Sustainable Resilience in Healthcare Delivery: A Comparative Study on Safety Awareness in Hospital-Based and Pre-Hospital EMS in Times of Crisis

Abstract

This research initiates a comprehensive evaluation of safety awareness among emergency medical service (EMS) practitioners in Riyadh, Saudi Arabia, an area experiencing substantial academic and regulatory transformation. By employing the Safety Attitudes Questionnaire, the study explores safety awareness across various EMS domains, unveiling a significant consistency that is unaffected by the work environment, professional tenure, or gender. Importantly, there are no significant disparities in safety awareness between hospital-based EMS practitioners and their pre-hospital counterparts, regardless of their tenure or gender. The findings highlight a homogenous safety awareness landscape among Riyadh’s EMS practitioners, suggesting strategies to sustain and strengthen patient safety culture irrespective of workspace, experience, or gender. This research not only presents these key findings but also advocates for sustainable resilience in healthcare delivery. It emphasizes the need for continued efforts to instill a culture of safety, underpinned by regular training and the adoption of swift response strategies, ensuring a sustainable approach to patient safety in times of crisis.

1. Introduction

Emergency medical services (EMS) are integral to the worldwide healthcare infrastructure, akin to safety-critical organizations like military field units, nuclear and chemical installations, and hospital trauma units [1]. The World Health Organization (WHO) designates EMS as a system orchestrating personnel, facilities, and equipment to provide efficient health and safety services for sudden illness or injury [2].

EMS is characterized by its community role in providing pre-hospital healthcare. The core objective is to offer immediate and proficient care to individuals facing sudden, life-threatening emergencies, thereby minimizing deaths and long-term morbidity [3]. EMS covers a range of services, such as enabling emergency care access, offering community care, care during transport, and care within medical facilities. Paramedics, a vital part of the EMS system, cater to patients across various socioeconomic strata [4].

The EMS system in Riyadh, Saudi Arabia has recently undergone significant academic and regulatory transformations, underpinning the motivation for this study. With an aim to enhance the effectiveness of healthcare delivery and overall patient safety, these changes have stimulated a critical appraisal of the safety culture within the EMS units, specifically in the context of hospital-based and pre-hospital services.

Although EMS does not always involve immediate staff or patient risks, the safety-critical nature of the organization is unmistakable [5]. Understanding and continually improving the safety culture is, therefore, crucial. By elevating medical treatment standards and reducing incidences leading to inefficiencies or heightened mortality, EMS organizations can better serve their communities.

Paramedics, albeit without medical degrees, are adequately trained for their roles [6]. Nevertheless, they encounter hurdles such as traffic congestion, bystander interference, deficiencies in medical and administrative competence, lack of respect for autonomy, patient resistance, legal complications, and societal perceptions about their profession [6], all affecting their performance and effectiveness.

Safety awareness in EMS is crucial, particularly in disaster-prone countries like Saudi Arabia. Hospital leaders managing potentially hazardous operations bear the responsibility to enhance safety consciousness. Glendon defines safety awareness as fundamental assumptions and beliefs held by organizational members about safety [7]. Establishing a solid safety culture is essential for frontline medical providers to deliver optimal patient services.

This study assesses workplace safety knowledge among hospital-based and pre-hospital emergency medical service providers in Saudi Arabia. Though many studies have explored factors contributing to safety awareness in medical services, few have examined differences between hospital-based and pre-hospital emergency medical services regarding safety awareness.

Safety culture, as per safety experts and WHO, is a blend of individual and group values, attitudes, perceptions, competencies, and behaviors determining an organization’s health and safety management commitment [8]. As injuries or deaths can occur in safety-critical organizations, creating a safety culture is vital. EMS has made notable strides worldwide, becoming a significant element of effective healthcare systems [9]. They have broadened their practice scope to handle medical and trauma emergencies using advanced clinical technology [10].

An organization’s safety culture is influenced by its managers, employees, supervisors, and leaders. Leadership is key in fostering teamwork and safety. In healthcare, management’s safety commitment is linked to collaboration, and an organization’s safety culture fundamentally impacts system safety [11]. National guidelines, organizational management, and leadership are major determinants for promoting a safety culture in the EMS environment [5].

A study by Alanazi in Saudi Arabia illuminated the challenges faced by paramedics and how these could affect their efficiency [12]. A survey was administered to 140 paramedics across the provinces of Jeddah, Riyadh, and Dammam, which highlighted significant positive responses to factors such as traffic congestion, bystander and family member interference, deficiencies in EMS procedures, lack of trust and autonomy, patient resistance, legal complications, and perceptions of the public and patients’ families. These results underline the necessity for hospital administrators, EMS leaders, and health authorities to address these barriers, promote patient dignity, and enhance paramedic knowledge and training.

