Burden of Disease
Investing in emergency medical care should become a priority. Emergency medical systems address a diverse set of diseases that span the spectrum of communicable infections, noncommunicable conditions, obstetrics, and injuries. All of these conditions may present to the EMS in their acute stages (for example, diabetic hypoglycemia, septicemia, premature labor, or asthma), or they are acute in their natural presentation (for example, myocardial infarction, acute hemorrhage, or injuries). Accordingly, defining the burden of disease addressed by EMS can be problematic.
Malaria causes 300 to 500 million acute episodes worldwide annually and results in an estimated 1 million deaths, mostly in Sub-Saharan Africa. Effective emergency care can avert these deaths, as well as those from acute respiratory and diarrheal diseases in children and from noncommunicable diseases such as diabetes, hypertension, and other cardiovascular diseases. In addition to the acute presentation of chronic conditions, the lack of access to medical care and lack of sustained effective treatment means that subacute episodes and flare-ups may be life threatening. Early recognition can prevent the emergency precipitated by infectious disease and many other medical conditions or can limit the effects.
More than 500,000 maternal deaths occur each year; 95 percent of these deaths are in low-income countries where emergency care is often lacking. It is estimated that 15 percent of all pregnant women experience a potentially life-threatening condition and will need emergency care. Prenatal screening methods alone may not be effective in reducing this risk ratio. Although identifying risk factors for acute complications is easy, identifying which of the at-risk women will actually develop a life-threatening condition is not possible (Graham 1997). The only way to prevent the deaths is by ensuring access to emergency obstetric care for all pregnant women.
Injuries were responsible for 21.7 percent of global deaths and 31.1 percent of disability-adjusted life years (DALYs) lost in 2001 (WHO 2002). Because both unintentional injuries (chapter 39) and injuries caused by interpersonal violence (chapter 40) are by definition acute events, nearly all require emergency care (see table 68.2). In 2001, more than 80 percent of all deaths attributable to injury were in low-income countries. Most injuries attributable to violence involve a predominantly young and productive population (WHO 2002) that is resilient and can respond well to appropriate emergency care.
[Table .]
The conditions listed in table 68.2 represent 45 percent of all deaths and 36 percent of the disease burden (including disability) that occur in low-income countries. The numbers represent a conservative estimate of the potential burden, because they do not include all the conditions that could benefit from emergency care and they do not include data from high-income countries.
