Guatemala

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General

Capital – Guatemala City

Land Size – 107,159 sq km

Population – 13,550,440

Language(s) – Spanish 60%; Amerindian languages 40% (23 officially recognized Amerindian languages)


Prehospital Care


Overview

  • Until recently, prehospital care was provided solely by FD
    • Lacked formal medical education and had only basic equipment
    • Medical responses to frequent natural and man-made disasters best characterized by lack of preparedness and coordination
  • In past decade, awareness of importance of EMS has increased dramatically
    • Aggressive efforts focused on development of prehospital care in general and disaster preparedness in particular.
    • Significant improvements already made in:
      • Training
      • Equipment
      • Standardization
      • Inter-regional Coordination
    • Recent gov’t initiatives hold promise of nationwide positive impact on emergency care delivery to population
  • Future Challenges
    • Severe resource limitations
    • Continued improvements in quality care and access
      • Expansion of prehospital care training/certification (esp. rural)
    • Establishment of dedicated degree program in EMS training within local medical school
    • Reorganization of FD into three separate divisions of specialty:
      • Paramedic
      • Extrication
      • Firefighting
    • Obtain further funding to facilitate modernization of training/equipment
    • Increased collaboration between two existing FDs
    • Creation of centralized emergency dispatch system


History

  • 1951 – Large fire consumed great portion of Guatemala City
    • No formal EMS or disaster planning system at time
      • Led to formation of Cuerpo Bomberos Voluntarios (CBV) by Chilean
        • Initially solely voluntary, funding from private donations only
        • Firefighting only
        • Sought First Aid Training from local MDs as need for medical attention on-scene and en route became apparent
        • Splints, basic First Aid kit
        • Eventually all members began serving as firefighter and medical providers
  • 1957 – disagreements between founders of CBV
    • Led to formation of Bomberos Municipales (Municipal Fire Department)
      • Under jurisdiction of municipal gov’t – primary patron
    • Rivalry between two entities emerged
      • Subsequent intermittent conflicts and redundant use of resources
    • Only recent recognition of rivalry’s deleterious effects; causes two leaderships to increase cooperation in both training and operations
  • Originally used modified pickup trucks to transport firefighting equipment
    • Eventually used for Pt transport as well
    • 1970 – First ambulance employed
      • Today all ambulances are almost exclusively used-vehicles by foreign donation
    • Modified pickup remains predominant transport vehicle
  • Alerta Medica (1992) and Paramedic (2002)
    • Private, For-Profit
    • Dedicated solely to prehospital interventions
    • Care/Transportation provided only to subscribers (annual fee)
    • Operate primarily in Guatemala City
    • MD on-board
    • Uniformly more advanced equipment than public FDs:
      • ET Intubation and IV Access
      • Wide range of Meds
      • Immobilization
      • Cardiac Monitoring and 12-lead ECG
      • Defib
      • Portable Ventilators
      • Capacity to obtain cardiac enzymes on-scene
    • Serve less than 5% of population


Lead Agency

  • Ministry of Health
    • Gov’t division ultimately responsible for provision of prehospital care
      • In past role has been limited by severe budgetary constraints
    • 1999 – created staff position directly responsible for emergency care development and disaster planning
      • Has taken increasingly active role in level of emergency care development, including:
      • Pre-/In-hospital Care
      • Disaster Preparedness
    • 2000 – sponsored first governmental workshop to educate Guatemala City Public ED staff in basics of trauma and critical care medical mgmt.
      • Led to collaboration with outside organizations to sponsor several emergency care and disaster conferences and training programs
      • Promoted atmosphere of cooperation w/in EMS structure
    • 2002 – Coordinadora Nacional para la Reducción de Desastres (CONRED – National Coordinator For Disaster Mitigation) created Comite de Asesonía Tecnico para Rescate y Emergencia Prehospitalaria (CATREP)
      • Committee to create and monitor EMS protocols


Funding

  • Mixed healthcare system:
    • Private
    • Public:
      • Provided by Central gov’t
      • System of public hospitals and clinics
      • Social Security System for gov’t employees and independent military facilities


International Assistance

  • Foreign NGOs have played important roles in EMS development due to economic restraints
  • Agencies depend on foreign aid for equipment donations and for assistance with training initiatives
    • Partnerships are thought to have served as catalyst for developmental initiatives
  • 1989 – US Office of Foreign Disaster Assistance/Latin America and the Caribbean (OFDA/LAC) has supplied resources for APAA to FDs
    • Primary goal of OFDA/LAC is to create self-sufficiency in disaster mgmt for countries w/in region by providing technical support of training for prevention/mgmt of disasters
  • 1980’s – Miami-Dade Fire/Rescue paramedic system
    • Worked throughout Latin America on grant from OFDA/LAC
    • Train-the-Trainer Programs:
    • First-Responder
    • Fire-Fighting
    • HAZMAT Response
    • Courses designed so that local instructors can eventually teach independently
  • Emergency International (EI)
    • US NGO that functions worldwide to assist local providers in advancement of emergency medical care (in Guatemala since 1991)
    • Aim to create cadre of local leaders to continue to advance field in future.
    • 1998 – Fundación Para el Desarrollo de la Medicina de Emergencia y Prehospitalaria (FUNDAMEP – Foundation for the Development of Emergency & Prehospital Medicine)
      • Provides training throughout country
      • 1997 – Organized first-ever Central American Conference on Emergency Medical Care
      • 1999 – Creation of Guatemala’s first-ever national licensing examinations for EMTs and Paramedics
      • Train-the-Trainer programs
        • Cardiac Care
        • Trauma
        • Maternal-Child Emergencies
        • Disaster Preparedness
        • Collaborations with local partners to implement/evaluate disaster drills


Levels of Care & Education/Training

  • 1994 – independent Traumatologist began initiative for more formal medical training of FDs
    • Group of various MD specialists offered training in various courses (i.e., BLS, ATLS) to CBV.
  • 1997 – with help of Emergency International (US NGO), CBV began first EMT training program (TUM)
    • Basic – 200h
    • Expanded to Intermediate and Advanced – 450h
    • Bomberos Municipales invited to join shortly afterward
    • First unified system of training between two org’s
  • 1999 – First group of intermediate paramedics completed training
    • Certification by Universidad de San Carlos de Guatemala initiated
  • 2000 – Initiation of new course: Curso de Asistente de Primeros Auxilios (APAA)
    • Intended to be more basic than TUM, eventual goal of being required for all FFs in country
    • 100h training over 14 days
    • Taught by CBV; only such program in existence in republic
  • In past 3-5yrs, certification programs for more advanced modular courses:
    • ACLS
    • PALS
    • HAZMAT
    • Occur in piecemeal fashion with voluntary help of domestic MDs, Red Cross, several foreign NGOs
  • Feb. 2003 – opening of first university-certified paramedic training program
    • 30mos part-time training
      • 120h/month practical training


Medical Direction


Specialty Care


Dispatch


National Emergency Telephone #

  • No current integrated centralized system to initiate EMS or disaster systems
    • Separate numbers for police, each of the separate providers, as well as for each station.
      • FDs frequently called to same incident
      • Many authorities publicly state this dual system is benefit because rivalry reduces RTs
      • Ministry of Health beginning to recognize that integrated EMS system would greatly benefit country


Emergency Medicine & Emergency Care


Disaster

  • See: “Lead Agency” & “International Assistance”


References


Links

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