Challenges of the Saudi Arabia Ministry of health

emergency medical services resource capacity to address the

COVID-19 Pandemic
Abstract
The COVID-19 epidemic has created global healthcare system problems like none other. This
epidemic is more than just a health problem; it has also brought up some ethical dilemmas.
Healthcare workers are put in a tight position once they choose which patients to prioritize
because of a scarcity of resources when the patient population is contaminated with a disease.
The quality of EMS in urban and rural locations varies worldwide. Despite the lack of studies
addressing this explicitly, better service delivery is needed in rural and urban EMS stations.

The goal of this research is to explore available resources, accessible Personal Protective
Equipment (PPE), emergency healthcare practices, institutional policies, and views among MOH
professionals in Saudi Arabia with the objective of tackling the COVID-19 epidemic. This study
will emphasize the performance and efficiency of emergency medical care as a major component
of the COVID-19 pandemic and people and their availability at this time. Moreover, there have
been no current study in Saudi Arabia on COVID-19 and MOH EMS. To implement the
COVID-19 emergency medical care program throughout all areas in Saudi Arabia, retrospective
cross-sectional research will be conducted among the average population. The design of the
research is transversal, descriptive & qualitative. A cross-sectional research method will be used
for this study. The study instrument is an online survey. The survey will be distributed randomly
by a website. Prevalence of the assessed outcomes will be calculated, and its relationship with
the variables of interest will be compared and analyzed using ANOVA or Chi Square test
according to the variable’s types.

Keywords: EMS, COVID-19, Health Care System

Contents
Abstract......................................................................................................................................................2
INTRODUCTION.....................................................................................................................................1
RESEARCH OBJECTIVES.....................................................................................................................1
LITERATURE REVIEW.........................................................................................................................2
RESEARCH PLAN AND DESIGN:........................................................................................................4
RESEARCH METHODOLOGY:............................................................................................................4
Data collection and analysis..................................................................................................................4
Procedure...............................................................................................................................................5
Statistical Analysis.................................................................................................................................5
Ethical Consideration............................................................................................................................5
INTRODUCTION
The World Health Organization (WHO) said on January 30, 2020, that the spread of the COVID-
19 Pandemic is a matter of worry and urged officials to raise the degree of emergency health
response. After then, the Saudi Arabian government established stringent policies to restrict the
spread of the disease throughout the kingdom's provinces. According to WHO guidelines, Saudi
Arabia's Ministry of Health (MoH) and many other nations have begun implementing COVID-
19 case identification and isolation procedures [ CITATION Wal20 \l 1033 ] .

The COVID-19 outbreak has presented several nations with the problem of preventing the spread
of the virus. A retrospective assessment of previous epidemics may assist guide the response to
future outbreaks. An approach to prepare for and fight outbreaks of infectious diseases, together
with developing an effective and speedy strategy to establish a path back to health, may expedite
the response [ CITATION Omn20 \l 1033 ] . While difficulties in logistics may limit the development
of efficient methods for infectious disease control, they are also related to the detection and
identification of outbreaks, which can hinder planning. As an illustration of the ethical problems,
there is a viral epidemic of unknown origin.

This is one of several projects focused on the EMS supply in the Riyadh area of Saudi Arabia
(KSA). Researchers have previously published findings based on a retrospective review of Saudi
Red Crescent EMS medical files. The results of the first part of the study inspired current
research, which seeks to understand the causes of the observed disparities in EMS delivery times,
base equipment, and personnel training levels between rural and urban regions [ CITATION Joh21 \l
1033 ]. To understand differences between rural and urban EMS, the research seeks to gather
insights from frontline employees via personal interviews about organizational variables in their
day-to-day work practice. Suggestions may be made to help close existing service gaps based on
this information to assist with general EMS operations in Saudi Arabia.

RESEARCH OBJECTIVES
This research seeks to understand the ethical difficulties healthcare workers encounter at Saudi
Arabia's hospitals and research institutes.

