1 TRACK E Status of Emergency Medicine Around the World

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

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

4 Country information Southest country in America. Almost 4 million km2. 8th in the world km. Long km wide. 4 seasons during all the year. Highest mountains in America in the west km. Atlantic Ocean Coast in the east. EM in Argentina

5 Country information inhabitants. 60% of them live in 10 biggest cities. Coexist big cities with large uninhabitated areas Great differences between them. + than 50 % poor. EM in Argentina

6 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 EM in Argentina

7 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. EM in Argentina

8 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 in private. EM in Argentina

9 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 EM in Argentina

10 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. EM in Argentina

11 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. EM in Argentina

12 Emergency Medicine Education The 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 in Argentina

13 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 in Argentina

14 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?. EM in Argentina

15 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. EM in Argentina

16 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. EM in Argentina

17 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. EM in Argentina

18 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. EM in Argentina

19 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. EM in Argentina

20 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 EM in Argentina

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

22 THANK YOU FOR YOUR ATTENTION MUCHAS GRACIAS POR SU ATENCION EM in Argentina