Gastrointestinal bleeding care across hospital and EMS settings in the Almaty region: a cross-sectional survey of organization, practice, and service capacity

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Abstract
Background: Gastrointestinal bleeding (GIB), particularly upper gastrointestinal bleeding (UGIB), requires rapid coordination between emergency medical services (EMS) and hospital teams, yet evidence on how service organization affects timeliness and practice is limited in Kazakhstan. Aim: To evaluate the organization of GIB care in Almaty region, with emphasis on clinician knowledge and practice, EMS performance, and organizational features of hospital care. Methods: We conducted a cross-sectional survey between March and October 2024 involving two broad respondent groups and three distinct samples: a hospital-based group comprising 99 inpatient clinicians and 99 hospital representatives, and an EMS group comprising 120 personnel. The three samples completed different questionnaires and were analyzed separately. Descriptive analyses, chi-square or Fisher's exact tests, and exploratory Spearman correlations were used. Results: Inpatient clinicians showed near-universal agreement with guideline-based UGIB management principles, but self-reported adherence was inconsistent. Only 1.0% reported always using validated risk scores, and 99.0% reported only sometimes protecting the airway before endoscopy in patients with active hematemesis and altered mental status. In unadjusted respondent-level analyses, clinicians with ≥5 years of experience more frequently reported adequate training and perceived risk scores as useful (both p < 0.001). In the EMS group, all six respondents reporting arrival within 10 min were in the ≥16-team category (6/58, 10.3%; Fisher's exact p = 0.047). Reported ambulance-team availability showed a modest inverse correlation with continuous arrival time ( ρ =−0.277, p = 0.002), while completion of selected examinations and vital-sign assessments differed across team-availability categories (all p < 0.001). All hospital representatives reported 24-hour endoscopist availability, but important elements of written protocol content were reported less consistently. Conclusions: UGIB care in the Almaty region showed consistently described structural endoscopy availability but incomplete protocol content, together with selected inpatient-practice and prehospital differences. The EMS findings were exploratory and require confirmation using operational and patient-level data.

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