Abstract

The World Health Organization has numerously recognized the increased importance of the emergency medical services. Specific accent is always laid on the fact that the overwhelming majority of the cardio and neuro-related diseases can be effectively tackled by the physicians if they are timely diagnosed by the emergency medical crew and resuscitative measures have been exercised to stimulate the heart of brain activity of the affected person. It is a widely known fact that the development of the healthcare system in general and of emergency medical services in particular in Saudi Arabia significantly distinguishes from the development and formation of the similar services in other countries. The aim of this paper is to outline the most important milestones of the development of the entire healthcare system of Saudi Arabia, to accentuate the importance of the emergency medical services in this country and to elucidate the characteristics of the modern development of this service in Saudi Arabia. Specific accent is made on the comparative analysis of the Saudi Arabian healthcare system and similar systems of the Western and American countries.

Introduction

The importance of the creation of the entire healthcare system has been recognized by the medieval rulers both of the Western and Oriental worlds. Shahs and sultans of Saudi Arabia are reported to have installed the first similar systems in the early VII century, when their European colleagues even did not consider the massive epidemic deceases of the population as one of the crying needs of their internal policy. 

With regard to the geographical factors that affected the general civilization development of Saudi Arabia, it can be stressed that climatic conditions was the major one, which influenced the creation of the highly developed system of local hospitals and carriages entrusted with the task to deliver those diagnosed with various ailments. Moreover, specific attention shall be laid to the fact that grave ailments were always present in the Saudi Arabia region. The ordinary population of the state formations of this region constantly suffered from leprosy, cancer, heart attacks, small pox and other contagious and non-contagious diseases. Following the endemic scopes of the infection, ancient rulers of Saudi Arabia fully comprehended the necessity to establish health care units capable of providing expedient and most importantly effective health care services.                            

Nowadays, Saudi Arabia is known to be one of the largest countries of the Middle East, and with regard to the extensive oil supplies of the country, it can be counted as the major economic driving force of the region. While with the advent of the new millennium, the importance of the development and heavy direct investments into the healthcare system in general was recognized and conducted by the authorities of Saudi Arabia (it is reported that in the period between 2003 and 2008, approximately, 4% of the entire gross domestic product was invested to this area). In 2006, the upgraded and modernized healthcare facilities and professionalism of the medical and paramedical staff of the system brought tremendous results and the country was ranked to be the 26 world’s best healthcare system, leaving behind the countries of Europe and the United States of America as well. Simultaneously with the growth and everlasting modernization of the healthcare system in general, the country heavily invested to the development of the emergency medical services in particular. As a matter of fact, it is necessary to emphasize the fact that the development of the emergency medical services is integrally connected with the development of the overall healthcare system of the country.                                 

The first officially documented emergency medical services were the part of the military troops conquering the Arabian Peninsula under the banners of the prophet Mohammad. The main functions of those institutions included the responsibility to transfer injured soldiers from the battlefields to the surgeons or other physicians to heal their wounds. Special attention was given only to surgical intervention and the researchers’ report that since no ways to eradicate the infection was known to the physicians. If a wounded one was lucky enough, the lethal contagious ailments did not affect him/her and he/she ultimately recuperated. If, in the course of a surgery, he or she was infected with any virus, the probability of dying from job infection or from the related disease was considerably high.

Early Development of Emergency Medical Services in Saudi Arabia

In 632, with the assumption of power by one of the closest associates of Prophet Mohammad, Abu-Bakr chaotically established check-points of the urgent medical aid for the military were systematized and the medical service of the army even received special regalia, which helped to distinguish them from the rest of the army units. At this period of the medical development, it has been explored that the entire healthcare system, although still rudimentary with regard to the available tools and methods applied by the practicing physicians was heavily influenced by the relatively developed healthcare system of the Persian Empire. In particular, the surgical methods and the basic orthopedic techniques and methods were imitated by the Arabian emergency physicians. Moreover, there are a variety of documented reports that the early military leaders of Saudi Arabia region including Prophet Mohammad himself and his chiefs included professional Persian healers to provide medical assistance to the army and to train the emergent medical workers of the Saudi army.  

Overall, it can be assumed that all sectors of the early emergency medical services of the Saudi Arabia were in the rudimentary state in comparison with their Persian colleagues. However, at the same time their medical accomplishments allowed to advance their European colleagues.

