The roles and responsibilities of physicians in Pre-Hospital Emergency Medical Services: A Caribbean perspective

A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country's health service because it provides early medical care to critically ill and injured persons in the field There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician's licence to deliver medical care.

El servicio médico de emergencia pre-hospitalaria (SMEPH) es un componente vital del servicio de salud de un país, porque provee atención médica temprana y sobre el terreno a personas accidentadas o enfermas en estado crítico. Las evidencias indican que la atención temprana reduce la mortalidad y la morbosidad, a la vez que ofrece al paciente la mejor oportunidad posible de sobrevivir y mejorar la calidad de vida. Los territorios caribeños han estado desarrollando su SMEPH como parte de un programa de reforma del sector de la salud. En un estudio del SMEPH en 12 países caribeños, la Organización Panamericana de la Salud informó que no había directrices claras con respecto a las funciones y responsabilidades del médico en el SMEPH en la mayoría de países. De hecho, unos países tenían servicios en los que no había participación directa del médico. Presentamos aquí una revisión breve de las funciones y responsabilidades reconocidas internacionalmente para los médicos en el SMEPH, y hacemos recomendaciones con referencia particular al Caribe. Sugerimos que hay necesidad de que los médicos participen de manera activa y directa en el desarrollo del SMEPH, porque el técnico médico de emergencia es reconocido como una extensión del médico sobre el terreno, y se supone que esté amparado por una licencia para impartir atención médica.

Open splenectomy in Jamaican children with sickle cell disease / Esplenectomía abierta en niños jamaicanos con la enfermedad de células falciformes

A total of 110 patients with sickle cell disease who had open splenectomy at the University Hospital of the West Indies over a 10-year period are reviewed Patients with homozygous sickle cell disease numbered 94, S beta0 and S beta+ thalassaemias (11 and 4 respectively) and one patient with SC disease. Postoperative acute chest syndrome was the most common complication (9 of 110). There were no life threatening emergencies and no mortalities. Eleven patients received preoperative blood transfusion and operative times were short averaging 60 minutes among the 110 patients. Open splenectomy remains the gold standard for patients with sickle cell disease requiring splenectomy.

El presente trabajo revisa un total de 110 pacientes con la enfermedad de células falciformes, que fueran sometidos a una esplenectomía abierta en el Hospital Universitario de West Indies, a lo largo de un período de 10 años. Los pacientes con enfermedad de células falciformes homocigóticas fueron 94, con talasemias S b0 y S b+ fueron 11 y 4 respectivamente, y un paciente presentaba la enfermedad por hemoglobina SC. El síndrome torácico agudo postoperatorio resultó ser la complicación más común (9 de 110). No hubo emergencias con riesgo de vida ni mortalidades. Once pacientes recibieron transfusión de sangre en el postoperatorio y los tiempos de operación fueron cortos, con un promedio de 60 minutos entre los 110 pacientes. La esplenectomía abierta sigue siendo la norma de oro para los pacientes con la enfermedad de células falciforme que requieren esplenectomía.

Potential role for advanced trauma life support programme in improving trauma care in Jamaica

Data from the Road Safety Unit in the Ministry of Transport and Works, Jamaica, show an increase in road traffic accidents from 7861 in 1991 to 11,010 in 1999. The average number of deaths annually was 380 +/- 48 (SD) while injuries averaged 3320 +/- 262 per year. This represents an injury to death ratio of 8.7 compared with 24.9 for Trinidad and Tobago and 40 for Canada. During the period 1991 to 2000, an average of 796 +/- 159 (SD) murders were committed annually. The number of murders increased by over 280 per cent between the decade of the seventies and the nineties. Data from the trauma registry of the University Hospital of the West Indies showed that 29.6 per cent of all admissions to the surgical ward between January 1998 and December 31, 2000, were due to injuries. There were 97 deaths (3) during this period and 33 occurred in the Accident and Emergency Department with 70 per cent occurring within 120 minutes of their arrival. The Advanced Trauma Life Support (ATLS) Programme emphasizes the resuscitation and stabilization of injured patients in the first few hours after injury. Most Emergency Departments in Jamaica are staffed by relatively junior medical officers and the low injury to death ratio among victims of motor vehicle accidents may be due to suboptimal care. Introduction of an ATLS programme in Jamaica may reduce the number of preventable deaths and also stimulate interest in trauma care thus increasing preventative measures to decrease the high incidence of trauma in Jamaica