The Development of an Integrative Guideline for the Emergency Medical Services System for Emergency Patients Experiencing Mental Health Crises in Rayong Province

Abstract

This mixed methods research aimed to study: 1) the current situations, problems and solutions; 2) the components of emergency medical service system (EMSS) development; 3) the factors affecting EMSS development, and 4) to craft integrated guidelines concerning the development of the EMSS for emergency patients experiencing mental health crises in Rayong Province. There were two groups of participants. Group one was comprised of 80 administrators and medical and non-medical personnel performing duties related to emergency medicine or mental health, as well as police, community leaders and public health volunteers. Group two was comprised of  400 people living in Rayong Province. Stratified random sampling was used based on district population. Two research tools were used: 1) an interview form and 2) questionnaires using a 5-point Likert rating scale. The qualitative data was analyzed  using content analysis and the quantitative data was analyzed using frequencies, percentages, means, standard deviations, Pearson’s correlation coefficients, and multiple regression analysis.

             The results of the research related to the four study objectives are as follows. First, regarding the current situation, problems and solutions, it was found that there are approximately 1 to 2 emergency psychiatric patients per month. These patients were typically sent to the emergency department because they were acting dangerously in public, such as running amuck, behaving manically,  or destroying things. However, the community hospitals are unable to comprehensively manage these patients and have to refer them to higher-level hospitals.  The causes leading to the acting-out were mostly related to non-compliance with prescribed medications, an insufficient number of psychiatrists to provide coverage, and the psychiatric patients being homeless. The solutions would be as follows: the number of psychiatrists must be increased, there must be telephone contact and co-ordination for providing 24/7consultation, a good referral system for psychiatric patients must be developed, and the delivery system for sending basic psychiatric medications to local community hospitals when needed.   Secondly, based on the integrated data from the interviews and the relevant research documents, the components integral to EMSS development are: (1) the factors which affect EMSS development, such as  the quality of the information system, participation, training, communication, the emergency receiving and reporting system, and personnel; (2) having integrative and collaborative improvement of patient management, having a self-managed community system, an emergency medical management system, and community hospital. Third, the factors affecting the emergency call and dispatch system included the receiving and reporting system, participation, communication and information systems and they statistically significantly affected the development of EMSS by 84.40 % at level .01. The receiving and reporting system affected this issue most. Fourth, with regard to the development of integrated EMSS guidelines for patients experiencing a mental health crisis, it was found that the a Quality Management Cycle (PDCA) would be most appropriate because it includes various teams of relevant personnel from the related organizations in every step of the development process to promote developing well-crafted EMSS protocols to ensure appropriate response to, and treatment of, psychiatric patients experiencing mental crises and public safety.