68. Emergency Medical Services

Abstract

Throughout the world, anyone may require emergency medical services, from rural farmers, whose most common form of transportation may be animal–drawn carts, to sophisticated residents of high–income cities and suburbs. Developing strategies to meet the needs posed by such diverse circumstances requires innovation and a reorientation of public health planning.

Defining the burden of disease addressed by emergency medical services is problematic, as those diseases span the spectrum of communicable infections, noncommunicable conditions, obstetric conditions, and injuries. Acute episodes of malaria, for example, result in an estimated 1 million deaths each year, most of which could be averted by effective emergency care. Ninety–five percent of the 500,000 maternal deaths that occur each year happen in low–income countries where emergency obstetrical care is lacking.

Emergency care does not have to be expensive or rely on high–tech interventions to be effective. In Ghana, where transport to a hospital is usually by taxi or bus, commercial drivers have received a six–hour basic first–aid course at a cost of just US$3 per participant. India has developed a two–day trauma management course for health professionals that takes into account local conditions and capabilities and costs only US$50 per trainee.

Improved organization and planning for emergency care can be done at reasonable cost and lead to better outcomes. With sufficient focus, low–income countries could help to define more cost–effective emergency systems than are available in high–income countries.