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TRACK E. Status of Emergency Medicine Around the World. Status of Emergency Medicine in Argentina. Dr. Marcelo Muro 9/2003 . EM in Argentina. Overview. Country information EM specialty status EM system information

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overview

EM in Argentina

Overview
  • Country information
    • EM specialty status
    • EM system information
  • Challenges /innovative strategies
  • Difficulties and pitfalls.
  • Summary
country information

EM in Argentina

Country information
  • Southest country in America.
  • Almost 4 million km2. 8th in the world.
  • 3000 km. Long- 1200 km wide.
  • 4 seasons during all the year.
  • Highest mountains in America in the west.
  • 2000 km. Atlantic Ocean Coast in the east.
country information5

EM in Argentina

Country information
  • 37.000.000 inhabitants.
  • 60% of them live in 10 biggest cities.
  • Coexist big cities with large uninhabitated areas
  • Great differences between them.
  • + than 50 % poor.
country information6

EM in Argentina

Country information
  • Variable health cover. Average 50 %.
  • The worst Socioeconomical condition .
  • Many Health Private and Worker Unions institutions shut.
  • Increase of public health services demand.
  • No National Emergency real System , interaction or resources for EMS
health general information

EM in Argentina

Health General information
  • Life Expectancy is near 80 in high class.
  • 21/oo children mortality in poor provinces.
  • Cardiovascular , Cancer and Trauma lead mortality causes in all ages.
  • Infections and nutrition diseases are the pediatric major problems.
  • Increase of Intentional trauma and Tuberculosis prevalence.
health care system

EM in Argentina

Health Care System
  • County and Provincial organizations more important than National.
  • Only in 8 Big cities: high complexity available in public health.
  • Incomplete National Health Insurance.
  • No integrated data register systems.
  • FD : 4000 public beds - 2000 in private.
health care system9

EM in Argentina

Health Care System
  • Inconsistent distribution of Primary care programs.
  • Less Prepaid medical assistance response.
  • Disappearance of workers unions health institutions.
  • Private Medicine for High social class.
  • Unequal use of Medicine protocols
medical education

EM in Argentina

Medical Education
  • 10 National 12 Private medical schools.
  • 7 years to graduate.
  • 50% follows Residences to specialization
  • Specialty: Complete Residence or 5 years assistance to a specific Unit .
  • Specialist recertification each 5 years.
emergency medicine status

EM in Argentina

Emergency Medicine Status
  • EM is not a National specialty.
  • Cardiologists, Clinics, Anesthesiologists, Surgeons, Intensive care, in Prehospital.
  • Multiple specialties in Emergency Rooms.
  • The ghost of Emergency medicine specialists.
emergency medicine education the way to the recognition and the change

EM in Argentina

Emergency Medicine EducationThe way to the recognition and the change
  • The 80´s in EM.
  • 3 fellowships 2 years long available .
  • 2 EM residence models: basic/ postbasic.
  • EM instructor in all specialties .
  • The use international EM protocols.
em system information

EM in Argentina

EM System information
  • Coexist aspects from Franco–German and Anglo–American models= Mixed model.
  • Large areas with poor emergency response organization.
  • Developing or “Mature” care systems in some of the biggest cities (county)
  • Underdeveloped systems in rural regions
em system information14

EM in Argentina

EM System information
  • Different Emergency development stages.
  • Unequal Emergency training attempts
  • Poor use of Emergency protocols
  • People misuse Emergency Care resourses.
  • In cities phisicians in the street.
  • Firemen, nurses, paramedics? .
pre hospital emergency care

EM in Argentina

Pre-hospital emergency care
  • Type 2 ALS , BLS units.
  • Phisician in cities. Variable EM training.
  • Some MCI trucks in specific points.
  • Dispatchers + medical coordinator.
  • Public EMS County budget: free.
  • Private: prepaid + fee for service.
  • Poor integration between private/public.
in hospital emergency care

EM in Argentina

In-hospital emergency care
  • Regional distribution for diseases.
  • Major EM patients in public hospitals.
  • Multi-specialty model.in ER..
  • Best EM Schools in Public hospitals.
  • Poor relationship with other services.
  • Only few quality and research programs.
challenges and strategies

EM in Argentina

Challenges and Strategies
  • Recognition of EM as a specialty.
  • The political fondness for EM..
  • Generalization of EM Protocols.
  • The training programs , are adequate?
  • Integration with the other services .
  • Unify Data resgistration = research.
  • Optimize the regional solutions.
  • .Avoidance of Robinson Crusoe syndrome.
challenges and strategies18

EM in Argentina

Challenges and Strategies
  • Development of Emergency Residences.
  • Define the needed laws.to get the recognition
  • Continue with International EM programs.
  • Discussion of the human structure of ER.
  • Train all the crew.
  • Acceptance of the mixed model situation.
  • Research, quality, correct use of Ems.
difficulties and pitfalls

EM in Argentina

Difficulties and pitfalls
  • The Finantial problem..
  • Politics discontinues EM programs.
  • Distances and isolated areas.
  • The old model and trade union pressions.
  • The resistence to change.
summary

EM in Argentina

Summary
  • The mixed model
  • Big distances , people in Cities.
  • In the way of the recognition of EM
  • ACLS,BTLS,PHTLS, ATLS available.
  • Incipient research process.
  • The need to integrate.
  • EM is in the best moment of history
chance or reasons reasons or barbarism casualidad causalidad causalidad barbarismo

EM in Argentina

Chance or Reasons?Reasons or barbarism.Casualidad ó causalidad?Causalidad ó barbarismo

Ernesto Sabato