What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review

Autoři: H. N. Moafa aff001;  S. M. J. van Kuijk aff003;  G. H. L. M. Franssen aff004;  M. E. Moukhyer aff005;  H. R. Haak aff002
Působiště autorů: Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia aff001;  CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands aff002;  Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands aff003;  Maastricht University Library, Maastricht, The Netherlands aff004;  Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia aff005;  Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands aff006;  Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226230



The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine.


We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical.


Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future.


This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain.

Trial registration

PROSPERO registration number: CRD42019123896.

Klíčová slova:

Ambulances – Critical care and emergency medicine – Death rates – Hospitals – Intubation – Kuwait – Medical services – Transportation


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2019 Číslo 12