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Mobile Ambulatory Application Asafny and Traditional Phone Request 997: A Comparative Cross-Sectional Study

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Arwa Althumairi at Imam Abdulrahman Bin Faisal University
Arwa Althumairi
Zainab Alnasser
Zainab Alnasser
Zainab Alnasser
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Sarah Alsadeq
Sarah Alsadeq
Sarah Alsadeq
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Nouf Khalid Al-Kahtani at Imam Abdulrahman Bin Faisal University
Nouf Khalid Al-Kahtani
  • Imam Abdulrahman Bin Faisal University
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Abstract and Figures

Purpose This study aimed to determine whether there was a time difference between the ambulatory application Asafny and traditional type 997 in reaching people in need and interacting appropriately. Materials and Methods This study was conducted using retrospective cross-sectional study. A total of 2120 ambulance requests was extracted from Saudi Red Crescent Authority servers in Eastern Province, Kingdom of Saudi Arabia. The requests were extracted between 2017 and 2019. Results There were no significant differences between the two methods of request. In 2019, the shortest times for all phases of requests were recorded. “Ordinary patient” was the most common cause for requests. Conclusion Over the years, efforts by the Saudi Red Crescent Authority facilitated improvements in ambulatory services by adapting new technology and services. This has helped reduce times for all phases of emergency requests.
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ORIGINAL RESEARCH
Mobile Ambulatory Application Asafny and
Traditional Phone Request 997: A Comparative
Cross-Sectional Study
This article was published in the following Dove Press journal:
Open Access Emergency Medicine
Arwa Althumairi
Zainab Alnasser
Sarah Alsadeq
Nouf Al-kahtani
Afnan Aljaffary
Health Information Management and
Technology (HIMT) Department, College
of Public Health, Imam Abdulrahman Bin
Faisal University, Dammam, Saudi Arabia
Purpose: This study aimed to determine whether there was a time difference between the
ambulatory application Asafny and traditional type 997 in reaching people in need and interacting
appropriately.
Materials and Methods: This study was conducted using retrospective cross-sectional study.
A total of 2120 ambulance requests was extracted from Saudi Red Crescent Authority servers in
Eastern Province, Kingdom of Saudi Arabia. The requests were extracted between 2017 and 2019.
Results: There were no signicant differences between the two methods of request. In 2019,
the shortest times for all phases of requests were recorded. “Ordinary patient” was the most
common cause for requests.
Conclusion: Over the years, efforts by the Saudi Red Crescent Authority facilitated
improvements in ambulatory services by adapting new technology and services. This has
helped reduce times for all phases of emergency requests.
Keywords: 997, ambulances, Red Cross, Saudi Arabia, reaction time, emergency service,
hospital, Asafny, Saudi Red Crescent Authority, mobile applications
Introduction
Long ambulance response times have contributed to thousands of deaths worldwide.
Delayed reactions endanger the lives of people. Udawant et al (2017) found that indivi-
duals died due to the inaccessibility of proper and timely treatment.
1
Even in South Asia,
there were recommendations to strengthen emergency medical services with the aim of
reducing the number of needless deaths and disabilities by improving emergency medical
services.
2
A systematic random sample of people in Greater Manchester, UK who
requested an ambulance by dialing 999 was performed to determine the acceptability of
their emergency medical dispatch system and measure callers satisfaction of the service.
3
Carvalho focused on improving the effectiveness and efciency in the emergency medical
responses by solving dispatch and relocation ambulance problems that he believed
impacted on the health status of those who called for ambulances.
4
For Saudi Arabia,
a comparison of Asafny and the 997 system has not yet been reported. Therefore, in the
present paper, we compared these common ambulance services in terms of response times
in Saudi Arabia.
Background
The Saudi Red Crescent Authority (SRCA) was established on 1/16/1963 Hijri by
Royal Decree to provide emergency medical services (EMS) in all administrative
Correspondence: Arwa Althumairi
Health Information Management and
Technology (HIMT) Department, College
of Public Health, Imam Abdulrahman Bin
Faisal University, Dammam, Saudi Arabia
Tel +966 13 3335213
Email aalthumairi@iau.edu.sa
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Open Access Full Text Article
regions of the kingdom of Saudi Arabia for both Saudi
citizens and foreigners by calling 997. It also provides
services such as training programs, volunteering, and con-
ferences. SRCA has 66 ambulatory centers in Eastern
Province with a connection of 44 hospitals, which helps
to contact the hospital system before reaching the hospital
to prepare for arriving patients.
Currently, technology has evolved and contributed to
improve health services. In 2016, the Saudi Red Crescent
Authority initiated Asafny and it began operating in 2017.
Initially, the focus of the Asafny Application was deaf and
non-Arabic speaking people. The application has a number
of features, including saving patient personal and health
information in the application so that whenever they face
an emergency situation, they can call an ambulance using
the application and the Red Crescent Authority can
directly access their information and location to save
time. The third method for ordering an ambulance is the
“SOS,” which stands for Save our Souls. The SOS appli-
cation is already installed in iPhone devices, allowing
automatic calls to local emergency number in the country
with the patient’s current location.
