WHERE WE STAND: ANALYSIS OF AMBULANCE SERVICES OF KARACHI.
Abstract
Around 20 ambulance services operated in Karachi; however, the network of Edhi, Chhipa and Aman ambulance services provides the bulk of patient transport. The study aims to compare the quality of ambulance service delivery with international standards. With a mix- method approach, 357 patients/attendants and key stakeholders participated in the study. The results revealed a wide range of differences in service quality. Aman services delivery quality is rated 72% compliant, but it constitutes less than 20% of the share of inpatient transportation due to limited ambulances while Edhi and Chhipa contribute 80% of patient transportation, but their service delivery quality is rated only 13%. In the subset of monitoring, infection control, and medicine, Edhi & Chhipa services meet 0% standards. The thematic analysis revealed that the primary reasons for the poor quality are lack of legislation & minimum standards, Poor or no monitoring, financial constraints, and lack of awareness. In conclusion, the ambulances services operating in the city lacks minimum service quality standards, thus pose a constant threat to patient life using these services.
References
Acerra, J.R., Iskyan, K., Qureshi, Z.A., Sharma, R.K., 2009. Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med 2, 77–82. https://doi.org/10.1007/s12245-009-0106-y
Akhlaq, A., McKinstry, B., Sheikh, A., 2020. Stakeholders perspectives and deployment strategies of health information exchange illustrated through an in-depth case study of Pakistan. Informatics for Health and Social Care 45, 130–150.
Babiarz, K.S., Mahadevan, S.V., Divi, N., Miller, G., 2016. Ambulance Service Associated With Reduced Probabilities Of Neonatal And Infant Mortality In Two Indian States. Health Affairs 35, 1774–1782. https://doi.org/10.1377/hlthaff.2016.0564
Bahadori, M., Abdi, M., Teimourzadeh, E., Ayoubian, A., Yaghoubi, M., 2013. Assessment of the quality of transport services at a military healthcare center using SERVQUAL model. Journal of Military Medicine 15, 177–183.
Baqir, M., Ejaz, K., 2011. Role of pre-hospital care and ambulance services in Karachi. J Pak Med Assoc 61, 1167–1169.
Bhargava, V., 2019. Service Quality: Introduction, Definitions, Dimensions and Model. Essays, Research Papers and Articles on Business Management. URL https://www.businessmanagementideas.com/service-marketing/service-quality/20971/ (accessed 4.10.21).
Broh, R.A., 1982. Managing quality for higher profits: A guide for business executives and quality managers, 1st Edition. ed. McGraw-Hill, New York.
Bruce, D., Cano, M., Viza, E., 2019. Are Current SERVQUAL Dimensions Applicable for Measuring Service Quality within the Scottish Emergency Services? 17.
Chandran, A., Ejaz, K., Karani, R., Baqir, M., Razzak, J., Hyder, A.A., 2014. Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan. Emerg Med J 31, 990–993. https://doi.org/10.1136/emermed-2013-202762
Christensen, E.F., Bendtsen, M.D., Larsen, T.M., Jensen, F.B., Lindskou, T.A., Holdgaard, H.O., Hansen, P.A., Johnsen, S.P., Christiansen, C.F., 2017. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region. B.M.J. Open 7, e014508. https://doi.org/10.1136/bmjopen-2016-014508
Crampton, R.S., Michaelson, S.P., Wynbeek, A., Miles, J.R., Gascho, J., Stillerman, R., Aldrich, R.F., 1974. Reduction of pre hospital, ambulance, and hospital coronary death by the pre hospital emergency cardiac care system: a rationale for training emergency medical technicians, nurses, and physicians. Heart & lung : the journal of critical care 3, 742–747.
Cronin, J.J., Taylor, S.A., 1992. Measuring Service Quality: A Reexamination and Extension.
Journal of Marketing 56, 55–68. https://doi.org/10.2307/1252296
Crosby, P.B., 1979. Quality is free : the art of making quality certain. New York : McGraw - Hill.
