Background: Post-Traumatic Stress Disorder is characterized by directly experiencing traumatic events or witnessing, learning, or repetitively experiencing the details of these events. High risk occupations (i.e., EMS personnel) frequently encounter traumatic eventscoping with events exceeding the range of human experiences. Regional lack of studies necessitated the need to report the prevalence of PTSD among healthcare providers in Saudi Arabia (SA). Aims and Objective: To explore the prevalence of PTSD among EMS personnel. Materials and Methods: This a descriptive cross-sectional study at King Abdul Aziz Medical City (KAMC), Riyadh, SA among 110 paramedics, emergency medical technicians (EMT), and ambulance drivers who were conveniently selected for this screening. Post-Traumatic Stress Disorder Checklist, the Civilian version, (PCL-C) was used to screen the participants, and cut-off point was 30-35. PTSD symptoms (present & absent) was considered as outcome measure. Results: Total of 110 participants were contacted, 74 (67%) agreed to participate. Around half of the participants were EMT (52%). Total number of screened individuals is 52, 14 (26.9%) had positive screening, of those, EMT had higher proportion than paramedics (32% vs 20.8%). Conclusion: This report is the first PTSD prevalence among healthcare providers in SA. The results showed that 26% of EMS personnel had positive screening for PTSD. Attention should be directed toward this issue by regular psychological evaluation and implementing psychological rehabilitation programs for EMS personnel. The study reflects only one center in the city, thus generalization would not be inappropriate.

Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia’s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020‐2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18‐44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. “Unavailable subspecialty” was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy.

Background: Healthcare systems globally face complex challenges including rising costs, increasing chronic disease burden, and fragmentation of care. Systems-based models represent promising approaches to healthcare transformation, yet their implementation remains incompletely understood. Objective: To critically analyze the Saudi model of Care (MoC) as a case study of systems-based healthcare transformation, examining its conceptual framework, implementation strategies, and projected health outcomes. Methods: We conducted a narrative review synthesizing publicly available official documents on the Saudi MoC, primarily the 2017 overview and 2025 revision, identified through targeted searches of Ministry of Health websites and grey literature portals (no date restrictions); formal quality appraisal was not applied as sources were official policy documents, with bias mitigated through cross-verification and critical analysis. Results: The Saudi MoC exemplifies systems-based transformation through its multi-layered framework organized around six patient-centered systems of care spanning the lifecycle. Key innovations include: (1) an architectural approach integrating activated individuals, healthy communities, virtual care, and traditional clinical settings; (2) a comprehensive intervention taxonomy with 42 specific initiatives; (3) explicit contextual adaptations for diverse settings; and (4) a phased implementation approach with detailed performance metrics. National indicators improved during the reform period, including life expectancy and maternal and child health. These are national trends observed during the period of health reforms. Causal attribution to the Model of Care requires a counterfactual evaluation. Conclusions: This analysis of the Saudi MoC contributes to the literature on systems-based healthcare transformation by illuminating how theoretical principles can be operationalized at national scale. The model’s patient-centered design, comprehensive intervention taxonomy, and attention to implementation factors offer valuable insights for other healthcare systems pursuing transformation. Further research should examine actual implementation outcomes as the model matures.

Background: This study aimed to investigate the relationship between patients with severe sepsis or septic shock being transported to the Emergency Department (ED) by Emergency Medical Services (EMS) and the compliance with the 3-h sepsis resuscitation bundle [Surviving Sepsis Campaign (SSC)], and to compare the management and laboratory results of patients transported by EMS or non-EMS transport. Methods: A retrospective cohort study was conducted using data from a quality-improvement project at King Abdulaziz Medical City in Riyadh. The data for patients who presented to ED with sepsis (severe sepsis or septic shock) was categorized as being transported with EMS or non-EMS. The two groups were compared in terms of compliance with the SSC bundle and 30-day mortality. Results: In a sample of 436 patients with severe sepsis or septic shock presented at the ED during the study period, EMS transported almost one-third of the patients (134, 31%) and 302 patients (69%) used non-EMS transport. For the EMS group, adherence to intravenous fluid was 91.4% compared with 87% for the non-EMS group (p = 0.19), antibiotics (EMS 50.7% vs non-EMS 52%, p = 0.81), blood cultures before antibiotics (EMS 53% vs non-EMS 47.4%, p = 0.21), and measuring lactate levels (EMS 73.1% vs non-EMS 57%, p = <0.01). The mortality rate was 48.5% for the EMS group and 54% for the non-EMS group, which was not statistically significant. Conclusion: Whether transported with or without EMS did not result in a statistically significant difference in patients presenting with sepsis, in terms of the adherence to the SSC bundle elements or the 30-day hospital mortality rate. The only statistically significant difference was the time to lactate measurement.

Background/Objectives: Saudi Arabia implemented the Saudi Medical Appointments and Referrals Centre (SMARC) e-referral system to coordinate patient transfers and enhance healthcare access across the country. This nationwide system was established to improve coordination between healthcare facilities and provide timely access to specialized services. SMARC operates as a centralized coordination hub connecting secondary and tertiary care facilities across all specialties nationwide. This study evaluates SMARC’s evolution since 2020–2021 and efficiency improvements through 2023–2024 after major expansion efforts. Methods: This retrospective analysis examined 755,145 e-referrals across all 13 administrative regions of Saudi Arabia during 2023–2024. The study analyzed data extracted from the SMARC database covering two consecutive years. Outcomes assessed included acceptance rates, referral destinations (internal within the same region vs. external to other regions), and factors associated with system performance. Results: The total volume of e-referrals through SMARC increased substantially by 19.34% to 755,145 in 2023–2024. Acceptance rates for referrals improved markedly from 74.13% to 90.19% over this period. The proportion of internal referrals increased from 80.13% of total referrals to 87.52%. In contrast, external referrals to other regions declined from 19.87% to 12.48% of the total. Critical care referrals (ICU, CCU, NICU, PICU) decreased from 12.39% to 9.91%. Referrals for life-saving emergency conditions showed a noticeable decrease from 6.65% to 2.18%. Referrals to hospital outpatient departments (OPD) also showed an increase from 48.07% to 66.66% of total referrals. Conclusions: SMARC demonstrated considerable improvements in key metrics including referral acceptance rates and growth in regional self-sufficiency. This progress is associated with the Kingdom’s goals for advancing its healthcare system under Vision 2030 initiatives. The system has enabled more effective care coordination and access to specialized services across regions. These achievements were observed during a period of significant healthcare infrastructure expansion documented during this period, including growth in specialized centers, increased ICU bed capacity following governmental regulation after the COVID-19 pandemic, and expansion of trained medical subspecialists.