Alnasser et al. studied patient awareness, knowledge, and attitudes toward patient safety and the factors affecting this knowledge [13]. The cross-sectional study at King Khalid University Hospital in Riyadh, Saudi Arabia, involved 410 patients and utilized self-administered paper-based surveys. The results revealed a significant lack of knowledge and misconceptions about patient safety, highlighting the need for patient education via training programs [13].

Albalawi et al. identified the factors contributing to patient safety culture in Saudi Arabia [14]. The systematic search included 14 high-quality papers, emphasizing the importance of establishing a blame-free culture, improving leadership and communication skills, learning from errors, and integrating patient perspectives into safety initiatives [14].

This study fills existing knowledge gaps by investigating the nuances of safety awareness among EMS practitioners in Riyadh, Saudi Arabia. Specifically, it compares the safety awareness between hospital-based and pre-hospital EMS professionals, considering the influence of experience and demographic factors, such as age. Based on a comprehensive literature review, we propose that pre-hospital EMS practitioners may exhibit higher safety awareness than those in hospital-based EMS, practitioners with over five years of experience may have a greater understanding of safety awareness, and a direct relationship may exist between age and safety awareness among Riyadh’s EMS practitioners. The research aims to provide extensive insights into the dynamics of safety awareness among Riyadh’s EMS practitioners, intended to inform effective policy interventions and foster an enhanced safety culture throughout Saudi Arabia’s healthcare sector.

2. Materials and Methods

2.1. Study Design

This research employs a cross-sectional study design to examine safety awareness levels among hospital-based and pre-hospital EMS professionals in Saudi Arabia. The rationale behind choosing this design was influenced by a few key factors.

The specific objectives of the study necessitated a design that could capture safety awareness at a singular point in time. The cross-sectional design fits this requirement flawlessly as it facilitates data collection from a particular population at one specific moment.

The scarcity of existing data on safety awareness among EMS practitioners in Saudi Arabia also drove the choice of this design. It permitted the gathering of fresh, primary data from the target population, thereby enriching the subject’s data pool.

Furthermore, the study aimed to compare the safety awareness levels between two distinct groups of EMS providers: those operating within hospital-based settings and those in pre-hospital settings. The cross-sectional design catered to this need for comparative analysis, allowing for the examination of differences and similarities between these groups.

Lastly, the choice of a quantitative approach, embedded within the cross-sectional design, facilitated a structured and systematic analysis of the collected data. This approach opened the potential to quantify safety awareness levels and ascertain statistical relationships between various variables. Thus, given the objectives and scope of the study, it was deemed the most appropriate design.

2.2. Participants

The geographical setting of this research study was Riyadh, Saudi Arabia. The decision to conduct the study in this location was informed by its position as the capital city, which harbors a wide range of healthcare facilities, thereby offering a diverse and representative sample of EMS professionals.

Within the context of Riyadh, participants were drawn from various segments of the EMS workforce. These included doctors, paramedics, staff nurses, and emergency medical technicians. This diversity in professional roles allowed for a more comprehensive understanding of safety awareness from multiple perspectives within the EMS field.

The participant pool for this study was derived from two selected EMS-providing organizations. A total of 1800 providers were initially identified as potential participants from these organizations. However, only 317 of these professionals expressed their willingness and availability to partake in the survey. This initial acceptance rate underscores the voluntary nature of participation, a fundamental tenet of research ethics.

The final sample for the study was composed of 310 participants who successfully completed the survey. Of these, 258 were men, and 52 were women. This gender distribution reflects the existing workforce composition in the EMS field in Riyadh, Saudi Arabia, thereby contributing to the representativeness of the study sample. By maintaining a representative sample, the study enhances the generalizability and applicability of its findings within the context of Riyadh’s EMS workforce.

We obtained ethical approval for our study from the Institutional Review Board of King Saud University, Riyadh. All methods were performed in accordance with the relevant guidelines and regulations. All survey participants were informed about the purpose of the study, and all provided informed consent.

2.3. Sample Size Calculation

For our study, we opted for a randomized sampling technique to enhance the representativeness of our participant pool and minimize potential bias. This methodological choice aligns with our study’s objectives, allowing us to ensure that each member of our target population had an equal chance of being selected.

