Saudi Red-Crescent Society (SRCS) participates in Hajj every year with a large well-trained medical team, expert in dealing with emergency cases in Hajj. Although provision of health care to these cases has been entrusted to the Ministry of Health, but Saudi Red-Crescent Society share the responsibility of transportation of these patients and provision of first aid and emergency care to them. Activities of SRCS, especially in relation to patient transportation to MOH health facilities, has not been studied adequately. To assess the workload and practices of the medical teams of the SRCS regarding referral and transportation of emergency cases to the health facilities, to assess the coordination and communication mechanism between SRCS and MOH teams regarding referral and transportation of emergency cases and to provide information based recommendation for improvement of coordination mechanism between SRCS and MOH regarding patient referral and transportation.
Methodology
A descriptive cross-sectional self-administered questionnaire based study was conducted among team of SRCS in Makkah and Mina centers during Hajj 1429 H. Out of the 22 centers in Makkah and the 31 centers in Mina, half of them i.e. 11 centers in Makkah and 16 centers in Mina, were selected randomly. All the teams posted in these centers were included in the study (55 teams from Makkah centers and 56 teams from Mina centers).
Results
Regarding team leaders, 63.1% were below 30 years of age with experience of 7 ± 6 years. 95.5% of them had at least one certificate in life support while 4.5% had no certificates. 6.3% have not done any CPR and 26.0% have not done any Endo-tracheal intubation during their whole careers. Duty hours for those teams were 17± 6 hours (range from 12 to 24 hrs). During last shift, the total number of cases attended by 109 teams was 1,342 cases with a mean of 12±5 cases for each team. Emergency care was provided for 1,154 cases (mean of 11 ± 4 cases for each team). The teams transported 813 cases to hospitals (mean of 8 ± 3 cases for each team). The average of the longest response time was from 2 to 210 minutes. The average of the longest transfer time was from 4 to 180 minutes. One hundred and three-team leaders (96.3%) out of 107 reported delay in transporting cases to hospitals. The most common reasons of this delay in transportation were overcrowding on the streets (82.0%), delay during locating the emergency case inside the camp or the scene (43.2%) and delay due to poor support from traffic/security staff (39.6%). Regarding the workload on teams, 47 teams (83.9%) worked 16 hrs and more in Mina, while only one team (1.8%) in Makkah centers (chi2 72.91; P-value <0.001). In Mina centers, 29 teams (53.7%) attended more than 14 cases last shift, while in Makkah only 6 teams (10.9%) had that number of cases (chi2 20.97 ; P-value <0.001). Emergency care was given for more than 14 cases by 22 teams (40.7%) in Mina while 4 (7.3%) teams in Makkah (chi2 15.01; P-value <0.001). Transportation of 8 or more cases was done by 40 teams (74.1%) in Mina compared to 7 teams (12.7%) in Makkah centers (chi2 39.35; P-value <0.001). In Makkah 10 (20.8%) teams had an average response time of 12 minutes or more as compared to 21 (42.9%) teams in Mina (P=0.035). Regarding average transfer time, in Makkah 18 (40.0%) teams had average transfer time of 15 minutes or more as compared to 22 (56.1% teams in Mina (P=0.201). Regarding communication and coordination before transportation, only 41.1% team leaders reported that there was coordination and communication with the hospitals before transportation of cases, the rest reported no communication or not sure.
Conclusion
Workload was quite high especially in Mina compared to Makkah during Hajj as assessed by long duty hours, large number of cases per shift, long transportation time and small size of teams. There was statistically significant higher workload in Mina as compared to Makkah, during last shift. There was hardly any communication and coordination between SRCS staff and MOH staff before transporting cases to health facilities.