Intro
Introduction
Emergency medical conditions typically occur through a sudden insult to the body or mind, often through injury, infection, obstetric complications, or chemical imbalance; they may occur as the result of persistent neglect of chronic conditions. Emergency medical services (EMS) to treat these conditions include rapid assessment, timely provision of appropriate interventions, and prompt transportation to the nearest appropriate health facility by the best possible means to enhance survival, control morbidity, and prevent disability (see table 68.1). The goal of effective EMS is to provide emergency medical care to all who need it. Advances in medical care and technology in recent decades have expanded the parameters of what had been the traditional domain of emergency services. These services, no longer limited to actual in-hospital treatment from arrival to stabilization, now include prehospital care and transportation.
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Despite the best efforts of primary care providers and public health planners, not every emergency is preventable. Emergency medical care is needed in diverse circumstances: prospective patients range from rural farmers or fishers whose most common mode of transportation may be canoes or animal-drawn carts, to factory workers living in densely populated urban slums, to residents of high-income cities and suburbs. Actual provision of emergency care may range from delivery using trained emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the range of needs posed by such diverse circumstances will require innovation and a reorientation of public health planning.
A number of misconceptions about emergency care are often used as a rationale for giving it low priority in the health sector, especially in low-income countries. These ideas include equating emergency care with ambulance transportation, neglecting the role of the community and facility care provided, and assuming that emergency departments and physicians are the only acute care resources. Such a narrow view ignores the important contributions of other disciplines, skills, and personnel. Perhaps the most common misperception is that emergency medical care is inherently expensive and requires high-technology interventions as opposed to simple and effective strategies.
Emergency care, which may be delivered in crisis situations with poor planning and ineffective use of resources, may be inefficient. In many countries, few resources are set aside for possible emergencies, and when situations that demand emergency care arise, they precipitate hurried and costly resource deployment. Efforts to improve emergency care, however, do not necessarily increase costs. This chapter shows that improved organization and planning for emergency care can be done at a reasonable cost and lead to more appropriate use of resources, improved care, and better outcomes (White, Williams, and Greenberg 1996). This chapter does not address nonacute conditions, even though emergency care is often the only recourse for people with nonemergency conditions because of the failure of these other components of the system (see figure 68.1).
[Figure
68.1]