The calculation of our sample size was executed with precision, using specific inclusion and exclusion criteria to identify suitable participants. We grounded our computations on a formula commonly used in epidemiological studies to determine appropriate sample sizes, as follows:

n = N ∗ X/(X + N − 1)

In this formula, ‘n’ represents the sample size, ‘N’ is the total population, and ‘X’ is a composite measure calculated as:

X = Zα/22 ∗ p ∗ (1 − p)/MOE²

Here, ‘Z’ is the Z-score, which corresponds to the desired confidence level (Z = 1.96 for a 95% confidence level). The term ‘p’ represents the estimated response rate or proportion (set at 0.5 or 50%, which is the most conservative estimate), and ‘MOE’ refers to the margin of error, which we established as 0.05 or 5%. This margin of error reflects the amount of random sampling error that can be tolerated.

Substituting the values into the formula, we derived:

X = (1.96)20 × 50 × 5/(0.05)2

This calculated ‘X’ was then used to determine the final sample size ‘n’ for our population of interest, estimated to be approximately 1800.

Through the careful computation of our sample size, we ensured that our study was adequately powered to detect meaningful differences in safety attitudes between our hospital-based and pre-hospital EMS groups. This, in turn, strengthens the reliability and validity of our findings and allows them to be generalized to the broader EMS population within our study region.

2.4. Participant Categorization

This study recognizes that certain medical professionals may operate in both hospital-based and pre-hospital settings, potentially blurring the categorization lines. However, for the purpose of this analysis, we have established a clear criterion to differentiate between the two groups.

Participants were categorized based on their primary workplace setting and their total years of experience in the EMS field. This helped to add an additional dimension to the analysis. If a practitioner spends a majority (>50%) of their working hours in a hospital-based setting, they were classified under the ‘hospital-based’ category. Conversely, if a majority of their working time is spent in a pre-hospital setting, they were classified under the ‘pre-hospital EMS’ category.

This clear delineation allowed us to maintain the distinctiveness of the two comparative groups. It also helped to ensure that the insights and experiences shared by the participants were primarily rooted in the categorized working environment, thus preserving the integrity of our comparative analysis.

2.5. Research Variables

Our survey adopted several validated scales to measure different aspects of safety culture. These scales have been previously utilized in safety culture studies and have been shown to have good reliability and validity.

Safety climate was evaluated using the Safety Attitude Questionnaire, a 7-item scale that measures employees’ perceptions and attitudes towards safety within their organization. Sample items include “I feel free to question the decisions or actions of those with more authority” and “In my workplace, it is difficult to discuss errors”.

Teamwork climate was assessed using the Teamwork Perceptions Questionnaire (TPQ), a 6-item scale that assesses perceptions of teamwork within a unit. Sample statements include “In this clinical area, it is easy for personnel to ask questions when there is something that they do not understand”.

Perception of management was gauged by the perception of management scale, a 5-item scale that measures the perception of management’s ability to prioritize safety. Sample items include “Management supports my daily efforts” and “Management does a good job of training new hires”.

Stress Recognition was evaluated by the stress recognition scale, a 4-item scale measuring the ability to recognize personal stress and its impact on performance. Example items include “I am less effective when fatigued” and “Stress from personal problems affects my performance”.

Working conditions were evaluated by the working conditions scale, a 4-item scale measuring perceptions about the working environment. Sample items include “Our levels of staffing are sufficient to handle the number of patients” and “I have the resources (e.g., people, materials, rooms) needed to provide quality patient care”.

Job satisfaction was assessed by the job satisfaction scale, a 4-item scale measuring overall job satisfaction. Sample items include “I like my job” and “Working here is like being part of a large family”.

2.6. Data Collection

The data for our study was systematically gathered using the Safety Attitudes Questionnaire. This robust instrument was deployed to measure and compare key elements of safety awareness among emergency medical services practitioners in Riyadh. We adapted the SAQ for our study population, focusing on several subscales including safety climate, teamwork climate, perception of management, stress recognition, working conditions, and job satisfaction. We used a 5-point Likert scale to assess each of these aspects, providing a comprehensive view of our participants’ perspectives and experiences.

Before beginning data collection, we undertook several preparatory steps to ensure an efficient and ethical process. We briefed the head of the emergency department at the participating hospital about the research objectives and the plan to involve their pre-hospital care providers. Upon obtaining administrative approval, we visited the hospital on a scheduled date to interact with potential participants.

During this visit, we clarified the study’s objectives, methodology, and potential implications to prospective participants. Prioritizing transparency and informed consent, we furnished each individual with a written consent form that thoroughly explained the scope of their participation, their rights as research participants, and the measures we had taken to ensure confidentiality.

