There is a lack of published evidence examining how stakeholder attitudes influence Emergency Medical Services (EMS) system performance in the Caribbean. In Barbados—and likely across the English-speaking Caribbean—the beliefs, emotions (affect), and behaviors of stakeholders working in Accident and Emergency (A&E) departments and prehospital EMS systems may directly affect patient outcomes in the out-of-hospital setting.

To investigate the relationships between beliefs, affect, and behaviors among EMS stakeholders in Barbados, guided by the framework outlined in the Emergency Medical Services Agenda for the Future. The study further explored stakeholder perspectives on issues related to medical direction and legislation/regulation within the EMS system.

This convergent parallel mixed-methods study used both surveys and semi-structured interviews with a purposeful sample of 105 credentialed EMS stakeholders in Bridgetown, Barbados. Participants included A&E physicians (n = 29), prehospital EMS providers (n = 64), and A&E nurses (n = 11). Quantitative data were analyzed using linear regression with SPSS™, and qualitative data were interpreted thematically using NVivo™. Reliability coefficients demonstrated strong internal consistency: beliefs (α = .88), affect (α = .82), and behavior (α = .57, improved to α = .64 following confirmatory factor analysis). Significance was set at α = 0.05 with a 95% confidence interval.

Ethical Oversight: Institutional Review Board (IRB) approvals were obtained from the University of the West Indies (UWI), Cave Hill Campus, Barbados, and the University of Phoenix, Arizona, United States.

Two of the seven quantitative hypotheses yielded statistically significant results:

• Research Question 1 (RQ1): A significant relationship was found between beliefs and behaviors among prehospital EMS providers (β = 0.439, p = 0.003, R² = .130).
• Research Question 4 (RQ4): Affect was significantly associated with beliefs across all stakeholder groups:
  • A&E Physicians (β = 0.234, p = 0.022, R² = .179)
  • EMS Providers (β = 0.188, p = 0.002, R² = .150)
  • A&E Nurses (β = 0.240, p = 0.024, R² = .448)

Eight qualitative themes emerged from the semi-structured interviews, highlighting stakeholder insights related to interprofessional trust, communication, clinical oversight, role clarity, legal frameworks, and perceptions of system readiness.

This study demonstrates that stakeholder beliefs and affect significantly influence professional behavior within Barbados' EMS system. These findings reinforce the need for comprehensive reforms that promote collaboration, clarify roles, and strengthen the regulatory and medical oversight infrastructure.

The development of a regional Emergency Medical Services Agenda 2050 for the Caribbean is recommended. This initiative should be driven by a multidisciplinary panel including the Caribbean Public Health Agency (CARPHA), the Pan American Health Organization (PAHO), the Caribbean Disaster Emergency Management Agency (CDEMA), the Caribbean Association of Fire Chiefs (CAFC), the University of the West Indies (UWI), Ministries of Health, national ambulance services, and A&E leadership. Such an agenda should focus on workforce development, EMS legislation, expanded scope of practice, and increased public health integration across prehospital systems in the Caribbean.

Dr. Hezedean A. Smith, DM, CFO, CEMSO, FACPE, CPM, EF/ESO, MIFireE, CHSE, PMD
Founder & Principal Consultant, Global Emergency Services Consulting Group