Moreover, when urgent medical assistance was provided to the member of the injured combatants on the battlefield or to the ordinary citizens, in contrast to their Persian colleagues, the physicians and the paramedics did not consider the religious factor. Naturally, the Lord was prayed and implored about the promptest recuperation about the deceased one, but all necessary surgical, orthopedic and therapeutic actions were done to accompany the prayers.

The Middle Ages

With the solidification of the state institutions and with the overall state development of the country, the need to enhance the existing healthcare institutions in general and emergency medical services in particular, clearly emerged for the rulers of the country. In 1213, in the midst of the devastating European crusades to the territories of the neighboring Jerusalem and Palestine, the existence of the emergency medical services in the kingdom was officially recognized and stately fixed. The person responsible for the service was appointed by the Chief Physician of the Court. Although, directly there is no causation between the bloody crusades and the development of the emergency healthcare establishments of the domestic Saudi medical infrastructure, marginally the crusades exercised great impact on the medical evolution of the Saudi Arabia Kingdom. In particular, the army of Muslims hired the doctors from the territories controlled by the Saudi Arabia leaders. The experience, they got in the course of the crusades, substantially contributed to their professional development. They adopted the experience, which had been previously accumulated by their Syrian colleagues, who occurred to be chief medial forces of the Muslim army and whose system of emergence medical care was indeed impeccable for that time. Moreover, when the truce was concluded, the Arabian emergency medical workers had ample opportunities to get in contact with their European colleagues.

Overall, the middle age period was remarkable for the development of the medical institutions of Saudi Arabia in general and emergency medical services in particular. Sultan Ali ibn Abi Talib was among the major contributors and the benefactors of the healthcare system. In 1232, he was the first who included the emergency medical services costs into the state budget of the country and special treasury agent was appointed to supervise that the allocated costs were utilized in accordance with their purpose. Moreover, a sophisticated system of facilities (temporary medical centers) was erected throughout the country. Medical school with basic preparatory courses for those willing to become “paramedics” (the aides of the professional physicians) were scattered throughout the country. 

However, the access to medical elite was very selective. The educational system designed to prepare future doctors and physicians did not exist that time. In order to become a doctor, willing people had to apply for a pupillage and then for an apprenticeship with a practicing physician. The physicians took the interns only if they could provide themselves with meals and the rest of their basic needs or they agreed to aliment the applicants, but only the most talented ones.  Ibn S%u012Bn%u0101 (980 – 1037) was among those who broke his way out by his diligence and ardor. When he became one of the most renown and well-received physicians not only of Arabia but of the entire Oriental World as well he was among the most ardent henchman of overall installation of the emergency healthcare checkpoints across the country.          

Overall, it can be concluded, that while the need to cultivate the healthcare emergency facilities system was fully comprehended by the rulers of the state formations of the middle-aged Saudi Arabia, the level of technology and limited competence of the medical staff were the major impediments for the delivery of the highly professional medical services for the nation.

The Ottoman Expansion and its Impact on the Development of the Emergency Healthcare Establishments

With the Ottoman conquest of the majority of the Saudi Arabia sovereign territories in 1517, the development of the emergency health institutions of Arabia skyrocketed. In accordance with the popular opinion of the scholars, that dynamic rise can be easily explained. In particular, it is always highlighted that since the Ottoman Empire was expansive in its nature and occupied territories from Southern Spain to Arabia, there was a unique opportunity for the medical community to combine Western and Eastern experience and approaches of emergency medical help. The shahs appointed from the close entourage of the Ottoman sultan quickly realized the importance and the possible consequences of the combined approaches. What is nowadays widely practiced among the educational institutions all over the world was installed by the Chief medical workers of the Kingdom. Being more exact, under the sway of the Ottoman Empire, the emergency medical servants had broad opportunities to get consulted with their advanced Western colleagues. Moreover, there is a convergent opinion of the historians that the physicians of the Istanbul Sultan´s court were the most accomplished and professional medical workers of that times. Therefore, being closely connected with the Porte, the development of the healthcare medical system in general and emergency medical services in particular progress fundamentally.  