After consenting, participants received an online questionnaire link via WhatsApp or email, enabling them to complete the SAQ at their convenience during the same session.

For our study, we utilized the SAQ version referenced in Venesoja et al., (2021) [5]. Although originally written in Finnish, this version was carefully translated into English. We then tested the psychometric properties of this translated version to confirm its validity and reliability for our study population.

The survey tool used in our study has been widely validated in numerous prior studies. For our specific sample, we calculated Cronbach’s alpha for each subscale of the SAQ to ensure its internal consistency. All subscales demonstrated a Cronbach’s alpha above 0.7, which is generally accepted as a good level of reliability.

This methodical approach to data collection and instrument selection ensured a comprehensive and trustworthy evaluation of safety awareness among our study participants, thereby reinforcing the validity of our findings.

2.7. Data Analysis

Data gathered from the survey responses underwent rigorous analysis via appropriate statistical methods to yield meaningful and relevant results.

An independent t-test was used as a comparative tool to evaluate the differences in safety awareness levels between hospital-based EMS professionals and their pre-hospital counterparts, while a one-way analysis of variance was used to analyze the effect of years of experience on safety awareness. The independent t-test was chosen because it is suitable for comparing the means of two independent groups, which in our case were hospital-based and pre-hospital EMS professionals. The key assumption made here was that the data from both groups were normally distributed and had equal variances.

This test was applied to gauge the effect of participants’ work experience on their safety awareness. Differences were considered statistically significant at p < 0.05.

Further enhancing the depth of our analysis, Pearson’s correlation coefficient was utilized. Pearson’s correlation was used because it is a measure that reflects the strength and direction of a linear relationship between two continuous variables. This measure was calculated for variables such as participants’ gender and various components of their professional experience, including safety climate, teamwork climate, perception of management, stress recognition, working conditions, job satisfaction, and overall safety awareness. The assumption behind using Pearson’s correlation is that the variables are normally distributed and there is a linear relationship between each pair of variables.

Beyond the univariate analyses, we also conducted multivariate logistic regression to identify the predictors of safety awareness among the participants. All variables that were significant at p < 0.20 in the univariate analyses were included in the multivariate model. This method allowed us to control for potential confounding variables and identify independent predictors of safety awareness.

All statistical analyses were performed using SPSS version 28 (Statistical Package for the Social Sciences), a widely accepted and utilized software for conducting complex data manipulations and analyses in social science research. This software’s advanced features and functionalities facilitated the execution of robust and reliable statistical tests, thereby enhancing the validity and reliability of our research findings.

2.8. Ethical considerations

Institutional review board (IRB) approval was obtained from the King Saud University Research and Ethics Committee (Ref No: KSU-HE-22-500).

3. Results

This section is dedicated to examining the hypotheses and providing robust statistical answers to the research questions proposed in this study.

Our dataset underwent a thorough analysis using the IBM SPSS Statistics software package (version 25.0). This advanced statistical software allows for the use of multiple analytical procedures, ensuring a precise and comprehensive assessment of the data.

The SPSS software package was selected for its capability to offer a range of data analysis techniques suitable for our study. These techniques include basic descriptive statistical procedures such as frequency analysis and means, and more complex inferential statistical methods like t-tests and correlation analysis. These tools facilitated our understanding of safety awareness levels among EMS practitioners in Riyadh.

This analysis served to statistically validate our research queries and helped to create a broader understanding of the current state of safety awareness within Riyadh’s EMS sector. Additionally, the analysis enabled the identification of any potential patterns or trends, which are discussed in the subsequent sections.

All data handling and analysis processes strictly adhered to ethical guidelines, ensuring the confidentiality and privacy of all participants. The results derived from this analysis are presented and interpreted in the following sections of this chapter.

3.1. Reliability and Validity

The statistical consistency and internal reliability of our study were determined through the calculation of Cronbach’s Alpha values for each of the assessed variables. Cronbach’s Alpha is a widely accepted statistical tool used to measure the internal consistency or reliability of a test score for a sample of examinees.

Table 1. Reliability statistic.