Context
Ambulances were established decades ago to assist people
during emergency situations. They are required to attend to
the injured regardless of the location of the incident. These
vehicles observe specied routing strategies that at times
lack efciencies due to a number of reasons, including an
increased number of emergency incidents and the occur-
rence of many requests. Despite the existence of signi-
cant technological and scientic developments in the
healthcare sector over recent decades, increased demand
for ambulance services exists in which the people are more
exposed to the risk of illness due to rises in disease-
causing factors, including longevity, sedentary behavior,
violence, and diseases associated with aging; the increased
risk has resulted in a rise in demand for emergency ser-
vices, with ambulance response times being a key factor
affecting overall quality of care.
5
Several studies have
investigated the various ways to increase ambulance ser-
vices efciency. For example, Sarı
6
found that the
Segment Effect Value formula, a GIS navigation approach,
is crucial in directing and guiding the movement of ambu-
lances, as it enables them to achieve acceptable ambulance
response times (ARTs).
6
These ndings are consistent with
those of previous studies that indicated that geospatial time
analysis of ambulance deployment is associated with
reduced response times.
7
The routing of ambulances triggered studies concern-
ing their reallocation. The deployment of the locations of
emergency vehicles determines their availability and effec-
tiveness in reducing response times.
8
According to
Nogueira, Pinto, and Silva (2016),
8
the ambulance quan-
tity and base locations inuence the performance of EMS.
8
In the UK, emergency vehicles have failed to realize
their response time targets for both possible and actual
life-threatening calls. Consequently, investigators have
performed studies to produce measures of improving this
condition; according to Slater (2017),
9
the use of alterna-
tive secondary and tertiary resources enables ambulance
services to achieve the response time targets.
9
Another
study that adopted a simulation model based on action
learning revealed that an ambulance service must shift
from the nearest crew response model to one that allows
for a specied multi-organizational service to denite need
categories.
9
These ndings suggest that ARTs are achiev-
able, subject to the institution of appropriate policies.
A considerable number of studies have investigated the
means of lowering ARTs. Typically, governments have
a prespecied duration within which an emergency vehicle
should arrive at the location of the incident. However, they
are considering reducing these time limit targets.
According to research, this move would improve patient
care, because lowering ARTs increases survival rates.
10
Technological decits are leading factors affecting
emergency medical responses in various parts of the
world. Consequently, ambulances experience delays that
ultimately adversely affect quality of life of the callers.
Various technological interventions have been developed
to overcome these limitations. Gupta developed a smart
ambulance system and found that the internet of things and
smartphone technologies could reduce time complexity
and enable the provision of faster provision of medical
services.
1
Kobayashi, Kimura, and Kenichi developed
a smart ambulance approach alarm system model and
discovered that technology is key to the minimization of
trafc on roads.
11
These ndings suggest that the consid-
eration of the optimal ARTs improves healthcare and save
lives. Fitch (2005)
12
found that measuring performance,
responding to ambulance requests in a professional appro-
priate way, meeting the supply with the demand, and
applying technology are all factors that could improve
response time performance.
12
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The Red Crescent Authority in Saudi Arabia developed
a mobile application called Asafny to support 997 emer-
gency call services. Despite the development of this tech-
nology, some people still insist on using 997. The reasons
for this are mainly the lack of internet access for some
people. The 997 system and Asifny were both established
to provide people in need with ambulance care quickly to
save lives. Comparing these two systems will help identify
limitations or strengths in both emergency methods, and
will thereby support the Ministry of Health in achieving
their aim of saving lives. Ambulance centers are distrib-
uted based on the vision and mission of the Saudi Red
Crescent Authority to achieve the priority aim of serving
and saving patients by reducing response times so as to
reduce disabilities and to keep individuals active in the
community.
11
According to recent statistics at the Saudi
Red Crescent Authority website, the Eastern Province has
a number of 171 ambulance vehicles. A comparison of
these two ambulatory request methods has not been pre-
viously reported. This research topic was addressed due to
the lack of SRCA information regarding 997 and Asafny
in the literature.
Aims and Objectives
We aimed to quantify the time differences of requests
by year and the common causes of requests along with
their response times for both Asafny and 997.
At the end of the study, we determined whether to
accept our hypothesis that ambulance arrival times trig-
gered by the mobile ambulatory application Asafny would
be similar to those of the traditional 997 call requests. The
null hypothesis was that ambulance arrival times triggered
by the mobile ambulatory application Asifny would be
different from those triggered by traditional 997 phone
calls.
Materials and Methods
Research Design
This study was based on a quantitative research methodol-
ogy using a comparative retrospective cross-sectional
research design. This method was used to facilitate collect-
ing data in a short period of time and to provide us with an
initial status of the ambulatory services as well as oppor-
tunities for improvements. The independent variable was
the method of ambulance request whether by the mobile
ambulatory application Asafny or traditional phone request
(997). There are two categories of dependent variables: the
rst one is the characteristics of the ambulance requester
that is the cause of requests. The demographics of the
people included in this study were amended by the data
source to maintain the privacy of individuals; the other
dependent variables are related to the request itself, and
include the year of request, the time from accepting the
request until arriving at the accident/emergency location,
the time from leaving the accident location until arriving
to the hospital, and the time from arriving at the accident
location until closing the case for home-treated patients.
Study Setting
A retrospective data collection was conducted from all the
emergency requests in Eastern Province between 2017 and
2019 by the Red Crescent Authority. The data can be
obtained at The Saudi Red Crescent Authority website
(https://www.srca.org.sa/en). The Red Crescent Authority
in Saudi Arabia was established in 1963. It is the only
body throughout the Kingdom that provides emergency
ambulance services by contacting the hotline number 997
and ordering an ambulance. The General Center is located
in Riyadh city, and 459 branches are distributed in large
cities. The divisions of branches were established in var-
ious locations within the large cities based on branch
manager decisions.