The Rise of Wahhabis and its Impact on the Emergency Medical Services

In 1744, the first Islamic state was founded by Muhammad ibn Abd-al-Wahhab, who proclaimed the independence of the Saudi Arabia from the “invasive” dominance of the Ottomans. The achievement of independence contributed positively to the development and rise of the state organs and inherently genuine Arabian culture, but severance of connections with Istanbul impacted negatively the evolution of medicine in the region. With the spread of the Wahhabis ideology, the diseases were to be treated in accordance with the postulates of the Islamic law outlined in Quran and other legitimate sources of Islam. With regard to the peculiarities of the emergency medical services, it shall be reported that the abandonment of the kingdom by the vast majority of the Ottoman healthcare practitioners had very bad influence on the system. First and foremost, following the pleas of the religious leaders, the rulers of the kingdom deliberately demolished the existing facilities and the emergency infrastructure. While under the rule of the Ottomans, a physician with his team was summoned to a patient, the advent of the Wahhabis signaled that the help, both spiritual and medical would be provided by the mullahs. Overall, the decline of the healthcare system, which lasted to the first half of the 20th century commenced under the rule of the Wahhabis.

The Advent of the 20th Century and Medical Revolution

1916 was one of the most important years in the entire history of the Arab Peninsula. The Bedouin army led by the caliph of Mecca overthrew the rule of the Ottoman Empire. The revolutionary movement was heavily supported by the governments of France and the United Kingdom. Another way of European experience integration took place, since the revolutionary army was reinforced by the medical platoons of the Royal Army of GB and medical divisions of the French Foreign legion. While the revolution was underway, the medical staff of the newly-born Arabian kingdom had ample opportunities to get integrate Western experience. Under the meticulous supervision of the British agents first relatively modern hospitals were created on the territories of the Kingdom.

When the revolution was over, a number of important cooperation agreements were concluded between the government of the newly-born kingdom and its European partners.  Under those agreements, European healthcare practitioners migrated to the Kingdom.                

One of the landmark events took place in 1926, when the General Protectorate for Aid and Health was established. The directive, which stipulated the existence of the protectorate, equally created legal grounds for financing of the project. It was stipulated, in particular, that medical school shall be established in the kingdom. Special department of the school was charged with the task to train highly professional for the needs of the medical industry.  Special attention shall be laid on the fact that in 1931, the emergency medical service was denoted as a separate division of the health ministry. The training of the general practitioners was reported to be significantly different from the training of the staff for this service. While the medics and paramedics of the emergency crew were trained, their resuscitation skills and their abilities to make surgeries under extreme circumstances were cultivated additionally.  The staff were trained both domestically and took internships with the leading European healthcare institutions.

Year 1954 was notable for the creation of the Ministry of Health. Within the next decade, rich oil reserves of the kingdom were exploited and the country started to accumulate immense wealth. The economic boom of the country started. Alongside with the oil supply contracts, the Ministry of Health entered into a number of covenants of vital importance for the medical industry. It is important to mention that year 1964 was the most important for the entire emergency medical services of the country, since the budgetary funds for the existence of this institution were allocated in a separate fund. With the abundant financial support from the government, the emergency medical department launched set of various initiatives with the aim to improve the quality of the delivered services. Most importantly, new cars and portable medical facilities were purchased and all emergency crews were equipped with such armament.

Another important accomplishment took place in 1970, when National Development Plan was adopted. In accordance with the plan, healthcare industry received 13% of the entire Saudi Arabia budget funds. Bearing in mind the fact that Saudi Arabia was ranked among the richest countries, it can be inferred that the healthcare sector was one of the most heavily financed.  Emergency Medical Aid was ultimately formed as a separate division of the Ministry of Finance, with its separate governance, training programs and international partners.

Since 2000, the Emergency Medical Aid programs of Saudi Arabia are booming. Every five years the equipment of the mobile emergency crews is fully renovated and the staff is retrained. The Department, under the millennium development program concluded a number of agreements with the United Kingdom, the European Union, and the USA as well as with the leading Oriental countries. Those agreements provide that the crews of the emergency service take internships and preparatory programs with the leading clinics of those countries. Having returned to their homeland, Saudi physicians integrate their international experience to the domestic healthcare system.

Summary

Having recapitulated the main points of this research, several inferential conclusions can be drawn. Firstly, the start of the emergency medical services of the region was fully consistent with the cultural peculiarities and the geographical location of the kingdom. The medicine was rapidly developing; the country was subjugated by the Ottoman Porte due to the big territories occupied by the empire the availability of the international experience interchange.

The sway of Wahhabis religious fanaticism marked tremendous degradation of the medical service, since the majority of the available methods were proclaimed outlawed. New era of the medical revolution commenced with the Arab Revolution and relative secularization of the health care system.

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