The evolution of emergency medicine in Jamaica / La evolución de la medicina de emergencia en Jamaica

Emergency Medicine in Jamaica has evolved rapidly over the past 20 years and has gained recognition as a specialty. A residency training programme has been established, trademark life support courses are now available, moves to develop areas of sub-specialization have begun and an emergency medicine association has been formed. There has been an increase in the diagnostic modalities in the main teaching institution, the University Hospital of the West Indies (UHWI). There is an urgent need for improvements in pre-hospital care. This will require the development of an efficient Emergency Medical Service (EMS). More emphasis and attention is required on disaster medicine, toxicology and trauma. Increased training of emergency physicians and nurses, advances in academia and research, and greater advocacy by local emergency physicians will further advance the specialty.

La medicina de emergencia en Jamaica ha evolucionado rápidamente en el curso de los últimos 20 años, y ha ganado reconocimiento como especialidad. Se ha establecido un programa de entrenamiento de residencia, y existen en la actualidad cursos comerciales en soporte de vida, se han iniciado movimientos para desarrollar áreas de sub-especialización, y se ha creado una asociación de medicina de emergencia. Ha habido un aumento en las modalidades de diagnóstico en la principal institución docente - el Hospital Universitario de West Indies (UHWI). Existe una necesidad urgente de lograr mejoras en el cuidado pre-hospitalario. Esto requerirá el desarrollo de Servicios Médicos de Emergencia (SME) eficientes. Se requiere más énfasis y atención a la medicina de desastre, toxicología y trauma. El aumento de entrenamiento de médicos y enfermeras de emergencia, los avances en la academia y la investigación, y una mayor defensa de los médicos de emergencia local, contribuirán al ulterior progreso de la especialidad.

The evolution of emergency medicine in Jamaica.

Emergency Medicine in Jamaica has evolved rapidly over the past 20 years and has gained recognition as a specialty. A residency training programme has been established, trademark life support courses are now available, moves to develop areas of sub-specialization have begun and an emergency medicine association has been formed. There has been an increase in the diagnostic modalities in the main teaching institution, the University Hospital of the West Indies (UHWI). There is an urgent need for improvements in pre-hospital care. This will require the development of an efficient Emergency Medical Service (EMS). More emphasis and attention is required on disaster medicine, toxicology and trauma. Increased training of emergency physicians and nurses, advances in academia and research, and greater advocacy by local emergency physicians will further advance the specialty.

Headache and Chiari I malformation in the pediatric population.

There has been disagreement regarding surgical intervention in treating pediatric patients with Chiari I malformation with headache as sole complaint. Therefore, we retrospectively reviewed our experience over a 6-year period, with patients less than 5 years of age (mean = 34.8 months) with radiographically confirmed Chiari I malformation. We identified 7 patients who presented with headaches as their only complaint. The headaches varied in location and severity. All patients were treated with posterior fossa decompression and syringosubarachnoid shunt when indicated. At follow-up, all patients were noted to have rapid clinical improvement (mean = 11.6 weeks) and remain asymptomatic. Our data suggest that patients less than 5 years of age with Chiari I malformation benefit from surgical decompression when presenting with a chief complaint of headache.

Capital equipment budgeting: changing an art to a science.

In today's integrated healthcare environment, one component of financial management remains antiquated in many facilities--the budgeting process for capital equipment. Many institutions budget for capital equipment based upon individual departmental wish lists and hopeful dreams. These highly inefficient practices are being replaced with automated systems that create departmental data exchanges, utilization analyses, life-cycle cost justifications and enterprise-wide budget roll-ups. This article shows how automated capital budgeting systems help reduce capital spending by identifying utilization trends, providing for demand matching, and maintaining cost control data which enable the financial manager or asset steward to analyze and justify appropriate acquisitions.

Planning equipment acquisitions.

As the mire of healthcare reform continues to grow, many providers are developing an insatiable appetite for alternatives to the way they currently do business. For some, solutions come in the form of repackaging the same old stuff. Others have jumped recklessly into every managed, capitated, or reformed idea that has come along. Old-school thinkers are still awaiting government direction. Providers of quality healthcare face increasing demands on their shrinking capital funds. An aging population, indigent care, AIDS patients, medical waste disposal, nursing shortages, declining reimbursement, increasing labor costs, and the federal healthcare reform threat have negatively affected cash flow. Though previous cost-plus reimbursement encouraged wasteful spending, the threat of healthcare reform has already caused providers and suppliers alike to work together to cut costs even without government mandates. The impact has been the closure of over 600 facilities nationwide in the past ten years. More than 70,000 acute care hospital beds have been lost from the US healthcare system. Many healthcare facilities have merged into managed care systems, integrated delivery networks, and regional alliances whose costs can be consolidated and controlled. At the same time, new services and profit centers are also being created to increase revenue. A healthcare moves into alternative care environments--home care, ambulatory care, diagnostic testing--these providers need more capital equipment to serve an increased patient load. Coupled with an aging installed base of technology in the acute care environment, healthcare managers face an ever-growing need for capital equipment and creative financing programs to meet longer payment options.(ABSTRACT TRUNCATED AT 250 WORDS)

Marketing specialty hospitals in the 1990s: making patients the best marketing spokespeople.

These are a few of the ways that a health care provider can influence the patient's perception of the treatment received. That impression is a lasting one. A positive referral can be a strong marketing tool that generates revenue and goodwill. If an institution provides quality health care services in a comfortable environment, then patients can easily be encouraged to tell their families and friends about their experiences in the institution.

A disaster's effects on material management operations.

No one should ever have to encounter a disaster of the magnitude of Avianca flight 052, Hurricane Hugo, or the San Francisco earthquake of 1989. However, we all learn about the appropriate preparation and response that is necessary for managing a disaster effectively after these events. The importance of material management functions in providing the resources for the implementation of direct patient care is often neglected, and recognition is rarely given to these heroes in a disaster situation.