13
The reporting systems for each
large city are separate from one another, while backup
for all ambulatory requests is maintained in the General
Center in annual report format. Some of the services
provided by the authority include providing necessary
urgent aid in accidents, transporting the injured to govern-
mental and contracted hospitals, training the hospital
employees and volunteers for emergency situations, and
auxiliary body for medical departments in war. Since
2017, the Red Crescent Authority adopted the Asafny
application to facilitate ordering ambulances for deaf,
mute individuals and non-Arabic speakers. It is important
to mention that this is not an alternative to the traditional
997 system.
Study Data (Ambulance Request)
The study data were extracted from 2017 (the start year of
Asafny) up to 2019. A clustered random sample of people who
ordered ambulances in Eastern Province, Kingdom of Saudi
Arabia (KSA) has been taken from each year based on
a averaging the number of requests. The inclusion criteria
were all 997 and Asafny requests including home-treated
cases. The exclusion criteria were cancelled requests and
those missing data, for example times of the request, date,
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473
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reasons. “Save Our Souls” (SOS) requests were excluded from
this study because this service is provided to certain mobile
phone types only and it is not directly delivered by SRCA.
Data Collection Methods
All ambulatory requests are served by the Red Crescent
Authority (a copy of a sample of data variables is found in
Tables 1 and 2). The data regarding ambulatory services are
kept in a different server. These servers were meant for differ-
ent ambulatory requests (Asafny and 997). The model for the
ambulance request processes are illustrated in Figure 1. We
believe data were saved for quality, judicial, or political issues;
therefore, these are considered secondary data.
Instruments
The data were extracted from Saudi Red Crescent Authority
servers. This is the optimal way to obtain the data because it
is difcult to follow up all cases, especially when they are
related to sensitive situations, times, and geographical areas.
One of the challenges faced is the data cleaning process,
because the date and time formats for the different emer-
gency methods (Asafny and 997) are different.
Procedure and Timeline
The data were requested from the Red Crescent Authority in
the Eastern Province after face-to-face meetings with the
Eastern Operations Department Manager to clarify the pro-
ject and its aims. This study measures four time differences
involved in ordering an ambulance, as follows: 1) accepting
the order until reaching the requester location; 2) reaching the
location to leaving the location; 3) leaving the location until
reaching the hospital; and 4) total time from accepting the
order until closing the case. “Reaching the location to leaving
the location” was the longest time period for both methods of
ambulance request. Before the analysis stage began, data
cleaning and missing data checks were carried out. These
included deleting blank and duplicated rows, as well as
calculating the differences between the time phases. (the
Excel calculation is attached in Table 1 and 2 and Figure 2)
Analysis
The study involved some collection of data taken by the
ambulatory service providers when responding to requests
and calls from the public when needed. The collected data
were cleaned in Excel and then entered into a Statistical
Package for the Social Sciences (SPSS) v 25 Armonk,NY.
for further analysis. The analysis involved describing
request characteristics using percentage, mean and stan-
dard deviation (SD), presenting the patterns of request by
years from 2017 to 2019, and comparing the type of
requests using descriptive statistics. After running normal-
ity tests, the data skewness were between −2 and 2, repre-
senting normally distributed data. Therefore, parametric
data analysis was used for the current study.
Results
A total of requests 871 (39%) and 1249 (61%) were
extracted for Asafny and 997, respectively. The mean
(SD) of total times from accepting orders until closing
the case were similar for Asifny and 997 (Table 3). For
all time phases, the Asafny SD was (<1 Min), which was
shorter than that of 997 requests that varied from one
phase to another. Accepting the order until reaching the
requester location recorded was less than a mean of 14 in
Asafny (13 minutes), compared to 14 minutes for 997.
Reaching the location until leaving the location recorded
the highest mean that was exactly the same for both
methods of ambulance requests (mean = 00:17), and
997 present the highest values of SD = (00:33) and
Median (IQR) = 00:13 (0:14). The time for leaving loca-
tion until reaching the hospital for the Asifny application
was less than 1 minute, as recorded for accepting order
until reaching the requester location; however, with mean
= 00:08 for 997 requests, the highest variance in median
Table 1 How the Data Been Sorted in the Red Crescent Centre
A B C D E F G H I J
Order
No.
Order
Acceptance
Ambulance
Moving
Reaching
the
Location
Leaving
the
Location
Reaching
the
Hospital
Leaving
the
Hospital
Close
the
Case
Type of
Injury
Reason of
Cancelation
3911 11/03/1439
03:24:00
PM
11/03/1439
03:23:49 PM
11/03/1439
02:59:25
PM
11/03/
1439
02:49:21
PM
11/03/1439
02:30:59
PM
11/03/
1439
02:21:16
PM
11/03/
1439
02:21:15
PM
18
Respiratory
crisis
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(IQR) between the methods of ambulance requests was
recorded in which the Asafny application recorded
shorter median (IQR) (00:06 (0:11)), and the Asifny
had the range time (<1 Min - 2:03) compared with the
remaining Asifny phases. The total time from accepting
order until closing the case had a lower mean and median
(IQR) for Asafny with mean 00:36 median = (00:32
(0:17)) compared to 997 mean = 00:38, median (00:33
(0:22)). In this phase, the maximum time and SD for 997
was (<1 Min - 4:27) and (00:46) and Asifny was (<1
Min – 4:19) and (00:1) which was shorter than that
of 997.