The researchers will conduct a sample of subjects in Saudi Arabia. Saudi EMS presently
employs potential participants as technicians, paramedics, or EMS station managers, and they

1
must have at least five years of experience in the EMS. An examination of the data will be
carried out using a theme analysis methodological technique. The results are intended to
illuminate the critical ethical questions that arise during crises, enabling authorities to establish
reasonable rules and guidelines.

LITERATURE REVIEW
An increase in national and regional call volumes occurred during the three months of the
COVID-19 epidemic. Contrary to previous reports, which indicate a decline in emergency
department use in other nations, EMS call volume has increased. The percentage of phone calls
going up throughout areas of Saudi Arabia had some variance [ CITATION Han21 \l 1033 ]. The
worldwide healthcare system faced unprecedented difficulties because of the COVID-19
epidemic. For those with COVID-19, 13% get very sick and need hospitalization, while 5%
require admission to an ICU (ICU). Those with the worst instances of the illness suffer from
ARDS, sepsis, septic shock, and other critical problems, including organ failure and heart
damage. Risk factors for mortality include being old with major COVID diseases such as
immune system problems.

On 2 March 2020, the Ministry of Health (MOH) officially confirmed the discovery of the first
COVID-19 case in the Kingdom of Saudi Arabia (KSA). By 9 March 2020, there were 20 cases,
and the government decided to cancel all social activities, and to shut education and government
offices to prevent the spread of illness. The KSA declared on 21 March 2020 that all planes,
buses and trains will be suspended to and from the KSA and between its main cities. In addition,
the government has isolated all imports of currency outside the Kingdom.

A worldwide public health crisis emerged due to the epidemic, demanding the healthcare
systems of all countries, including rich industrialized ones. Healthcare professionals must now
balance the welfare of a single patient with that of the general community, increasing tensions in
the process. Medical service providers were placed under immense strain as hospital bed
demands grew. Around 9–11% of COVID-19 patients need life-supporting treatment in a critical
care unit or middle-care unit, creating difficulties for healthcare systems and hospitals, which are
already stretched to capacity by the global epidemic [ CITATION Ahm20 \l 1033 ].

2
Having access to specific details regarding the EMS uptick during the COVID-19 outbreak
offers a chance to reevaluate how resources are allocated and used. The government should focus
on disaster preparation planning according to location, time of day, any day of the week.
Additionally, the effects of natural catastrophes, limited regional diseases, and protracted
pandemics, as well as local threats, such as terrorist activities. The Kingdom's EMS systems need
to be evaluated to see whether they have the capacity to respond to both the typical number of
emergency calls that they receive in a year and to multiple crisis events and prolonged incidents
like the COVID-19 Pandemic [ CITATION Ban21 \l 1033 ].

Operating rooms (ORs) are potential risk locations for airborne disease transmission owing to the
presence and the need for high transmission risk activities, such as the airway evaluation, by a
multidisciplinary team. Other difficulties for the epidemic COVID-19 include worldwide
demand for resources, fatigue among personnel, higher risk of transmission and increasing
burden on our healthcare systems.

Hospital facilities for administration and control of human resources

The KSA government chose to set up a national control and control center for the following
purposes: 1) monitoring and follow-up of cases; 2) planning preventive measures based on
COVID-19 national and worldwide daily updates; 3) restriction of viral spread in hospitals and
beyond; 4) optimization, in anticipation of the outbreak, of hospital workforce;5) rational, ethical
and organized distribution of scarce resources.

According to a global study, most healthcare systems, including sophisticated emergency

systems, cannot respond to COVID-19 instances due to system failure. With large numbers of
highly contagious patients, overpopulated emergency rooms found it difficult to retain control of
the situation. Throughout most of the globe, the critical care services demanded by patients
surpassed the available supply. Add to this the vast number of patients, and the lack of resources
were problems for doctors. Those forced to make meaningful choices about who would get
essential medical treatment, such as a ventilator, even knowing that those who did not receive
care would almost certainly die. Doctors had to concentrate on those patients who were most
likely to live, not those with a slight possibility of surviving [ CITATION Ahm21 \l 1033 ].

