufficient sleep and proper nutrition, to boost their readiness and confidence in handling trauma situations (46,47). Additionally, meditation is believed to help mentally prepare paramedics, enhancing their confidence when responding to trauma patients (48).\u003c/p\u003e\n\u003cp\u003eIn terms of preparation, training and practice can greatly improve paramedics\u0026apos; performance when responding to trauma patients (49). Several participants highlighted various ways they update their knowledge and skills, including attending specialized courses, academic lectures, conferences, simulation training, reading books and journals, reviewing SRCA protocols, and debriefing cases with colleagues (50). Simulation training, in particular, is believed to significantly enhance specific skills, while debriefing with colleagues offers a valuable opportunity to gain knowledge and learn from peers (51).\u003c/p\u003e\n\u003cp\u003eStrengths and limitations of the study:\u003c/p\u003e\n\u003cp\u003eIn terms of strengths, this study was conducted across various Saudi cities, revealing consistent themes and subthemes that reflect similar responses, challenges, and obstacles. Further, although the interviews and analyses were conducted in Arabic, a bilingual checker with expertise in qualitative research and paramedicine performed a back-translation to confirm the accuracy of the forward-translation. This study also had several limitations, which may be linked to its design. Firstly, it only interviewed paramedics with advanced knowledge and skills, excluding EMTs, which could have provided a broader perspective of EMS clinicians\u0026apos; experiences in handling trauma patients. Secondly, the study included only one female paramedic, potentially introducing gender bias and limiting a comprehensive understanding of female paramedics\u0026apos; experiences with trauma patients. Thirdly, the study did not include interviews with patients, which could have offered a more complete view of the trauma experience from both the clinicians\u0026apos; and patients\u0026apos; perspectives. Fourthly, other methods, such as patient interviews or direct observation of practice, may yield different results, as interviews provide insight into what participants believe is happening, rather than what is actually occurring. Lastly, this study may be limited by participant selection, as those with strong opinions or interest in the topic might be more likely to participate. This could result in missing important perspectives, especially from individuals with less knowledge or interest in trauma care and patient management.\u003c/p\u003e\n\u003cp\u003eImplication of the study for policy and practice:\u003c/p\u003e\n\u003cp\u003eThis study offers several important implications, particularly in addressing the challenges paramedics face when managing trauma patients. Many participants emphasized the need to increase prehospital staff to better meet the high demand for calls. Additionally, it is suggested that implementing a triage system would enable ambulance units to prioritize and respond primarily to the most critical cases. Currently, in Saudi Arabia, some non-life-threatening calls are dispatched to general practitioners. Raising public awareness about which cases require ambulance services and which do not could help redirect resources toward critical, life-threatening cases (52). Furthermore, educating the public on how to behave at trauma scenes, and how individuals can assist rather than hinder, could significantly improve trauma care. Lastly, the handover process should be standardized across receiving facilities to streamline communication between paramedics and hospital staff, ultimately enhancing patient care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFew studies have explored the challenges and obstacles paramedics encounter when responding to and caring for trauma patients. This study addressed these gaps by examining the experiences of Saudi paramedics in managing trauma patients, identifying key challenges such as trauma response coordination, information accuracy, handover issues, care provision, and paramedic confidence. It also highlighted the various methods paramedics use to acquire knowledge, including training courses, simulations, and case reviews. The main outcomes emphasize the need for public awareness, increased prehospital staffing, and a standardized handover process. Additionally, future research should consider incorporating practice observation methods with Saudi paramedics and interviews with trauma patients or their relatives to capture a broader range of perspectives and ensure a comprehensive understanding of the challenges in trauma care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Medical Services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHTLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eprehospital trauma life support\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSaudi Red Crescent Authority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKingdom of Saudi Arabia.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgment\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the funding of the Deanship of Graduate Studies and Scientific Research, Jazan University, Saudi Arabia, through Project Number: GSSRD-24\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eAA designed the study, NH, developed the plan and methodology, AA conducted the interviews with the participants, NH confirmed and back translated the transcripts, HA \u0026amp; BS \u0026amp; RA reviewed and approved the initial questions of interview guide, and later reviewed the final draft of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Jazan University, Saudi Arabia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval and informed consent to participate\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Jazan University Institutional Review Board (IRB), under reference number REC-45/08/985 (HAPO-10-001). It was conducted in compliance with local laws and institutional guidelines. Participants reviewed the study\u0026apos;s information sheet, confirmed their understanding, and provided signed informed consent before participating.