title: Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey.
abstract: BACKGROUND
  There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported.
  
  
  METHODS
  This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight.
  
  
  RESULTS
  Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur).
  
  
  CONCLUSIONS
  We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. shinsangdo@medimail.co.kr
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.forename: Hideharu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.forename: Omer
authors.initials: O
authors.lastname: Alsakaf
authors.forename: Sarah Abdul
authors.initials: SA
authors.lastname: Karim
authors.forename: Nalinas
authors.initials: N
authors.lastname: Khunkhlai
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.forename: Hyun Wook
authors.initials: HW
authors.lastname: Ryoo
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Ryu
authors.forename: Lai Peng
authors.initials: LP
authors.lastname: Tham
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
mesh_terms: D001208:Asia / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000191:economics / Q000379:methods; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D020407:Internet; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011795:Surveys and Questionnaires; D015996:Survival Rate