Variable	Cronbach’s Alpha	Cronbach’s Alpha Based on Standardized Items	N
Safety Climate	0.83	0.83	7
Teamwork Climate	0.82	0.82	6
Perception of Management	0.72	0.73	5
Stress Recognition	0.73	0.73	4
Working Conditions	0.80	0.80	4
Job Satisfaction	0.89	0.89	4

Note: Cronbach’s Alpha is a measure of internal consistency or reliability of a set of scale or test items. Values above 0.7 are generally considered acceptable. Cronbach’s Alpha based on standardized items is calculated similarly, but it uses standardized item scores. The ‘No. of Items’ column indicates the number of survey items used to compute Cronbach’s Alpha for each variable.

provides the reliability statistics (Cronbach’s Alpha and Cronbach’s Alpha based on standardized items) for the six measured variables: Safety Climate, Teamwork Climate, Perception of Management, Stress Recognition, Working Conditions, and Job Satisfaction. These scores are indicative of high internal consistency for all study variables, as a generally accepted rule of thumb in social science research is that a Cronbach’s alpha score of 0.7 or higher represents good internal consistency. Moreover, it is noteworthy to mention that Cronbach’s Alpha values remained the same when based on Standardized Items, further corroborating the reliability of the measures used in this study.

Alongside the Alpha values, the Table 1 also enumerates the item counts for each variable, which reflects the number of items in the questionnaire that pertain to each specific variable.

3.2. Participant Characteristics

The study involved 310 participants, all of whom are active EMS practitioners stationed in Riyadh, Saudi Arabia. The demographic profile of the participants in terms of gender, job title, place of work, and duration of work experience is summarized in

Table 2. Demographic statistics.

Characteristic	Frequency	Percentage
Gender
Men	258	83.2
Women	52	16.8
Job Title
EMT	33	10.6
Nurse	34	11.0
Paramedic	225	72.6
Physician	18	5.8
Place of Work
Hospital-based EMS	203	65.5
Pre-hospital EMS	107	34.5
Work Experience
<5 Years	164	52.9
5–10 Years	89	28.7
11–15 Years	35	11.3
16–20 Years	13	4.2
>20 Years	9	2.9
Total	310	100.0

Note: Summary of the demographic characteristics of the study participants, including gender, job title, place of work, and work experience. Frequencies and corresponding percentages are provided for each category.

.

The gender distribution among the participants was significantly skewed towards males, accounting for 83.2% of the respondents, with the remaining 16.8% being female.

In terms of professional roles within the EMS sector, the majority of the respondents were paramedics (72.6%), followed by nurses (11%), emergency medical technicians (EMT) (10.6%), and physicians (5.8%). The participants were also classified based on their place of work.

The majority were associated with hospital-based EMS (65.5%), while the rest were from pre-hospital EMS (34.5%).

Lastly, the distribution of work experience among the respondents was assessed. More than half of the participants had less than 5 years of experience (52.9%). The rest were divided among different experience categories: 5–10 years (28.7%), 11–15 years (11.3%), 16–20 years (4.2%), and over 20 years (2.9%).

These demographic characteristics helped ensure a diverse participant pool, facilitating a comprehensive understanding of safety awareness levels across different roles, workplaces, and experience levels within the EMS in Riyadh.

3.3. Inferential Statistics

An independent t-test served to investigate and compare safety awareness levels among hospital-based and pre-hospital EMS practitioners in Riyadh. Analysis outcomes disclosed no significant disparity in safety awareness levels.

Table 3. Safety awareness across workplace.

Variable	Hospital-Based EMS Mean	Pre-Hospital EMS Mean	Mean Difference	p-Value
Safety Climate	2.75	2.77	−0.02	0.38
Teamwork Climate	2.74	2.80	−0.06	0.21
Perception of Management	2.85	2.91	−0.06	0.13
Stress Recognition	2.75	2.77	−0.02	0.56
Working Conditions	2.85	2.88	−0.03	0.21
Job Satisfaction	2.80	2.88	−0.08	0.09
Safety Awareness (overall)	2.79	2.83	−0.04	0.33

Note: Mean difference is calculated by subtracting the pre-hospital EMS mean from the hospital-based EMS mean. The corresponding p-values are calculated using an independent t-test to analyze if there is any statistically significant difference between the two settings. A p-value of less than 0.05 is considered significant.

presents mean scores of different safety awareness measures, comparing the means of hospital-based EMS and pre-hospital EMS.

An additional independent t-test was employed to methodically scrutinize and compare the levels of safety awareness among the emergency medical services practitioners in Riyadh, taking into consideration their work experience (

Table 4. Safety awareness based on work experience.