The time taken by the service providers was between
33.08 and 40.0 minutes from accepting order until closing
the case for all years (Figure 3). The years 2017 and 2018
recorded 40 minutes from accepting order until closing the
case, while in 2019, the time decreased to 33.08 minutes.
The service providers took the shortest time from leaving the
location of accident until reaching to the hospital, between
6.9 and 8.1 minutes, with the year 2018 recording the long-
est time (8.1 minutes). Slightly more time was taken from
accepting order until reaching the requester location:
between 10.07 and 16.06 minutes; the year of 2017 recorded
the longest time interval. Much of the time was taken by the
service providers from reaching location until they leave the
location, between 15.8 and 18.14 minutes; the year 2018
recorded the longest time interval (18.14 minutes compared
with 15.8 in 2017). As noted, the year of 2019 recorded the
shortest time for all phases compared with 2017 and 2018.
The top ten types of injury for ambulatory requests are
summarized in Table 4. The table details the types of
injuries, their corresponding numbers, and time taken by
the ambulatory service providers to respond. Ordinary
patient requests were the predominant type, which
recorded the largest number of 730 (35% of total cases)
during the study period. This was followed by crash acci-
dents with 319 (15.4%), while the least requested case
types were run over and violence with the smallest num-
bers of 47 (2.3%) and 43 (2.1%), respectively.
T-tests were carried out to check for signicant differ-
ences between arrival times for Asafny and 997. The test
gave a p-value of 0.099. This is sufcient evidence to
accept the null hypothesis and conclude that there is no
signicant difference between method of request: Asafny
(mean = 00:36, SD = 00:25), and 997 (mean = 00:38, SD =
00:27), with t (2064) = −1.65, p-value 0.099, 95% CI
(−0:04: 18.16, 0:00: 22.249).
Table 2 How the Data Been Transformed for Study Purposes
A B C D E F G H I J K L M N O P Q R S T U V
155
7
11/03/1
439
02:21:15
PM
11/03/1
439
02:21:16
PM
11/03/1
439
02:30:59
PM
11/03/1
439
02:49:21
PM
11/03/1
439
02:59:25
PM
11/03/1
439
03:23:49
PM
11/03/1
439
03:24:00
PM
02:21:
15 PM
02:21:
16 PM
02:30:
59 PM
02:49:
21 PM
02:59:
25 PM
03:23:
49 PM
03:24:
00
PM
4 201
7
Asafny 0:09:
44
0:18:
22
0:24:
24
0:52:
30
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Discussion
This comparative cross-sectional study aimed to com-
pare the mobile ambulatory application Asafny and the
traditional phone request 997. There was no signicant
difference between the two methods, suggesting that the
Red Crescent Authority answers emergency requests
without differences in response time, meaning that
both request routes are handled equally. This was
expected because the SRCA was using the same process
after receiving requests as illustrated in Figure 1. The
only differences were found for the time of information
gathering from the requester. Assessing the distributions
of requests by different time phases in minutes and
years of the request showed that the year 2019 recorded
the shortest time for all phases in requests compared to
2017 and 2018. This suggests that services are being
provided in response to requests more quickly, indicat-
ing continuous improvement of SRCA over time.
A considerable number of studies investigated the
means of lowering ambulance response times, so as to
increase survival rates.
1
Further studies are needed to
compare survival and mortality rates based on ambu-
lance response times between Asafny and 997.
The top type of injury for the most common request
was “ordinary patients.” We suggest narrowing “ordinary
patient” to more specic terms, because as is, it is an
overly broad term. This might gather non-emergent cases
that consume substantial time and effort on the part of
emergency care that should be delivered to more severe
cases.
Ambulance order is received
A mobile ambulatory application
“Asifny” requests
Traditional phone requests “997”
requests
Order
acceptance
Arrival at accident/emergency location
Yes
Yes
Need
hospital
transfer
Patient is transferred to the hospital
No
Patient is treated at home
Case is closed
No
Figure 1 The owchart of ambulance requests.
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It could be explained that there were a number of
barriers that accounted for time taken, including the dan-
gerousness of the location, whether the injured individual
was trapped in a car or a closed place, in a private secure
site where they needed authorization to obtain access, or if
they were taking care of the case and trying to stabilize the
patient’s condition. Lam mentioned several barriers to
ambulance response time in Singapore and one of them
was the place of incident which affected ARTs.
14
Ambulances should assist people in emergency cases
regardless of their location. Therefore, efcient routing of
the ambulance is important. A study found that a GIS
navigation approach could guide the movement of the
ambulance resulting in acceptable ARTs.
1
Saudi parame-
dics are provided with tablets that allow them to sign each
phase in the case with its appropriate time. The tablets
have their own application to navigate the paramedic to
the requester location; however, sometimes it does not
•
Transfer date format to
time only in Table I.1
using the following
formula
RIGHT(B2:B65,
(=
-
from
cell B to G (highlighted in
yellow in table 2).
•
I,J,K,L,M,N and O were
added in table I.2 to
show only times.
