Principles
Best practice implies more than evidence-based practices that are prehospital for the intervention of emergency cases for the patients of PNG. The new paramedic system intends to utilize the best approaches to develop the best emergency case outcomes for PNG patients. Therefore, this new paramedic system intends to establish best practices such as sophisticating the ambulances to be stroke-specific with portable equipment such as CT scans for the EMS to treat the patients at the prehospital level with no need to reach the hospital. This report gives the best practice of the new paramedic system of Papua New Guinea by analyzing the history and the intended new paramedic services in the new system with the extension to both the urban and remote areas. Based on the approach of primary health care in Papua New Guinea, almost 50% of the health settings aids posts are closed due to a lack of drugs, supplies, and staff in remote areas (Smaghi et al., 2021, p 110). In urban centers, few clinics tend to be expensive for the communities. The services are provided by one national hospital, about 18 provincial hospitals, and 500 health centers (Jambulingam et al., 2022). The government of PNG is the main provider of health services through the management of the provincial hospitals, aids posts, urban clinics and centers, and subcentres of health. Also, there is a Medical council for churches that contains about 23 denominations whose salaries are government-funded ( ). Also, mining companies operate other facilities such as clinics that provide services of high quality due to facilities, staffing, equipment, and their utilization (Middleton et al., 2019, p 15). This creates greater cooperation since they are located in remote PNG areas. Historically, church facilities have a good reputation. However, they are underused due to a lack of awareness by the remote area residents. Therefore, they tend to run down between 1965 and 2000, there was a 65% increase in the PNG expenditure on the health sector, although the growth was 42% when the population increase was considered. In the subsequent years, there was an increase in health expenditure up to 8.5% in 2000(Smaghi et al., 2021, p 110). Therefore, this paper is essential to the proposed new paramedic system to increase awareness. It provides the best practices for the new paramedic system that will demonstrate the best practice for the EMS services to the residents.
The principles of operation of the new paramedic system include; educating the residents about the early signs of emergency cases to call the toll-free number for the Paramedic services. Also, the ambulance has to be sophisticated with emergency equipment and CT scans so that the response professionals for the new paramedic system can take care of the patient with no need to wait until they arrive at the hospital. In PNG, due to the geographical status of the area, transportation can take too long to access the hospital, which is not suitable for emergency cases (Middleton et al., 2019, p 15). They will recognize the disaster’s nature and evaluate the situation to develop the medical resources for the best paramedic care. The emergency dispatchers of medicine, responders, paramedics, and technicians should be licensed personnel that offers the first care standards during a crisis (Judge et al., 2022, p 82). They will also serve as integration partners locally and nationally to implement and develop the integrated and coordinated plans of crisis standards of care. The paramedic personnel and agencies may be engaged in local planning in their advisory trauma councils and health care coalitions. Therefore, it is important for them to be involved in implementing and planning at all crisis standard care levels (Jambulingam et al., 2022). During the planning and implementation of CSC, the state EMS has this responsibility, and they have to consider the entailed duties of carrying out the roles. This can be the provision of the EMS system functions in planning and the systems and personnel in the CSC plan implementation. This relates to the legal, and ethical issues, mental health, palliative care, outpatient, systems of alternate care, and hospital care for planning and implementing paramedical care during a disaster or crisis.
Leadership
Paramedical care will be the care given prehospital that is essential in emergency care that will always be intimated by a call on 911 from the patient dispatch center. The trained emergency personnel then interprets the need for care after receiving the ring and then dispatch the appropriate ambulance and other emergency responders to provide emergency care for the patient in prehospital settings (Peate et al., 2022). Paramedical care will therefore be a continuum of care that is conventional through an integrated and coordinated health care emergency system that has well-trained personnel and well-equipped services at dispatch, hospitals, and special centers of care such as pediatric, trauma, burns, and ambulance agencies, who will use rules and guidelines that are standardized and approved by directors of medications(Jambulingam et al., 2022).To implement the capabilities of the paramedical system, the dispatch, call centers, agencies, and hospitals will have to apply principles to undertake their emergency plans through approved protocols; Agreement aids have to be mutual for the paramedical agencies that request equipment and personnel assistance from the jurisdiction that is neighboring to offer services to the critical patient. Also, answering points for public safety, alterations of the dispatch protocols by the call centers, fewer resources being sent, and the paramedical providers being allowed to respond to fewer assistance requests(Judge et al., 2022). The transport destinations must be adjusted to enable transportation to care sites and clinics other than hospitals. Another principle has to be the usage of triage by the emergency personnel during a disaster, such as sorting, assessing, life-saving interventions, transport, and rapid treatment. The assessment will be done within 60 seconds to establish whether it has to be delayed or immediate treatment of the emergency patient (Blanc et al., 2019, p 14). The Paramedics also have to utilize the NIMS and ICS to provide a model consistent for the disaster response in all organizations. In case of the scarcity of personnel, equipment, and hospital beds during an emergency, the local paramedics will be forced to modify the services to crisis care (Judge et al., 2022). This means they shift from conventional, which would be the usual care standards whose goal is to save every casualty, to crisis standards whereby many lives are saved using the limited resources available such as limited supplies, staff, equipment, medicines or fuel, coordination, or communication disruptions and mutual aid. The principle of the utilization of limited resources has to be planned for and implemented by maximizing the use of limited personnel, response teams and the health care registries, triage criteria, and altered patient transport and destinations.