Variable	Less than Five Years of EXP Mean	More than Five Years of EXP Mean	Mean Difference	p-Value
Safety Climate	2.68	2.85	−0.16	0.52
Teamwork Climate	2.70	2.82	−0.12	0.29
Perception of Management	2.88	2.85	0.03	0.60
Stress Recognition	2.73	2.78	−0.05	0.26
Working Conditions	2.82	2.90	−0.08	0.65
Job Satisfaction	2.80	2.86	−0.06	0.75
Safety Awareness (overall)	2.77	2.84	−0.07	1.0

Note: The mean difference is calculated by subtracting the mean for ‘more than five years of EXP’ from the mean for ‘less than five years of EXP’. The corresponding p-values are calculated using an independent t-test to analyze if there is any statistically significant difference based on the years of experience. A p-value of less than 0.05 is considered significant.

). This analytical approach was specifically selected because it allows for the comparison of mean scores between two independent groups, as in this case, EMS practitioners with different lengths of work experience.

The results of this statistical analysis intriguingly indicated that there is no significant difference in the safety awareness of EMS practitioners in Riyadh when stratified by their work experience (p = 1.0). This outcome implies that work experience does not significantly alter the safety awareness levels of these practitioners, suggesting that other factors might be more influential.

The computed total safety awareness mean score of the EMS practitioners with less than five years of experience was found to be 2.77. Meanwhile, the total safety awareness mean score for EMS practitioners who have accumulated five or more years of work experience stood at 2.84. The observed difference between these two groups, with a mean difference of just 0.07, is statistically insignificant.

As such, these findings clearly demonstrate the absence of any significant differentiation in the safety awareness of EMS practitioners in Riyadh when considering the length of their work experience. This outcome provides a substantial contribution to the understanding of safety awareness factors among EMS practitioners and the role of work experience in this context. It offers a foundational platform for further investigations to explore other potential influences on safety awareness in the EMS field. Table 4 presents the comparison of safety awareness measures based on years of professional experience. Mean scores are calculated for practitioners with less than five years of experience versus those with more than five years of experience.

3.4. Correlation Analysis

The correlation between the gender of participants and variables such as safety climate, teamwork climate, perception of management, stress recognition, working conditions, job satisfaction, and overall safety awareness was computed using the Pearson correlation coefficient. The results of this analysis indicated no significant correlation between gender and safety awareness, as detailed in

Table 5. Correlations among study variables.

	1	2	3	4	5	6	7
Gender	-
Safety Climate	−0.001	-
Teamwork Climate	0.033	0.757 **	-
Perception of Management	0.047	0.690 **	0.704 **	-
Stress Recognition	0.137 **	0.446 **	0.466 **	0.579 **	-
Working Conditions	−0.044	0.675 **	0.646 **	0.735 **	0.447 **	-
Job Satisfaction	−0.069	0.627 **	0.606 **	0.639 **	0.331 **	0.767 **	-
Safety Awareness	0.016	0.846 **	0.841 **	0.877 **	0.658 **	0.875 **	0.823 **

Note: **. Correlation is significant at the 0.01 level (2-tailed). Correlation matrix presenting the relationships among gender and safety awareness variables. Each cell contains Pearson’s correlation coefficients (r), indicating the strength and direction of the relationship between two variables. Coefficients range from −1 to 1, with values close to −1 indicating a strong negative correlation, values close to 1 indicating a strong positive correlation, and values close to 0 indicating no correlation.

. Only a positive and statistically significant correlation was found between gender and the stress recognition variable.

The rows of the Table 5 represent the correlating variables, and the columns represent the variables that they are compared with. The correlations are determined by Pearson’s correlation coefficient, and ** indicates that the correlation is significant at the 0.01 level (2-tailed).

In this Table 5, the term “Safety Awareness” refers to the composite score of the SAQ, which includes safety climate, teamwork climate, perception of management, stress recognition, and working conditions. The numbers 1–7 represent the seven variables used in this study: 1—Gender; 2—Safety Climate; 3—Teamwork Climate; 4—Perception of Management; 5—Stress Recognition; 6—Working Conditions; and 7—Job Satisfaction. The cells in the Table 5 show the correlation coefficients between each pair of variables, with the significance level noted where applicable. For example, the correlation between Safety Climate and Teamwork Climate is 0.757, significant at the 0.01 level (2-tailed).

This study aimed to explore the relationship between the safety awareness of Riyadh’s EMS practitioners and factors such as their workspace, gender, and work experience. However, the study found no statistically significant difference in safety awareness among practitioners working in different settings (pre-hospital emergency medical services versus hospital-based EMS). Additionally, the results showed no significant disparity in safety awareness based on the gender or work experience of participants.