3
Risk perception is a key driver for reacting during pandemics and adhering to public health
measures. Previous studies have shown that appropriate exposure risk perceptions are a predictor
of risk-adverse actions and compliance with safety standards. Exaggerated perception of danger
was strongly linked with the abuse of preventive measures that may lead to panic responses and
misuse of health action due to insufficiently high-risk perceptions. Risk perception may be
influenced by numerous variables, by signals about risk communication. A new study collecting
data from 58 nations during the early stages of the COVID-19 pandemic shows that cultural
values and behavior have a key influence in public risk assessment. This study also showed that
a significant degree of uncertainty was strongly linked with poor risk communication with low
compliance with social distancing policies. In a recent Vietnamese study, poor or overpowering
risk messaging were linked to an inflated or overestimated sense of danger during the COVID-19
epidemic. Such results underlined the influence on public behavior of effective messaging during
the COVID-19 epidemic.

The Ministry of Health (MoH) has been particularly active in spreading information to the
general population, with the aim of reducing the spread of COVID 19 in Saudi Arabia, where
365,775 cases had been recorded, and 6342 fatalities as of January 2021,21. A questionnaire
survey was carried out with respondents from across the nation including various age groups,
socioeconomic classes and educational levels to ensure the efficacy of COVID-19 risk
communication.

RESEARCH PLAN AND DESIGN:

The research methodology used in this study is cross-sectional, descriptive, & qualitative. In
addition to the major cities of Jeddah, Riyadh, & Dammam, the research area also includes
several minor cities. Members of the ethical committees at the country's leading hospitals and
academic personnel at ten hospitals were part of the research. The information will be gathered
between September 2021. The study instrument is an online survey. The survey will be
distributed randomly by a website. Prevalence of the assessed outcomes will be calculated, and
its relationship with the variables of interest will be compared and analyzed using ANOVA or
Chi Square test according to the variable’s types. Prevalence of the assessed outcomes will be
calculated, and its relationship with the variables of interest will be compared and analyzed using
ANOVA or Chi Square test according to the variable’s types.

4
RESEARCH METHODOLOGY:
Data collection and analysis
Three rounds of modifications to the Delphi process will be made. One hundred participants will
be asked to come up with a list of the top 10 medical ethical problems to health care at COVID-
19, and then they will be divided into teams. The researchers will gather, compile, and score the
data from the forms. The reranking data will be given to all the members again in the second
round. Researchers will ask the subjects to rate the concerns from the list of ethical problems in
healthcare and provide the results.

Once the third round has been completed, the results will be given to the participants again, with
the list indicating their agreement or disagreement with the ranking. They will be told to assign
the things in a different order. If participants disagreed with their submitted issues, the study
team returned the feedback.

After receiving participants' updated rankings, the next step is to convene a panel of health care
specialists, who will then pick the top 10 medical ethical issues that face the Saudi public.

Later, the panel of experts will be divided into two groups, each of which will list the top ten
ethical issues confronting Saudi healthcare professionals. They will be asked to rate the
difficulties. After the training sessions, the Saudi providers will finalize the top 10 ethical issues
that COVID-19 presented.

Procedure
Questionnaires will be used to gather data. Participants will get questionnaires individually to
understand who is conducting the study, what the research project is about, and their role in it.
The people in the study will be told how long it will take to complete the survey. After they
complete the questionnaire, the participants will be told to deliver it to the Academic Affairs
Office, sealed in an envelope.

Statistical Analysis
The data were transferred to the latest version of R, 3.6.3, using RStudio (1.2.5033). The Chi-
square goodness-of-fit test will be used to evaluate the data, which will then be used to discover
the effect of categorical factors, such as the Saudis/Non-Saudis, gender, age group, & region.

5
Ethical Consideration
We will guarantee the privacy of all individuals involved in this research. Participants will
remain anonymous, and no personal information will be gathered. Participants' names will not be
asked for. Information identifying any person who wrote or saw the content will not be included
in the final document and will only be available to the writers. All participants will be allowed to
provide informed consent.

6
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