Development of Emergency Medical Services (EMS) in Iran: Components of Access

Introduction: One of the most important components of emergency medical services (EMS) which plays a major role in reducing mortality and disability of victims is access to healthcare services. Equitable access to healthcare services requires providing essential and accessible services for all people without imposing any financial burden on them. The aim of this study was to determine and prioritize the components of access to EMS in Iran. Methods: This study is a descriptive and cross-sectional study that has done in the first half of 2010 in Iran using DEMATEL method. The data about the access components of EMS in different systems was collected using researcher-made questionnaire. Afterwards, a sample of 30 Iranian experts in EMS who were selected using purposive sampling method were asked to evaluate the suggestions and revise the collected components using their scientific, practical and visionary experience. Then, the components were identified using Delphi method. The priority of components was depicted using MATLAB and Edraw Max 5 softwares. Results: Capitation, third party insurance, insurance for non-traffics cases, the budget of some especial organizations such as the tobacco companies, etc., distribution of facilities based on the characteristics of each region and distribution of facilities in urban areas based on the population density were determined as access components. Also, The components of third party insurance and capitation were determined as the most affecting and affected access components with the coordinates (1.44 and 1.44) and (0.09 and -0.09) respectively, on the pre-hospital emergency access components graph. Conclusion: Given the limited resources to access EMS, alternatives should be taken into consideration. Considering the high number of deaths from traffic accidents in Iran, part of car insurance premiums should be allocated to provide emergency services for people injured. Some Iranian organizations such as tobacco companies, oil manufacturing companies, etc. have a major role in cardio-vascular diseases outbreaks. Given that cardiovascular diseases are the most common cause of deaths in Iran, such organizations should pay costs of these diseases spreads and outbreaks.