4. Discussion

Our research is a significant endeavor in the empirical understanding of safety awareness among healthcare practitioners within Riyadh, Saudi Arabia, paying particular attention to EMS practitioners. Our study ventures into underexplored terrain by comparing hospital-based and pre-hospital services, thereby highlighting the nuanced differences in safety awareness influenced by workplace environment, gender, and years of professional experience.

While our research has widespread implications for the healthcare sector of Saudi Arabia, it is instrumental in further enriching the extant knowledge of safety culture within EMS services. Notably, the homogeneity of safety awareness among EMS practitioners in Riyadh could contribute to overall patient safety outcomes, a finding that aligns with the insights from comparable studies in other contexts, such as the work by Heidari et al. in the field of artificial intelligence applied to medical diagnosis [15].

Our findings, in spite of methodological constraints such as the sample size and the geographically limited scope, offer potential strategies for improving safety culture. Specifically, these include enhancing resilience in healthcare systems, similar to the resilience measures suggested in Kuzior et al.’s study on smart cities in the context of sustainable development [16].

Given the importance of safety culture, it is crucial that we understand and address the factors influencing its development and maintenance. The insights from this study provide a robust understanding of safety awareness, laying a strong foundation for future policy-making efforts aimed at strengthening safety culture within healthcare, similar to the call for food systems informatics as proposed by Tomich et al. to improve smart and connected regional food systems [17]. This could potentially lead to substantial enhancements in patient care outcomes.

The utilization of the EMS-Safety Attitudes Questionnaire in our research offers a robust and empirically validated methodology to gauge safety awareness [1]. The tool’s capability to aid in the evaluation of safety culture, both before and after the implementation of safety improvement initiatives, renders it an essential measure of program effectiveness.

Upon analysis via an independent t-test, our study indicates no significant differences in safety awareness between EMS practitioners in hospital-based and pre-hospital environments. These results are in alignment with prior research, including, notably, the study by Aboshaiqah et al. [18], which found a high level of safety awareness among Saudi healthcare practitioners.

The findings of our study harmonize with the broader body of research. For instance, an international systematic review of patient safety culture in pre-hospital care argues that such an analysis is fundamental to our understanding of the broader healthcare sector [19]. Like our research, this review inferred a wide spectrum of understanding and perceptions of safety culture among healthcare providers, mirroring the lack of significant difference we found in safety awareness between hospital-based and pre-hospital EMS practitioners [19].

Further substantiating our findings, research conducted in Qatar and India, respectively, found no significant difference in the level of safety culture awareness between male and female healthcare workers and between nurses with less than five years of experience and those with more, thereby corroborating our conclusion that gender and work experience do not significantly impact the level of safety awareness [20,21].

Our research also aligns with the outcomes of a comprehensive study conducted in 2011 [22], which examined paramedics’ perceptions of safety culture across various European countries. This study concluded that while safety culture varies considerably within EMS organizations, no significant differences were found in relation to gender or work experience. This supports our conclusion that these factors do not significantly influence safety awareness among EMS practitioners in Riyadh, Saudi Arabia.

Interestingly, our research also explored the influence of work experience on safety awareness among EMS practitioners. Contrary to conventional assumptions, our results indicated that work experience does not significantly influence safety awareness.

In the investigation of the impact of gender, the research identified no substantial link between gender and safety awareness among EMS practitioners. This discovery contrasts with some prior research, which suggested women might have higher safety awareness due to inherent empathetic tendencies [23]. The lack of empirical support for such a correlation in our study underscores the necessity for further exploration into the complex role gender plays in healthcare safety awareness [24,25].

Our study adopted an exhaustive approach to probe the association between gender and safety awareness, incorporating an array of variables including safety climate, teamwork climate, perception of management, stress recognition, working conditions, and job satisfaction. However, our data analysis established no clear link between the type of EMS service (hospital-based vs. pre-hospital) and safety awareness within the specific context of Riyadh. Thus, our study extends our comprehension of safety awareness in healthcare services to include EMS practitioners in Riyadh, Saudi Arabia.

The findings of our study underscore the need for an all-inclusive approach to safety awareness in healthcare services, irrespective of gender, experience, or workspace. Despite not finding any significant differences in safety awareness based on these variables, our study emphasizes the elemental importance of fostering a safety culture that permeates all sectors of healthcare.

Our study, with its extensive scope, urges us to delve deeper to identify a diverse range of influences that foster a robust safety culture. It acts as a stimulant for policymakers, administrators, and educators, promoting the concept of nurturing safety awareness as an integral part of the healthcare ecosystem, extending uniformly across both hospital-based and pre-hospital settings.

