How absolutely strange to have your EMS needs taken care of exclusively by foreigners. But then we have folks from other countries harvesting our crops, raising our children, building our homes, etc. And we don't pay them near what they are worth, as a rule.
Well, if you hire HCNs (host country nationals) you encounter several serious issues which could be counter productive to the delivery of EMS.
1. The crews go out of service 5 x a day for prayer which can take anywhere from 15-30 minutes depending on how long the line is at the feet washing stand, how fervent they get in their prayers and how crowded the area is if they pull over to mosque.
2. The crews are limited in who they can see and touch and there WILL be a general bias towards women in general--and the women will not give you any story close to the truth...especially if it is a woman issue, rape or assault.
3. Everyone is related. Sure I am being funny here, but again this will alter some care--how many distant cousins have you run on this month?
4. The biggest conundrum of all ( I actually experienced this one in Kuwait)....ready?
You are altering Allah's will!!!
By providing care and trying to save someone, you are challenging Allah's authority. If the guy got smacked by a car and is laying there dying, let him be!! Allah commanded it!!
5. Pain control--You know my extensive history with the ME and SWA...they simply do not support narcs for pain control. It is against their belief system. I have been in hospitals where I had to demand they give meds for certain conditions--had a guy with a femur fracture and they kept giving high dose of Motrin. They finally got out the morphine reluctantly and gave him 1mg. ONE MG!!
6. From many of my travels, I find ME people to be VERY lazy. No one wants to work when it is hot, they take frequent tea breaks apart from the prayer breaks...and absolutely NO ONE works on Fridays as that is their holy day. They also have many holy holidays throughout the year including Ramadan (30 day fast and lots of prayers) in which work damn near stops in its entirety.
I am sure there are other advantages/disadvantages I have not considered to the hiring of expats for medical care delivery but these are the big ones from personal experience only.