Exploring Positive Experiences, Challenges, and Sustainability Measures in Inter-Organizational Collaboration: A...

Community-dwelling populations in Japan are increasingly experiencing complex health and social challenges. Fire-based emergency medical service (EMS) agencies are encountering a growing number of socially vulnerable individuals and are emerging as key partners. However, evidence regarding the implementation and sustainability of such collaborations within Japanese communities remains limited. We aimed to explore the positive experiences and challenges of inter-organizational collaboration between fire-based EMS agencies and long-term care, welfare, and health organizations in Japan as well as strategies for its sustainability.

Semi-structured and joint interviews were conducted with 26 paramedics in administrative roles from 20 fire-based EMS agencies across Japan. These participants were licensed professionals with prior frontline experience who were currently assigned to divisions responsible for planning and coordinating EMS. They were purposively selected from fire-based EMS agencies that had responded to a nationwide survey. The interviews focused on experiences, challenges, and approaches related to collaboration with long-term care, welfare, and health organizations. Interviews were conducted via Zoom, transcribed verbatim, and analyzed using a qualitative descriptive approach. Codes were developed inductively, grouped into subcategories and overarching categories, and validated through member checking.

Collaboration with community organizations was perceived to enhance EMS efficiency and responsiveness, strengthen interprofessional collaboration and mutual understanding, and promote the appropriate use of EMS by facilitating patient referral to relevant support services. Key challenges included ambiguity in coordination roles, limited operational capacity within partner organizations, insufficient interprofessional understanding, and inadequate information sharing. To sustain inter-organizational collaboration, participants emphasized the importance of promoting relationship building and mutual understanding, establishing sustainable inter-organizational collaboration framework, improving infrastructure for information sharing and triage support, clarifying the roles and response policies of fire-based EMS agencies, enhancing interprofessional education, and securing adequate human resources within community organizations.

Inter-organizational collaboration between fire-based EMS agencies and community organizations appears to be a promising approach for advancing integrated emergency care within the community. The six identified practical measures may contribute to the long-term sustainability of collaborative models that bridge medical and social care needs in Japanese communities.