Deming, W.E., 1986. Out of the Crisis | The M.I.T. Press. MIT-CAES. Edwards, C.D., 1968. The meaning of quality. Quality progress 1, 36–39.
Feigenbaum, A.V., 2004. Total Quality Control 4th edition, Subsequent edition. ed. McGraw- Hill Professional Pub, New York; London.
Garvin, D.A., 1984. What Does “Product Quality” Really Mean? [WWW Document]. M.I.T. Sloan Management Review. URL https://sloanreview.mit.edu/article/what-does- product-quality-really-mean/ (accessed 4.10.21).
Grönroos, C., 1991. Scandinavian Management and the Nordic School of Services‐Contributions to Service Management and Quality. International Journal of Service Industry Management 2, 17–26. https://doi.org/10.1108/09564239110007247
Haugland, H., Rehn, M., Klepstad, P., Krüger, A., Albrektsen, G.E., Berlac, P.A., Braut, G.S., Bredmose, P., Burman, R., Burns, B., Corfield, A., Ebbing, M., Hjortdahl, M., Lippert, F., Madsen, P., Oretorp, P., Rognås, L., Thompson, J., Uleberg, O., Virta, J., Voelckel, W.G., Wubben, R., The EQUIPE-collaboration group, 2017. Developing quality indicators for physician-staffed emergency medical services: a consensus process. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 25, 14. https://doi.org/10.1186/s13049-017-0362-4
Health Profile of Sindh by District, 2017. . BUREAU OF STATISTICS PLANNING & DEVELOPMENT DEPARTMENT GOVERNMENT OF SINDH, Karachi.
Hyder, A.A., Razzak, J.A., 2013. The challenges of injuries and trauma in Pakistan: An opportunity for concerted action. Public Health 127, 699–703. https://doi.org/10.1016/j.puhe.2012.12.020
ISHIKAWA, K.A., 1985. What is Total Quality Control? The Japanese Way. Prentice-Hall. Johns Hopkins University, 2020. Spatial Analysis Optimization of Prehospital Services in
Karachi, Pakistan to Improve Ambulance Response Times (Clinical trial registration No. NCT02743169). clinicaltrials.gov.
Juran, J.M., 1951. Quality-control handbook. McGraw-Hill, New York. Kabir, S.M., 2016. METHODS OF DATA COLLECTION. pp. 201–275.
Karmacharya, P.C., Singh, G.K., Singh, M.P., Gautam, V.G., Par, A., Banskota, A.K., Bajracharya, A., Shreshtha, A.B., Mahara, D., Group, T.N.C.E.P., 2008. Managing the Injury Burden in Nepal. Clinical Orthopaedics and Related Research® 466, 2343– 2349. https://doi.org/10.1007/s11999-008-0384-3
Khan, A., Zafar, H., Naeem, S.N., Raza, S.A., 2010. Transfer delay and in-hospital mortality of trauma patients in Pakistan. International Journal of Surgery 8, 155–158. https://doi.org/10.1016/j.ijsu.2009.10.012
Kumaraswamy, D.S., 2012. SERVICE QUALITY IN HEALTH CARE CENTRES: AN EMPIRICAL STUDY 3, 10.
Mathew, T.P., Menown, I.B.A., McCarty, D., Gracey, H., Hill, L., Adgey, A. a. J., 2003. Impact of pre-hospital care in patients with acute myocardial infarction compared with those first managed in-hospital. Eur Heart J 24, 161–171. https://doi.org/10.1016/s0195-668x(02)00521-3
Mawani, M., Kadir, M., Azam, I., Razzak, J.A., 2018. Characteristics of traumatic out-of- hospital cardiac arrest patients presenting to major centers in Karachi, Pakistan—a longitudinal cohort study. International Journal of Emergency Medicine 11, 50. https://doi.org/10.1186/s12245-018-0214-7
Mawani, M., Kadir, M.M., Azam, I., Mehmood, A., McNally, B., Stevens, K., Nuruddin, R., Ishaq, M., Razzak, J.A., 2016. Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study. B.M.C. Emergency Medicine 16, 28. https://doi.org/10.1186/s12873-016-0093-2
Nichol, G., Detsky, A.S., Stiell, I.G., O’Rourke, K., Wells, G., Laupacis, A., 1996. Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis. Ann Emerg Med 27, 700–710. https://doi.org/10.1016/s0196- 0644(96)70187-7
Nishtar, S., Boerma, T., Amjad, S., Alam, A.Y., Khalid, F., Haq, I. ul, Mirza, Y.A., 2013. Pakistan’s health system: performance and prospects after the 18th Constitutional Amendment. The Lancet 381, 2193–2206. https://doi.org/10.1016/S0140-
(13)60019-7
Pakistan [W.W.W. Document], 2015. . Institute for Health Metrics and Evaluation. URL http://www.healthdata.org/pakistan (accessed 4.10.21).