1
-
Dates to hours
•
Column S: Acceptance of order
till reach requester location
(
formula: =K
-
I2)
•
Column T:Reach the requested
address till leave the location (
formula: =L2
-
•
Column U: Leave location till
reach hospital ( formula: =N2
M2)
•
Column V: time from order till
reach hospital (formula:
SUM(S2,T2,U
=
2
-
estimate time difference
•
We combined them all in
one Excel sheet and
called
column R to display the
method type and column Q
to specify the year.
•
the date format and time
difference calculation was
the similarly adapted for
both databases.
3
-
Data merging from two
type of emergency request
management system
Figure 2 Descriptions of database cleaning process.
Table 3 Comparison of Means Between Asafny and 997
Time Differences Asafny
N = 871 (39%)
997
N = 1249 (61%)
Mean (SD) Minimum -
Maximum
Median
(IQR)
Mean
(SD)
Minimum -
Maximum
Median
(IQR)
Accepting order until reaching the
requester location
00:12 (<1 Min) <1 Min - 4:15 0:09 (0.06) 00:13
(00:27)
<1 Min - 3:45 00:10
(0:07)
Reaching location to leaving location 00:17 (<1 Min) <1 Min - 4:18 00:14
(0:11)
00:17
(00:33)
<1 Min - 3:55 00:13
(0:14)
Leaving location until reaching the
hospital
00:07 (<1 Min) <1 Min - 2:03 00:06
(0:11)
00:08
(00:24)
<1 Min - 4:13 00:01
(0:12)
Total time from accepting order until
closing case
00:36 (00:1) <1 Min – 4:19 00:32
(0:17)
00:38
(00:46)
<1 Min - 4:27 00:33
(0:22)
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work appropriately and it faces some technical issues.
Therefore, in similar cases, the paramedics use their own
Google Maps navigator or they rely on their own knowl-
edge of the route and can reach the incident location in an
appropriate time without the aid of an application.
Initiating a new application to order an ambulance is an
intelligent way to reach those who cannot dial 997 for any
reason, including inability to speak Arabic or English and
deafness. In serious emergency situations, the application
provides medical history and blood type, specifying any
medication allergies of the requester. We wanted to
measure the health status of the requester after reaching
the hospital; the fact that we were unable to do this was
one of the limitations of the study. The paramedic’s
responsibility ends after reaching the hospital without
addressing whether the patient is alive or dead.
Furthermore, we could not obtain data regarding the
nationality or language of the requester due to the restric-
tion of these data and their availability.
To conclude, we suggest adding a dropdown menu in
the paramedic tablets to assign the state of the case at the
time of reaching the hospital. In addition, a qualitative
study is recommended to understand paramedic needs in
order to provide rapid, improved emergency services in
the KSA.
Ethics and Limitations
IRB approval was attained from the ofce of the Vice
President for Research and Higher Studies, Imam
Abdulrahman Bin Faisal University. The Institutional
Review Board number was IRB -UGS-2019-03-395,
approved on 12/18/2019. The data were aggregated, anon-
ymized, and saved on a secure server. Any cells that
constituted fewer than ve cases were hidden to avoid
breaching privacy.
One of the research limitations was the inability to
know whether the patient survived for hospital-treated
cases because the Red Crescent Authority ends its respon-
sibility at the point of delivering the case to the hospital or
aiding the case at its location. Some demographic
0
5
10
15
20
25
30
35
40
45
2017 2018 2019
Minutes
Accepting order until reaching the requester location
Leaving location until reaching the hospital
Reaching the location until leaving the location
Total time from accepting order until closing case
Figure 3 Distributions of requests according to phases, in minutes and year of the request.
Table 4 The Top Ten Requested Cases
Type of Injury Number of
Cases (%)
Mean Minimum -
Maximum
Ordinary patient 730 (35%) 0:38 <1 Min - 4:19
Crash accident 319 (15.4%) 0:34 <1 Min - 4:27
Fainting 233 (11.3%) 0:31 0:02–2:49
Respiratory crisis 163 (7.9%) 0:37 0:06–2:44
Fall 128 (6.2%) 0:38 <1 Min - 3:45
Epilepsy case 84 (4.1%) 0:33 0:01–1:35
Coma 63 (3.0%) 0:36 <1 Min - 1:44
Fire 58 (2.8%) 0:31 <1 Min - 2:25
Run over 47 (2.3%) 0:28 <1 Min - 0:49
Violence 43 (2.1%) 0:26 0:02–1:09
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information such as the age, gender, and nationality were
not shared because these were considered highly secure
data. Selection of the samples was based on randomly
select requests, this might reduce the generalizability of
the study results as cases and controls were matched only
on year rather than reason of requests of personnel hand-
ling request entering.
Conclusion
The Saudi Red Crescent Authority (SRCA) provides
ambulatory services across the country for both citizens
and non-citizens in Saudi Arabia. It is designed to
provide a hotline number (997) that individuals can
call and obtain direct help. In line with technological
advancements, SRCA adopted Asafny that enables deaf
and mute residents to order an ambulance. This study
highlighted that Asifny is equivalent to 997 in terms of
response time. There is a promising improvement in
response times year by year. The ambulatory request
for ordinary cases might be better specied so as to
determine whether they are urgent services. These
recommendations are meant to inform individuals
regarding the use of technology as well as to reach out
to senior citizens. There is an urgent need to make the
application user-friendly to all the citizens regardless of
their age. The project’s strength lies in use of adequate
methods; however, a qualitative study should be used to
identify the areas that need improvement. For future
studies, it is suggested to compare Asafny and 997 in
terms of survival and mortality rates based on ambu-
lance response times.