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data generated and analyzed during this study (audio files and transcripts) are not publicly available due to ethical considerations. Reasonable data requests can be directed to the corresponding author. Only the corresponding author has access to the data, and all findings are presented anonymously in accordance with the informed consent form.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization collaboration. GLOBAL STATUS REPORT ON ROAD SAFETY 2018 SUMMARY [Internet]. Geneva. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://apps.who.int/bookorders\u003c/span\u003e\u003cspan address=\"http://apps.who.int/bookorders\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeNicola E, Aburizaize OS, Siddique A, Khwaja H, Carpenter DO. Road traffic injury as a major public health issue in the Kingdom of Saudi Arabia: A review. 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A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. Int J Environ Res Public Health. 2023;20(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJadzinski M, Jack E, Darby I. Journal of Paramedic Practice What value does peer-assisted learning have in the training of student paramedics? Powered by Editorial Manager\u0026reg; and ProduXion Manager\u0026reg; from Aries Systems Corporation.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo J, Zheng K, Hong W. Public first aid education model design study based on user experience. Front Public Health. 2023;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Participants\u0026rsquo; criteria for the analysis study\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"114%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eID\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographics (position, city, and experience years)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eID\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographics (position, city, and experience years)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 4 years \u0026ndash; 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Abha, 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Jeddah, 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 2 years \u0026ndash; 9 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 2 years \u0026ndash; 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 2 year - 2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 1 years \u0026ndash; 8 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Makkah, 2 years \u0026ndash; 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 7 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Abha, 1 year - 8 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Jeddah, 1 year \u0026ndash; 4 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Jazan, 3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37.3737%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 9 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.06061%;\"\u003e\n \u003cp\u003eA20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3838%;\"\u003e\n \u003cp\u003eParamedic, Riyadh, 2 years \u0026ndash; 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"trauma patients, prehospital care, perceptions, paramedics","lastPublishedDoi":"10.21203/rs.3.rs-5142899/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5142899/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSaudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, They also stressed the importance of raising public awareness to enhance trauma care.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study explored Saudi paramedics' experiences in managing adult trauma patients. Key needs include more staff, standardized handovers, and greater public awareness. Addressing these challenges through increased staffing, improved coordination during handovers, and raising public awareness is crucial for improving trauma care outcomes\u003c/p\u003e","manuscriptTitle":"Exploring Saudi Paramedics’ Experiences in Managing Adult Trauma Cases: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 07:02:20","doi":"10.21203/rs.3.rs-5142899/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-05T04:15:38+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"60961008220836497670100330267007648605","date":"2024-10-13T05:58:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-10T07:00:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168032545440870612797013058890752697632","date":"2024-10-09T15:10:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"413150523138035170467845415020072294","date":"2024-10-08T06:59:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291286162086581976420269644966900779448","date":"2024-10-08T06:18:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151287719586492322458303011477371782640","date":"2024-10-08T06:08:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-03T17:57:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111940011783916838370241506242888434520","date":"2024-09-26T14:19:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-26T08:59:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-26T06:18:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-24T08:58:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-24T08:53:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2024-09-24T07:40:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0077cc0b-0e13-4b4f-bc79-cd6dad02e97d","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:17:11+00:00","versionOfRecord":{"articleIdentity":"rs-5142899","link":"https://doi.org/10.1186/s12873-024-01145-0","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2024-12-04 15:58:04","publishedOnDateReadable":"December 4th, 2024"},"versionCreatedAt":"2024-11-19 07:02:20","video":"","vorDoi":"10.1186/s12873-024-01145-0","vorDoiUrl":"https://doi.org/10.1186/s12873-024-01145-0","workflowStages":[]},"version":"v1","identity":"rs-5142899","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5142899","identity":"rs-5142899","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}