Emergency medical systems in low- and middle-income countries: recommendations for action

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. Keywords Emergency medical services/organization and administration; Emergency treatment/organization and administration; Triage; Transportation of patients; Allied health personnel/education; Cost-benefit analysis; Evidence-based medicine; Developing countries (source: MeSH, NLM). Mots cles Service medical urgences/organisation et administration; Traitement urgence/organisation et administration; Orientation patients; Transport sanitaire; Personnel sante auxiliaire/enseignement; Analyse cout benefice; Medecine factuelle; Pays en developpement (source: MeSH, INSERM). Palabras clave Servicios medicos de urgencia/organizacion y administracion; Tratamiento de urgencia/organizacion y administracion; Triaje; Transporte de pacientes; Tecnicos medios en salud/educacion; Analisis de costo-beneficio; Medicina basada en evidencia; Paises en desarrollo (fuente: DeCS, BIREME).
Introduction The goal of an effective emergency medical system should be to provide universal emergency care--that is, emergency care should be available to all who need it. However, there are [...]