Posted by admin on 11 Aug 09 in General | 2 comments

Why EMS Abroad Is Important

By Jason Friesen, NREMT-P
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An amended version of this article was originally posted at EverydayEMSTips.com
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As was described in a 2002 report by the World Health Organization (WHO), “Injury is one of the leading causes of mortality and morbidity worldwide”[1]. More specifically, road traffic injuries are the second leading cause of death worldwide for people aged 5-29 years, and the third leading cause for people aged 30-44 years (see Table 1). Coupled with other categories, such as self-inflicted injuries, interpersonal violence, burns, drowning, and war, the WHO estimated that injury is responsible for approximately 5 million deaths each year[1], which would be the equivalent of 27 Jumbo Jet crashes every day for a year.

Taken from a practical standpoint, these are the types of emergencies that a basic EMS system should be most effective in responding to. However, “the burden that injuries place upon societies is particularly large in countries with limited resources”[1]. According to a recent survey published by the WHO’s Department of Violence and Injury Prevention, only 134 of the 178 participating countries/areas reported the existence of a formal prehospital care system[2]. Although this number seems surprisingly high at first glance, it is important to understand that what qualifies as a “formal prehospital care system” is often left open to interpretation. In Zimbabwe, for example, a grant supplied by UNICEF in 2004 provided nine ox-drawn ambulances to the country’s prehospital care system to help alleviate the growing problem of maternal mortality.

In short, the majority of EMS systems worldwide suffer from scarce resources and inadequate services. And while there are myriad organizations dedicated to medical assistance worldwide, the vast majority of this assistance is largely relegated to hospital/clinical efforts or disaster relief. EMS-related efforts, however, are seemingly non-existent. This provides a unique opportunity for us, as prehospital providers, to offer training and support in an equally important discipline.

But when attempting to understand how we can affect positive, long-term change in underserved countries and communities, it is important to understand three basic principles:

• 1) as mentioned, traumatic injury is listed among the top causes of death worldwide.
• 2) EMS is most effective when its fundamental tenets are applied to traumatic, life-threatening injuries sustained in the prehospital setting
• 3) the benefits of existing healthcare facilities cannot be fully realized unless basic, yet effective prehospital care is provided.

With these three principles in mind there a number of positive changes that we can both offer to others, as well as to ourselves.

Helping Others

By committing to involve ourselves in the development of EMS abroad, including both training and prevention programs, we can positively impact foreign populations by:

• Diminishing the economic and societal burdens of premature death and disability
• Empowering communities to continue on a road toward self-reliance
• Enabling sustainable development; and
• Encouraging self-confidence, while renewing a sense of both hope and self-determination within the community

Helping Ourselves

By committing to involve ourselves in the development of EMS abroad, we can affect positive change within ourselves by:

• Creating an opportunity to identify with other societies and ideologies, and learn from their unique perspectives
• Working to encourage a positive opinion of our own communities and ideologies among international communities
• Diminishing the “Us and Them” mentality by forging new, meaningful relationships and working towards common goals
• Giving of ourselves; and
• Encouraging more involvement from others who may be able to help in distinct and diverse ways, through the sharing of our experiences in our own communities

Conclusion

Injury and disability is a non-discriminating disease. It is not defined by geography, socio-economic status, or lifestyle, but rather can affect any person at any time in any place. And unlike the wide range of diseases that afflict different societies, injury is one that can, fortunately, be best dealt with through basic, affordable training—in regard to both prevention and treatment. Studies have shown, for instance, that BLS training can be provided for as little as US$3 per person[3]. Likewise, “expired” EMS-related medical supplies could be used in these countries when it’s determined it’s the packaging and not the materials that have expired (disposal of supplies for which merely the packaging has expired is a monumental source of waste in the U.S.). Therefore, given the unique advantages we possess, failing to realize the full potential of the training expertise and abundant resources we have to offer would be missing a tremendous opportunity to alleviate the unnecessary pain and suffering that plays such a central role in preventing societies from progressing.

Author’s Note

It might not be far from the truth in saying that our opinions of a career in EMS may have strayed significantly from the scenes that we once envisioned while in EMT school. After awhile, the less appealing realities of EMS in the developed world may begin to take hold, and it becomes a common occurrence for people to burn out on the job as a result of everything but the blood and guts, or the wear and tear of high-stress calls. Taking time to participate in an EMS system outside one’s own country may help to “recalibrate” us as prehospital providers, where we’re involved with communities who both value our services, and benefit from their intended purpose. Getting back to a place where our services are called upon in situations when they’re truly needed, (as opposed to when they’re convenient), as well as employing the endless hours of training we’ve undergone in a setting where our skills and experience are productively used on a consistent basis, might very well offer a much needed second wind. As one paramedic said after a short time spent volunteering with paramedics in Tijuana, Mexico, “That’s why I got into EMS.”

And while any of the aforementioned reasons might be enough to inspire you to get involved as an individual, one of the greatest advantages of giving back by participating in EMS abroad might be from an organizational perspective. Each year more and more EMS agencies are working to set up “Sister Services”, where they pledge to engage in a long-term relationship with another EMS system in a foreign country. From skills and prevention training to providing much needed equipment and supplies, as well as making new friendships while adding to a greater sense of camaraderie between prehospital providers, these relationships can do a lot to bolster morale, stave off burnout, and provide incentives for employees to continue on in an invaluable service.

Source: Prehospital Trauma Care Systems. WHO, 2005

References:

1. Sasser S, Varghese M, Kellermann A, Lormand JD. Prehospital trauma care systems. Geneva, World Health Organization, 2005.
www.who.int/violence_injury_prevention/services/en/

2. Global status report on road safety: time for action. Geneva, World Health Organization, 2009.
www.who.int/violence_injury_prevention/road_safety_status/2009

3. Mock CN, Tiska M, Adu-Ampofo M, Boakye G: “Improvements in prehospital trauma care in an African country with no formal emergency medical services.” The Journal of Trauma 2002;53(1):90-7.

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