Abbreviations
ARTs, ambulance response times; EMS, emergency med-
ical services; GIS, Geographic Information Systems;
HIMT, Health Information Management & Technology;
IoT, internet of things; IRB, Institutional Review Board;
KSA, Kingdom of Saudi Arabia; SD, standard deviation;
SOS, Save our Souls; SPSS, Statistical Package for Social
Sciences; SRCA, Saudi Red Crescent Authority.
Acknowledgments
Many thanks to the Eastern Province Saudi Red Crescent
Authority. Special thanks to the Eastern Operations
Department Manager & CIT, Eng. Saleh Ali Saleh Al-
Asfour and to the System Engineering Communication &
Information Technology Head Quarters, Eng. Akeel
Yousef Alnwaiser, for giving us the opportunity to start
this thesis and provided us with the data. We are also
grateful to the paramedic Ammar Al Abadi, who answered
our spontaneous questions and gave us a clear picture of
how a paramedic works.
Disclosure
The authors report no conicts of interest in this work.
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... Only two studies were conducted to examine awareness; one in the western region (9), where 33% were unaware of the free-of-charge EMS number 997, and another recent study in Riyadh (7), where 73.2% claimed to know the EMS phone number and 38.5% recalled the number correctly. As Saudi Arabia is experiencing a series of pandemics in the past few decades such as MERS, EBOLA, and COVID-19, the demand for EMS has significantly increased (10). Thus, it is highly important that people's awareness of emergency numbers must be assessed at regular intervals. ...
... The differences in both the response to the calls or requests and the timeliness of the responses may be due to the extensive infrastructure behind the 997-emergency service. The interval between scene arrival and call receipt is the commonly accepted and used parameter in Saudi Arabia to discern the quality of emergency services being offered (8,10). Many countries globally deploy necessary efforts to achieve the response time of 8 min, set by the International Standards Organization (3). ...
Public awareness and use of 997 emergency medical service phone number during the COVID-19 pandemic
Article
Full-text available
  • Oct 2022
Background Emergency medical services (EMSs) are an important element of the healthcare system as it provides an opportunity to respond to critical medical conditions and save people's lives. In Saudi Arabia, EMS is offered via the EMS phone number “997” and mobile application “Asefny”. Methods This was an observational cross-sectional survey study exploring public awareness and use of the EMS phone number during the COVID-19 pandemic in Saudi Arabia. A bivariate analysis was performed to investigate factors affecting awareness and use of the EMS phone number and to compare the EMS acceptance to transport and timelines of ambulance arrival between requests made via the “997” EMS phone number and the “Asefny” mobile application during the country's emergency lockdown. Results A total of 805 participants were included in the analysis, where 66% reported awareness of the EMS phone number and 75% of them accurately identified the nature of the service provided by dialing the number. The men who participated, those with a bachelor's degree, with children, and with chronic conditions were more aware of the EMS phone number compared to the other participants. Of the total sample, 46.7% used EMS phone numbers at least one time (ever users). During the COVID-19 lockdown, the EMS accepted to transport 87% of the calls made by 997 phone number and 56.2% of the mobile application requests (P < 0.00). The ambulance arrived in ≤ 8 min in 53.6% of the 997 phone calls and 35.5% of the Asefny mobile requests (P < 0.00). Conclusions Findings showed commendable levels of awareness and the use of EMS phone numbers. However, the results suggest room for improvement by developing promotional and educational campaigns inspired by the factors identified as influential on both awareness and use. Mobile applications in EMS are promising to improve prehospital emergency service accessibility, which needs to be further investigated to assess its impact on the public health informatics experience.
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... In KSA, the Saudi Red Crescent Authority (SRCA) is the national provider of prehospital services and receives incidents via the unified number "997," as the main source, along with others such as the public safety unified number "911" and certain electronic applications, such as Asafny and Tawakkalna [2][3][4][5]. The dispatching process is subsequently facilitated by a dispatcher with prerequisite exposure to selected training courses including an Emergency Telecommunicator Course (ETC) and an EMD Course [6]. ...
An innovative curriculum development experience: Emergency Medical Dispatch role in the Healthcare Transformation Vision of Saudi Arabia
Article
  • Jan 2024
Background Healthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This includes facilitating the interpretation of various dispatch-related systems, receiving incident calls, categorizing cases, guiding proper resources deployment, and providing proper instructions before the arrival of healthcare providers. Considering the Kingdom of Saudi Arabia's (KSA's) health sector transformation plan as part of Vision 2030, developing an Emergency Medical Dispatch (EMD) Program as part of essential prehospital services will allow rapid and competent healthcare delivery. In this study, our purpose is to describe the curriculum development of the EMD Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems. Methods A selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over six months. This study aims to describe the approach followed in developing an innovative EMD Program to share the experience and ultimately standardize dispatch-related training programs. The data of this study was collected by reviewing approved documents of the EMD Program including program curriculum, syllabus, logbook, and exam blueprint after approval letters were received from the Health Academy, Saudi Commission for Health Specialties. Results The development of the EMD program utilized a consecutive mixed approach starting with a competency-based with backward design method to ensure the achievement of targeted outcomes followed by the Kern Six-step curriculum development model, namely: (1) problem identification and general need assessment; (2) targeted need assessment; (3) goals and objectives; (4) educational strategies; (5) implementation; and (6) evaluation and feedback. This resulted in four comprehensive modules and seventeen competencies in interpreting various dispatch systems, prioritizing incidents, deploying proper resources, and providing pre-arrival instructions throughout the fourteen-week EMD Program. Conclusion As part of the health sector transformation plan in KSA, EMD services play a fundamental role in the daily operations of prehospital healthcare services. Developing an EMD Program with a consecutive mixed approach might improve the current operations of EMD services.
