The effectiveness and the prospect development of urban China's emergency medical services (EMS) system : a systematic review

Background Increasing demand of emergency medical needs in urban China resulted in an increased importance to improve the effectiveness of pre-hospital emergency medical services (EMS) system. As the structure and response time have been effective in quality and performance of the system, some studies have explored the idea of using structure, process, and outcome as indicators to assess the pre-hospital EMS system. However, few studies have been carried out to investigate the effectiveness of the EMS system in urban China. Objectives A systematic review was conducted to measure and investigate the effectiveness of current pre-hospital emergency medical services system in urban China and attempt to propose recommendation for system construction. Methods Retrospectively analysis and observational studies published in English and Chinese between 2000 and 2015 were identified through MEDLINE, CNKI, and handsearching key journals. Results The search strategies in the electronic databases found out 599 articles. After limited to language, publication year, full text, and excluded duplicated paper and articles that did not meet the inclusion and exclusion criteria, remaining 15 articles screened by further evaluation of full text. Finally 12 articles met the inclusion criteria were therefor included in the systematic review. Of all the studies, nine of which focus on the outcome of the pre-hospital EMS system, and the structure were also examined in nine included studies, two of them took the process of the system into assessment. All the studies showed that the regional economy situation has a great impact on the structure of model design. Staffing, equipment and the distribution of rescue centers were important factors influence the effectiveness of pre-hospital EMS performance. New rules and regulation regarding the latest situation in regions was in urgent need to the rational use of medical resource and standardize procedure for implementing pre-hospital emergency care for medical staff. Conclusion Pre-hospital EMS systems are adopted in urban China but none of them is best fitting into any context. Government investment, rational distribution of medical sub-centers and well-developed paramedic profession greatly affected the effectiveness of pre-hospital EMS system. This systematic review has the advantage of allowing comparison between different models and measuring quality in pre-hospital emergency medical services. Further studies should pay more attention to all types of indicators in pre-hospital EMS system (i.e. safety, accessibility and equity), which were difficult to conduct in this dissertation.published_or_final_versionPublic HealthMasterMaster of Public Healt