Epidemiology and practice of emergency medicine in a developing country.
OBJECTIVE
To analyze the emergency medicine system in a developing country and identify areas of need and potential collaboration.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Kirsch
T D
TD
Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Hilwig
W K
WK
Holder
Y
Y
Smith
G S
GS
Pooran
S
S
Edwards
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education / Q000458:organization & administration; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011795:Surveys and Questionnaires; D013997:Time Factors; D014300:Trinidad and Tobago / Q000453:epidemiology