Assessing Performance Efficiency and Operational Challenges of Emergency Medical Services in Samut Songkhram, Thailand: A Mixed-Methods Study

Abstract

Background: Emergency medical services (EMS) are essential for saving lives and ensuring rapid response during emergencies and disasters. The performance efficiency of EMS systems is a critical component of public health infrastructure, particularly in areas with limited resources. Objectives: The present study assessed the performance efficiency and operational challenges of EMS in Samut Songkhram province, Thailand. Methods: A mixed-methods design was employed. Quantitative data were collected from 280 EMS personnel across five units using validated instruments: A 30-item Operational Challenges Scale [Content Validity Index (CVI) = 0.89, α = 0.92] and a 27-item Performance Efficiency Scale (CVI = 0.92, α = 0.90). Qualitative insights were obtained from focus group discussions with five EMS leaders. Descriptive statistics, multiple regression analysis, and thematic content analysis were applied. Results: Operational problems were generally rated as very low to low, while overall EMS efficiency was rated as high. Regression analysis indicated that personnel-related challenges (β = 0.526, P < 0.001) and administrative issues (β = -0.132, P = 0.010) were significant factors associated with efficiency, while operational issues demonstrated borderline significance (β = 0.098, P = 0.055). Conclusions: The EMS units in Samut Songkhram demonstrate strong operational efficiency, particularly regarding response times and equipment readiness. However, personnel and administrative challenges persist. Addressing staffing shortages, improving inter-agency coordination, and ensuring equitable funding are critical to sustaining EMS performance and resilience in Thailand and other low- and middle-income country (LMIC) contexts.