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Epidemiology and practice of emergency medicine in a developing country
T D Kirsch1, W K Hilwig, Y Holder
1Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Study Objective:
To analyze the emergency medicine system in a developing country and identify areas of need and potential collaboration.
Design:
Convenience sample surveys of all emergency visits over a 2-week period, hospital admission and health department statistics, and interviews with government officials, health providers, and EMS managers.
Setting:
Port of Spain General Hospital, Trinidad and Tobago.
Results:
The ED has more than 100,000 visits per year. No records are kept. No physician in this study had emergency medicine training; only one had completed any residency. The survey included 3,710 patients: 40.5% were admitted, and .3% died. Injuries accounted for 41.6% of all visits, asthma 7.8%. The mean time elapsed before a patient was seen was .5 hour; mean time to discharge, 1.9 hours. In only 9% of patients were laboratory tests performed. Prehospital providers had limited equipment and training.
Conclusion:
The ED and prehospital systems provide high-volume and often high-acuteness care. Barriers to improved care include limited specialized training and lack of medical records.