Rock P Cordero, Benjamin Joel L Breboneria, Eligin Jumel H Sayson, Jon-Jon T Martinez, Dina Joksimovic, Yasir M Aslam, Paulo Carl G Mejia, Nathira Al Hmaimat
System-level effectiveness cannot be assumed from these self-report perceptions. Instead, the Philippine EMS system maintains a high level of normative protocol awareness yet is structurally weak in its implementation. The "paradox of implementation" indicates that intervention must focus more on resource provision, standardization, and coordination than on protocol dissemination.
PURPOSE: This study investigated how emergency medical service personnel perceive the implementation of prehospital emergency care protocols in the Philippines, with particular attention to the discrepancy between self-reported adherence and reported operational barriers.
PATIENTS AND METHODS: The research utilized a sequential explanatory mixed methods design. Quantitative data collection involved a 56-item questionnaire answered by 114 EMS personnel from four regions in the Philippines (Metro Manila, Luzon, Visayas, Mindanao). Data collection for the qualitative component involved 4 focus group discussions and 6 in-depth interviews. Statistical techniques for analyzing qualitative data include descriptive statistics and chi-square tests of independence, while thematic analysis according to Braun and Clarke's six-step model, with two independent coders (Cohen's k=0.87), was used to analyze qualitative data.
RESULTS: Results obtained from the quantitative analysis suggested consistent high levels of implementation in all five domains of pre-hospital care (safety on the scene: mean=3.71, primary survey: mean=3.64, secondary survey: mean=3.61, detailed physical examination: mean=3.58, ongoing assessment: mean=3.74, all considered as high implementation). Qualitative results, however, demonstrated significant challenges in terms of operation, including time pressure while managing the scene, lack of airway and breathing devices, lack of standardization in training, no reassessment, insufficient documentation, and lack of communication between facilities. The contrast found in these results constitutes the core finding of the research.
CONCLUSION: System-level effectiveness cannot be assumed from these self-report perceptions. Instead, the Philippine EMS system maintains a high level of normative protocol awareness yet is structurally weak in its implementation. The "paradox of implementation" indicates that intervention must focus more on resource provision, standardization, and coordination than on protocol dissemination.