Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Prehospital emergency care (PEC) systems vary widely in structure, capacity, and stage of development, and existing evaluation tools are not tailored to the contextual needs of Southeast Asia. To address this gap, the Prehospital Emergency Care System Evaluation Tool (PECSET) was developed as a 32-element, consensus-derived framework to support system assessment, prioritization, and quality improvement. The objective of this study was to evaluate the prospective acceptability of the PECSET framework among Southeast Asian prehospital stakeholders using the theoretical framework of acceptability (TFA) and to identify regional variation in implementation priorities.

Methods: We conducted a cross-sectional survey of PEC professionals from the Philippines, Thailand, Vietnam, Indonesia, and Malaysia between April 2023 and June 2024. Participants were recruited from six resuscitation training conferences and attended a standardized two-hour educational session before completing an anonymous survey mapped to TFA constructs. We assessed differences between countries using Pearson chi-square tests. Our primary outcome measure was acceptability scores across five TFA domains (affective attitude, intervention coherence, opportunity costs, self-efficacy, and perceived effectiveness). Secondary outcomes included identification of high-priority implementation elements.

Results: Participants (N = 274; 66% response rate) included physicians (46%, n = 126), prehospital professionals (30%, n = 82), and medical directors (15%, n = 41). Intervention coherence was high: 92% to 100% of participants were likely or extremely likely to use PECSET for quality improvement. However, geographic variation existed; a small subset in Indonesia and Vietnam (n = 6) reported they were “unlikely” to use the tool, compared to none in Thailand, Malaysia, and the Philippines (P = .04). Regarding self-efficacy, while 100% (n = 274; 95% CI, 98-100%) reported confidence in application, only 20% (n = 55; 95% CI,15-25%) were “extremely confident.” Affective attitude was positive, with 97% (n = 266) intending to integrate the tool; only Vietnam (n = 4; 5% [95% CI, 2-10%]) and Indonesia (n = 2; 2% [95% CI, 0-13%]) indicated hesitation (P = .24). Secondary outcomes identified “layperson public awareness and education programs” as the top implementation priority across all five nations, although priorities varied.

Conclusion: The Prehospital Emergency Care System Evaluation Tool demonstrated high acceptability among potential end-users across Southeast Asia, indicating readiness for broader implementation and future evaluation of feasibility, fidelity, and system-level impact. As a stakeholder-informed evaluation framework, PECSET offers a practical approach to strengthening PEC systems in Southeast Asia and beyond.