The Influencing Factors of Implementation in Emergency Medical Service Systems - A Scoping Review

Area of Science:

• Emergency Medicine
• Health Services Research
• Implementation Science

Background:

• Emergency medical services (EMS) operate under significant time and resource constraints.
• Introducing novel treatments or modifying existing practices in prehospital settings presents unique implementation challenges.
• Effective implementation strategies are crucial for the successful adoption of new medical interventions in EMS.

Purpose of the Study:

• To systematically identify and categorize potential facilitators and barriers influencing the implementation of prehospital emergency medical services.
• To develop a comprehensive framework for understanding implementation factors in the prehospital environment.

Main Methods:

• A systematic scoping review was conducted using PubMed and EMbase databases, adhering to PRISMA guidelines.
• Original research articles published in English before December 2023, focusing on factors influencing prehospital EMS implementation, were included.
• Extracted influencing factors were thematically categorized.

Main Results:

• Nineteen articles were selected from 371 retrieved papers, yielding 46 influencing factors.
• These factors were organized into ten distinct themes: Outer system, Inner system, Practitioner characteristics, Resources, Communication and collaboration, Patient factors, Intervention characteristics, De-implementation of prior practices, Logistical issues, and Quality improvement.
• Key influencing factors identified include training, equipment, hospital communication, and practitioner attitudes.

Conclusions:

• A 10-theme framework for EMS implementation factors was proposed based on a review of the literature.
• Understanding these themes is essential for successful adoption of new practices and technologies in prehospital care.
• Focusing on training, resources, communication, and practitioner attitudes can enhance EMS implementation efforts.