Status of Emergency Medicine Around the World

1. TRACK E Status of Emergency Medicine Around the World

2. Status of Emergency Medicine in Argentina Dr. Marcelo Muro 9/2003

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

4. 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.

5. 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.

6. 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

7. 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.

8. 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.

9. 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

10. 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.

11. 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.

12. 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.

13. 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

14. 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? .

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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

21. EM in Argentina Chance or Reasons?Reasons or barbarism.Casualidad ó causalidad?Causalidad ó barbarismo Ernesto Sabato

22. EM in Argentina THANK YOU FOR YOUR ATTENTIONMUCHAS GRACIAS POR SU ATENCION