Parasuraman, A.P., Berry, L., Zeithaml, V., 1991. Understanding Customer Expectations of Service. Sloan Management Review 32, 39–48.
Patient Experience Survey | Council Of Ambulance Authorities [W.W.W. Document], n.d.
URL https://www.caa.net.au/patient-experience-survey (accessed 4.10.21).
Porter, M.E., 1980. Competitive Strategy: Techniques for Analyzing Industries and Competitors - Book - Faculty & Research - Harvard Business School. Free Press, New York.
Rasyida, D.R., MujiyaUlkhaq, M., Setiowati, P.R., Setyorini, N.A., 2016. Assessing Service Quality: A Combination of SERVPERF and Importance-Performance Analysis.
M.A.T.E.C. Web Conf. 68, 06003. https://doi.org/10.1051/matecconf/20166806003 Razzak, J.A., Cone, D.C., Rehmani, R., 2001. Emergency medical services and cultural
determinants of an emergency in Karachi, Pakistan. PrehospEmerg Care 5, 312–316. https://doi.org/10.1080/10903120190939896
Roser, M., Ritchie, H., 2016. Burden of Disease. Our World in Data.
Sample Size Calculator [WWW Document], n.d. URL https://www.surveysystem.com/sscalc.htm (accessed 12.8.20).
Schmalensee, R., 1970. Regulation and the Durability of Goods. Bell Journal of Economics 1, 54–64.
Sharma, M., Brandler, E.S., 2014. Emergency Medical Services in India: The Present and Future. Pre-hospital and Disaster Medicine 29, 307–310. https://doi.org/10.1017/S1049023X14000296
Sindh Rescue and Medical Services [W.W.W. Document], n.d. URL https://www.theamanfoundation.org/program/aman-ambulance/ (accessed 4.10.21).
Steenkamp, J.-B.E.M., 1990. Conceptual model of the quality perception process. Journal of Business Research 21, 309–333. https://doi.org/10.1016/0148-2963(90)90019-A
Stewart, S., 2002. Customer Satisfaction in the Metropolitan Ambulance Service.
Swan, P., 1970. Durability of Consumption Goods. American Economic Review 60, 884–94. Tan, C.N.-L., Ojo, A.O., Cheah, J.-H., Ramayah, T., 2019. Measuring the Influence of
Service Quality on Patient Satisfaction in Malaysia. Quality Management Journal 26, 129–143. https://doi.org/10.1080/10686967.2019.1615852
The Constitution of the Islamic Republic of Pakistan, 2018.
The SAGE Encyclopedia of Qualitative Research Methods, 2021. . SAGE Publications Inc. Tuchman, B.W., 1980. THE DECLINE; OF QUALITY QUALITY. The New York Times.
Zia, N., Shahzad, H., Baqir, S.M., Shaukat, S., Ahmad, H., Robinson, C., Hyder, A.A., Razzak, J.A., 2015. Ambulance use in Pakistan: an analysis of surveillance data from emergency departments in Pakistan. B.M.C. Emergency Medicine 15, S9. https://doi.org/10.1186/1471-227X-15-S2-S9
Downloads
Published
How to Cite
Issue
Section
License
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
