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Prehospital Emergency Medicine in Argentina
Silvio Aguilera MD, MBA Medical Director EMS Vittal Past President “Sociedad Argentina de Emergencias”
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Statistics Population Surface: 2.780.000 sq km
Total population: 40 millions Annual population growth rate: 1.3 % Percentage of population aged 60+ years: 13.6%
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Statistics Socials indicators Literacy rate: 97.4 %
Rate of unmet needs: 17.7 % Precarious housing situation Houses with 3 or more people per room Children between 6 to 12 years not in school 4 or more people per family that work
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Health indicators Statistics Life expectancy at birth: 74 years
Child mortality males/females (per 1000): 19/16 (probability of dying under age 5 years)
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National health accounts indicators
Statistics National health accounts indicators Total GDP: U$S millions (Rank: 33th) Total health expenditure: 10.2 % of GDP (Rank: 14th) Public health expenditure: % Private health expenditure: 45%
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Physicians 5.000 physicians graduated each year
One doctor per 313 inhabitants 5.000 physicians graduated each year Residencies are not mandatory 10-15% obtain a residency training programs No equivalent to board certification
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Hospitals Hospitals 3.311 Hospitals (Public and Private)
Public Hospital: 38% Private Hospital: 64% hospital beds(4/1.000 inhabitants) Public Hospital: 51% Private Hospital: 49% No equivalent to JCAHO, accreditation is not mandatory for hospitals
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Emergency Medicine Is not an specialty
Thirteen residency training programs (public and private) 100 residents More than physicians in ED and EMS Two National Emergency Medicine Societies
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Emergency Medical Services
Franco-German model Always there are a physician in the ambulance Not paramedic or EMT Driver and Nurse in ambulances Different kind of ambulances
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Emergency Medical Services
Publics and privates companies Privates companies more important than publics More than 400 private companies in Argentina Some privates companies are big ( calls each years)
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Emergency Medical Services
Many EMS in the same city (public and private) Private EMS only for associated (50%) Public EMS for all people Public EMS of different quality from city to city Not only one Telephone number for EMS publics (107) Private EMS: different telephone number
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Emergency Medical Services
Model of “dispatch priorities”: code: red or 1 or emergency yellow or 2 or urgency green or 3 or non-urgent visit (only in private EMS)
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Emergency Medical Services
Doctors works or 24 hours Bill: session fees (fixed hourly rate of pay), or salary
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Emergency Medical Services
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Emergency Medical Services
Founded in 1987 The biggest EMS company in Argentina Annual Income: U$S Market share (Buenos Aires City): 20% Employees: (880 physicians) In 12 city in different province of Argentina
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Emergency Medical Services
Physicians
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Emergency Medical Services
Physicians 880 MICU Transport Pediatricians 188 Visits 339 MICU Transport MICU NEO MICU Car Car 250 103 10 96 82 339
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Emergency Medical Services
Dispatch Center
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Emergency Medical Services
Dispatch Center
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Emergency Medical Services
Buenos Aires City and surrounding districts: population:
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Emergency Medical Services
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Emergency Medical Services
Ambulance units Mobile Intensive Care Unit (MICUs) Cars for non urgent visit
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Emergency Medical Services
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Emergency Medical Services
Principal reason for call Triage: red and yellow Shortness of breath Chest pain Mental Status Altered Abdominal Pain Upper extremity injury Hypertension Triage: green Fever Cough Nausea/Vomiting Abdominal Pain Diarrhea Acute Sore Throat
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Emergency Medical Services
Final diagnosis Triage: red and yellow Cardiovascular disorders Injury Respiratory disorders Abdominal disorders Mental disorders Nervous System disorders Triage: green Infectious disorders Abdominal disorders Respiratory disorders Injury Cardiovascular disorders Musculoskeletal disorders
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Emergency Medical Services
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Training International Training Center
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National Planification to Disaster Response
National Ministery of Health National Ministery of Interior DINESA Emergency Disaster Direction SIFEM Federal Emergency System
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National Planification to Disaster Response
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Injury patients Minor Trauma: (83%) Mild trauma: (15%) Severe trauma: (2%)
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