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... Saves individual information and location details to facilitate providing ambulatory services to them in case of an emergency [16]. ...
The role of the COVID-19 pandemic in expediting digital health-care transformation: Saudi Arabia's experience
Article
Full-text available
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A comprehensive literature review of Research engines was conducted up to March 2022 to retrieve the articles. We considered all published data, press briefings, and announcements by the Ministry of Health of Saudi Arabia (MOH). The search included both sources in English and Arabic. Thus, this paper aims to give a comprehensive overview of the evolution and role of telemedicine and E-health represented in multiple informatics mobile applications during the COVID-19 pandemic in Saudi Arabia. As a component of its subjective drives, the MOH has launched and developed a total of 12 mobile applications from 2012 to 2019, three apps of which were developed during the COVID-19 pandemic. My health “Sehhaty” was the cornerstone of telemedicine services provided by the MOH in Saudi Arabia during the COVID-19 pandemic. Virtually booked physician appointments exceeded 3.8 million. Appointment “Mawid” app number of users sprinted from 4 million to 25 million users and the number of appointments booked in the same app went from 8 million to 100 million appointments in pre-COVID-19 compared to the post-COVID-19 period. Furthermore, the Health 937 hotline numbers grew to 24.6 million calls. The Health “Seha” app provided 2 million remote medical consultations with an almost 8-fold increase compared to pre-COVID-19 times.
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An Innovative Curriculum Development Experience: Emergency Medical Dispatch Role in the Healthcare Transformation Vision of Saudi Arabia
Preprint
Full-text available
  • Nov 2021
Background Healthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This includes facilitating the interpretation of various dispatch-related systems, receiving incident calls, categorizing cases, guiding proper resources deployment, and providing proper instructions before the arrival of healthcare providers. Considering the Kingdom of Saudi Arabia’s (KSA’s) health sector transformation plan as part of Vision 2030, developing an Emergency Medical Dispatch (EMD) Program as part of essential prehospital services will allow rapid and competent healthcare delivery. In this study, our purpose is to describe the curriculum development of the EMD Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems. Methods A selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over six months. This study aims to describe the approach followed in developing an innovative EMD Program to share the experience and ultimately standardize dispatch-related training programs. The data of this study was collected by reviewing approved documents of the EMD Program including program curriculum, syllabus, logbook, and exam blueprint after approval letters received from the Health Academy, Saudi Commission for Health Specialties. Results The development of the EMD program utilized a consecutive mixed approach staring with a competency-based with backward design method to ensure the achievement of targeted outcomes followed by the Kern Six-step curriculum development model, namely: (1) problem identification and general need assessment; (2) targeted need assessment; (3) goals and objectives; (4) educational strategies; (5) implementation; and (6) evaluation and feedback. This resulted in four comprehensive modules and seventeen competencies throughout the fourteen-week EMD Program. Conclusion As part of the health sector transformation plan in KSA, EMD services play a fundamental role in the daily operations of prehospital healthcare services. Developing an EMD Program with a consecutive mixed approach including a competency-based with backward design method followed by the Kern Six-step curriculum development model led to a set of learning outcomes in the EMD Program including interpreting various dispatch systems, prioritizing incidents, deploying proper resources, and providing pre-arrival instructions to improve the current operations of EMD services, allow rapid access to healthcare facilities, and ultimately save more lives.
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Lack of Exercise Is a Major Cause of Chronic Diseases
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Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, preeclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longerterm sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
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Reducing Ambulance Response Times Using Geospatial-Time Analysis of Ambulance Deployment
Article
Full-text available
  • Sep 2010
  • ACAD EMERG MED
This study aimed to determine if a deployment strategy based on geospatial-time analysis is able to reduce ambulance response times for out-of-hospital cardiac arrests (OOHCA) in an urban emergency medical services (EMS) system. An observational prospective study examining geographic locations of all OOHCA in Singapore was conducted. Locations of cardiac arrests were spot-mapped using a geographic information system (GIS). A progressive strategy of satellite ambulance deployment was implemented, increasing ambulance bases from 17 to 32 locations. Variation in ambulance deployment according to demand, based on time of day, was also implemented. The total number of ambulances and crews remained constant over the study period. The main outcome measure was ambulance response times. From October 1, 2001, to October 14, 2004, a total of 2,428 OOHCA patients were enrolled into the study. Mean ± SD age for arrests was 60.6 ± 19.3 years with 68.0% male. The overall return of spontaneous circulation (ROSC) rate was 17.2% and survival to discharge rate was 1.6%. Response time decreased significantly as the number of fire stations/fire posts increased (Pearson χ(2) = 108.70, df = 48, p < 0.001). Response times for OOHCA decreased from a monthly median of 10.1 minutes at the beginning to 7.1 minutes at the end of the study. Similarly, the proportion of cases with response times < 8 minutes increased from 22.3% to 47.3% and < 11 minutes from 57.6% to 77.5% at the end of the study. A simple, relatively low-cost ambulance deployment strategy was associated with significantly reduced response times for OOHCA. Geospatial-time analysis can be a useful tool for EMS providers.
