title: Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency.
abstract: BACKGROUND
  Emergency Medical Services (EMS) provides out-of-hospital acute medical care to different types of serious emergencies. The team of EMS includes paramedics, besides many other staff working in the pre-hospital setting. Although the paramedics are the first responders to the patient in emergency, they face several barriers, which interfere with their efficiency.
  
  
  OBJECTIVE
  However, the magnitude of these obstacles is not known, hence; it was found worthwhile to evaluate the depth of these difficulties.
  
  
  METHODS
  A questionnaire that included eight different commonly experienced barriers and four different variables of strength was framed. The questionnaire was served to 140 paramedics in three different regions (Jeddah, Riyadh, and Dammam) of Saudi Arabia.
  
  
  RESULTS
  The positive response obtained was statistically significant for traffic congestion (P<0.01; P<0.001), nuisance by bystanders and family members (P<0.001), lack of competence of doctors and the administration in the EMS routines (P<0.05; P<0.01; P<0.001), lack of trust and confidence (P<0.001) lack of independence (P<0.001), patient's resistance (P<0.001), Interference of legal issues and litigation proceedings (P<0.05; P<0.001), paramedic's impression on general public and the family of the patients (P<0.001).
  
  
  CONCLUSIONS
  The authorities in the hospitals and EMS administration should improve the barriers which interfere with the efficiency of a paramedic and cause gross humiliation to the patients, and the Health authorities should impart proper education and training to the paramedics.
authors.affiliation: Department of Pediatric Emergency, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Abdullah Foraih
authors.initials: AF
authors.lastname: Alanazi
keywords: Barriers; efficiency; emergency medical services; interference; paramedics