This system will adopt the bottom-up leadership, which determines the quality of the services offered in relation to the safety and well-being of emergency patients. There are three criticisms of organizational leadership; bottom-up, top-down, and hybrid structures. The top-down structure is whereby the officials at the top positions of the organization take total control over important decisions more than those at the bottom of the hierarchy (Judge et al., 2022). The bottom-up structure seems to be the best for the new paramedic system since it gives those professionals on the ground to make key decisions and perform to their best as they are free to organize their work. The hybrid stricture combines both the top-down and bottom-up structures based on the situation on the ground of the paramedic system (Peate et al., 2022). The top-down is an autocratic structure—this style of structure commands and controls decision-making to fulfill the organization’s purpose. The plans and strategies are conceived at the top of the hierarchy and then cascaded to the other professionals to be implemented in the organization. Here decisions are only approved by the top manager of centralized control to avoid chaos and jailing of individuals (Jambulingam et al., 2022). This structure believes in leadership which leads to the falling apart of the paramedic enterprise. This method of organization is considered best practice if it only finds communication of the members down and up the hierarchy(Mitchell et al., 2020).
On the other hand, the bottom-up is the opposite of the top-down as it separates authority from the professionals working as it is bureaucratic, leading to disempowerment. From the analysis, the bottom-up is the best structure for any organization as the articles bemean the topdown as autocratic and for the past centuries and acknowledge.Bottom down allows self-management of situations in the paramedic sectors without depending on the decisions made by bosses it is therefore considered the best for this new paramedic system. (Cheer et al., 2021).
For the new system, KPIs are the paramedical performance indicators that would be used to measure the paramedic services as being of best practice or not (Peate et al., 2022). The structural indicators describe the settings that will offer the care services to the patients. In this new paramedic system, they include the facilities such as sophisticated ambulances which are strike specific, staffing whereby new emergency responders have to be employed and increased chances for volunteering, equipment such as portable CT scan machines, credentials to operate in prehospital settings, knowledge of the care providers and the patients about early signs of emergency cases and deployment of care providers to marginal areas of PNG. They will provide the measure of the quality of care indirectly and the relationship to the patient’s outcome(Mitchell et al., 2020). Timely response to emergency cases on calls and interventions to the patient with no need to reach the hospital implies best practice(Blanc et al., 2019, p 14).
Another indicator is the process whereby entails the encounters between the patient and the prehospital care provider in the emergency settings away from the hospital. It will evaluate the care steps provided to the patient. These repeatable action sequences are considered best practices across the paramedic systems to produce the best outcomes for the patient’s health (Saweri et al., 2022). This measure provides direct care quality assessment, unlike the structure and the product, indirect indicators. To improve the quality of services, the evaluation of the process inputs will be the best since they can be interpreted and acted on easily. However, the sophistication of the clinical services in the prehospital settings becomes complex, and therefore the quality of the services cannot be monitored (Blanc et al., 2019, p 14). An example of process indicators evaluation will involve the review of the records of the prehospital settings and assessing the appropriateness of treatment and compliance to the protocols of medications (Jambulingam et al., 2022). This can only be gauged by the director manager of the prehospital settings to establish the elements that require improvement.
The outcome indicator will evaluate the subsequent patient’s status of health after an intervention. However, most of the interventions prehospital are not evidence-based. These interventions have to be of best practice by considering the effectiveness of the critical care interventions. The outcome indicator will provide feedback about the prehospital care provided to the patients (Mitchell et al., 2020). This can be quantified by the number of patients who recover through emergency interventions using sophisticated ambulances without necessarily reaching PNG hospitals.
The manager’s role in the paramedic system would be complex, multifaceted, and misunderstood as the bottom-up leadership style would be applied. Therefore, it will be the responsibility of the employees, directors, and the service to understand the relationship and job description entailment to manage the new system, care providers, and the general public that seek the services. The paramedic oversight will also involve understanding the legislature of the local, federal, and state regulations of the prehospital medical care and the management protocols (Smaghi et al., 2021, p 110). However, the state, federal, and local legislatures are complex; therefore, the shift focuses on the management protocols and prehospital medical care. It will start with understanding the oversight foundation of the paramedic system and the roles of the director of the paramedic system based on the bottom-up approach. The oversights include; the operational activities of the day and the regulatory and staffing compliance as handled by the director of services.
Despite the medical Oversight being perceived as a continuum, it is divided into; a perspective that will focus on education, protocol development, and training considered the preparation stage of the medical Oversight. The concurrent Oversight will deal with medical control offline and online and response on scene. It will focus on ongoing action, field, and ongoing medical Oversight (Cheer et al ., 2021). This will be aired through radio, cellular, on-scene patient care, and telemedicine. The retrospective will deal with the paramedic system reviews and research. This will provide important information to the director and care providers to understand the relation between the safety of the public, the paramedic system mission, and the wellness of the patients.
Conclusion
The best practice for the new paramedic organization depends on the organization’s leadership in prehospital care and the knowledge of the care providers. The utilization of the learning will provide the best outcomes for the patient’s health, which then term the services best practice based on the structure, process, and results of the services offered. Also, the patient’s awareness of emergency cases has to be increased through PNG residents’ education.
The following recommendations have to be implemented to come up with best practices in the new paramedic systems. Implement education for residents to use toll-free call numbers for emergency cases to utilize during critical situations. The number can be called at any time, and the response team picks the patient from the dispatch center of the patient(Smaghi et al., 2021, p 110).
The paramedic personnel, equipment, and training have to be maximized to ensure the best process, structure, and outcome for the best practice to ensure the safety of as many patients as possible. The patients also have to be trained in the new paramedic organization about early signs of emergency cases, responding to it, and calling the emergency personnel for care provision.
The paramedic organizations should apply the bottom-up leadership style to ensure self-management of the professionals lower in the hierarchy without depending on decisions from high-rank directors for bureaucracy (Mitchell et al., 2020). This can only be possible by increasing funding for the clinics to ensure enough equipment for prehospital interventions, such as CT scans, sophisticated ambulances, and other first-aid kits for prehospital care.
References
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