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The acceptability of an emergency medical dispatch system to people who call 999 to request an ambulance
Article
Full-text available
  • Apr 2002
To determine the acceptability of an emergency medical dispatch (EMD) system to people who call 999 to request an ambulance. Postal questionnaires to two systematic random samples of approximately 500 named callers to one ambulance service before, and one year after, the introduction of EMD. The response rate was 72% (355 of 493) before, and 63% (297 of 466) after, EMD. There was a reduction, from 81% (284 of 349) to 70% (200 of 286), in the proportion of callers who found all the questions asked by the call taker relevant, although this did not adversely affect the proportion of callers who were very satisfied with the 999 call, which increased from 78% (268 of 345) to 86% (247 of 287). The proportion of callers who reported receiving first aid advice increased from 7% (23 of 323) to 43% (117 of 272) and general information from 13% (41 of 315) to 58% (157 of 269). Satisfaction levels with the amount of advice given increased, while satisfaction with response times remained stable at 76% (254 of 320) very satisfied before and 78% (217 of 279) after EMD. The proportion of respondents very satisfied with the service in general increased from 71% (238 of 336) to 79% (220 of 277). There was evidence in respondents' written comments of two potential problems with EMD from the caller's viewpoint. Firstly, some callers were advised to take actions that were subsequently not needed; secondly, a small number of callers felt that the ambulance crew did not treat the situation as seriously as they would have liked. Introducing EMD increases the amount of first aid and general advice given to callers, and satisfaction with these aspects of the service, while maintaining satisfaction with response times. Overall satisfaction with the service increased. However, some changes may be needed to prevent a small amount of dissatisfaction directly associated with EMD.
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Integrating the ambulance dispatching and relocation problems to maximize system’s preparedness
Article
  • Nov 2019
  • EUR J OPER RES
In the Emergency Medical Service (EMS) context, the decision-making process plays a very important role since some decisions highly impact patients’ health. This work focuses on the operational level by solving the dispatching and relocation ambulance problems. Dispatching decisions assign ambulances to emergencies and the relocation problem decides on the base to which available ambulances should be (re)assigned. To improve effectiveness and efficiency in the EMS response, integrated optimization approaches are proposed: a mathematical model and a pilot method heuristic. The aim is to maximize system’s coverage using a time-preparedness measure allowing relocations to any base. Experiments are performed using EMS data from Lisbon, Portugal, where solving these problems is still a handmade task. The optimization approaches are adapted to compare the proposed strategy with the current Portuguese EMS strategy which dispatches the closest available ambulance for each emergency and relocates ambulances to their home bases. Results highlight the potential of the mathematical model and of the proposed strategy to be applied in real-time contexts since key performance indicators (KPIs) are, in general, better than the ones obtained through the heuristic and the current Portuguese EMS strategy. The heuristic should be used when more emergencies occur in the same time period since a solution can be obtained almost immediately in contrast to the MIP usage.
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Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan
Article
  • Apr 2016
Objectives: Strengthened emergency medical services (EMS) are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan - GVK EMRI, Aman Foundation and Rescue 1122 - in order to draw out similarities and differences in their models. Study design: Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan). Methods: Qualitative methods - interviews, document review and non-participant observation - were utilized, and using a process of constant comparison, data were analysed across cases according to the WHO health system 'building blocks'. Results: Emergent themes under each health system 'building block' of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified. Conclusions: This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings.
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Reducing Emergency Medical Service response time via the reallocation of ambulance bases
Article
  • Apr 2014
The demand for highly efficient and effective services and consumer goods is an essential prerequisite for modern organizations. In healthcare, efficiency and effectiveness mean reducing disabilities and maintaining human life. One challenge is guaranteeing rapid Emergency Medical Service (EMS) response. This study analyzes the EMS of Belo Horizonte, Brazil, using two modeling techniques: optimization and simulation. The optimization model locates ambulance bases and allocates ambulances to those bases. A simulation of this proposed configuration is run to analyze the dynamic behavior of the system. The main assumption is that optimizing the ambulance base locations can improve the system response time. Feasible solutions were found and the current system may be improved while considering economic and operational changes.
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Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: Cohort study
Article
  • Jul 2001
To determine the association between ambulance response time and survival from out of hospital cardiopulmonary arrest and to estimate the effect of reducing response times. Cohort study. Scottish Ambulance Service. Subjects: All out of hospital cardiopulmonary arrests due to cardiac disease attended by the Scottish Ambulance Service during May 1991 to March 1998. Survival rate to hospital discharge and potential improvement from reducing response times. Of 13 822 arrests not witnessed by ambulance crews but attended by them within 15 minutes, complete data were available for 10 554 (76%). Of these patients, 653 (6%) survived to hospital discharge. After other significant covariates were adjusted for, shorter response time was significantly associated with increased probability of receiving defibrillation and survival to discharge among those defibrillated. Reducing the 90th centile for response time to 8 minutes increased the predicted survival to 8%, and reducing it to 5 minutes increased survival to 10-11% (depending on the model used). Reducing ambulance response times to 5 minutes could almost double the survival rate for cardiac arrests not witnessed by ambulance crews.
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