This research also underscores the enduring necessity for ongoing education and training programs centered around patient safety [26,27,28,29,30,31,32]. It emphasizes the need to introduce novel strategies that embrace all healthcare providers, irrespective of their years of service or their operational environment. The uniformity of safety awareness identified in our study necessitates a unified approach to its enhancement, stimulating the need for universally accessible and applicable patient safety training modules.

Our research illuminates the universality of safety awareness among healthcare providers in Riyadh, Saudi Arabia, thereby signaling a call to action for the healthcare industry. The need to elevate safety culture remains an ever-present objective that necessitates concerted efforts from all stakeholders [33,34,35,36,37,38]. Therefore, the insights from this study act as a clarion call, urging us to continually strive for the advancement of safety culture in healthcare, steering us towards a safer future for all.

5. Limitations

While this study significantly contributes to the understanding of safety awareness among healthcare providers in Saudi Arabia, it is important to acknowledge some limitations that may have influenced the results. Recognizing these limitations will be instrumental in guiding future research endeavors.

Firstly, the decision to exclude the Saudi Red Crescent Authority (SRCA) might have affected the depth of our understanding of EMS safety awareness. The SRCA plays an important role in Saudi Arabian EMS and their perspective could have been valuable. Future investigations should consider including such organizations for a more comprehensive perspective.

Secondly, the design of the study was cross-sectional, and it was conducted within a relatively short timeframe. This may not accurately capture the dynamic and evolving nature of safety awareness among healthcare providers, especially as practices and policies might change over time. This suggests the potential benefits of conducting longitudinal studies in future research to better understand the trends and changes in safety awareness over time.

Thirdly, we acknowledge that the participant demographic was significantly imbalanced, with only 18% being women. This imbalance could affect the comprehensiveness of our findings, as they might not fully represent the views and experiences of women in EMS. There is a need for future research on the cultural, societal, and operational factors that influence female participation in Saudi Arabian EMS.

Additionally, while our study successfully demonstrated correlations between different variables, the design of the study limits our ability to establish causation. We recommend that future research consider incorporating more complex analytical methods such as regression or path analyses to enable a more nuanced understanding of these relationships.

Another significant limitation is the potential language barrier and the possibility of response bias. While we translated the questionnaire from English to accommodate non-English speaking participants, we understand that there might be nuances lost in translation. Furthermore, given that the data collection was based on self-reported measures, there might be a potential for response bias which could affect the authenticity of the results. Future studies should address this by exploring other methods of data collection, such as observational or interview methods.

Finally, as our study focused solely on Riyadh, it might restrict the generalizability of our findings to different regions of Saudi Arabia. Given that different regions may have unique cultural and operational contexts that could influence safety awareness practices and perceptions, it would be important for future research to consider expanding the geographical scope of their studies.

6. Conclusions

This research unveils a consistent level of safety awareness among healthcare providers in Riyadh, regardless of work environment, gender, or tenure. This uniformity is a testament to the deeply ingrained safety culture in the healthcare sector, marking a successful effort in establishing a strong safety ethos in Riyadh.

Our findings challenge common assumptions, asserting that gender and professional experience do not significantly alter safety awareness levels among healthcare providers. This revelation prompts a necessary reevaluation of pre-existing beliefs within this context. Moreover, these insights provide a platform for developing and implementing novel strategies for cultivating an inclusive safety culture, not unlike the innovative approaches discussed in other relevant fields.

Adopting an established safety culture tool for the EMS setting, our study provides a blueprint for future research and interventions aiming to elevate the safety culture. It illustrates the potential for a pervasive patient safety culture in healthcare systems, irrespective of varying workplace conditions, genders, and experience levels.

Building upon these insights, we recommend that healthcare organizations and policymakers persist in their efforts to establish and maintain a robust patient safety culture, with regular training and swift response strategies playing a critical role in ensuring its resilience. The importance of such an approach, particularly in times of crisis, cannot be overstated.

The integration of rapid response strategies into the current patient safety culture could fortify the healthcare system, fostering a resilient, adaptable environment capable of managing unexpected scenarios. We urge the consideration of novel strategies such as those implemented in the context of sustainable smart cities and connected regional food systems. This step is crucial, and the need is immediate.

In summary, our study emphasizes shared safety awareness across the healthcare sector in Riyadh. This consistent understanding holds the potential to reinforce patient safety culture, ultimately boosting patient care outcomes. The call to action is clear and urgent. This consistency underscores the importance of continued and coordinated efforts from all stakeholders in the healthcare industry, mirroring the need for a concerted response to pressing issues in other sectors.