title: Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico.
abstract: BACKGROUND
  In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.
  
  
  METHODS
  In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site.
  
  
  RESULTS
  The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site.
  
  
  CONCLUSIONS
  This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.
authors.affiliation: Escuela de Medicina, Tecnológico de Monterry, Nuevo Leon, México.
authors.forename: Carlos
authors.initials: C
authors.lastname: Arreola-Risa
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Herrera-Escamilla
authors.forename: Ismael
authors.initials: I
authors.lastname: Contreras
authors.forename: Jorge
authors.initials: J
authors.lastname: Vargas
mesh_terms: D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel / Q000191:economics / Q000193:education*; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003479:Curriculum / Q000592:standards / Q000639:trends; D003906:Developing Countries; D004521:Educational Measurement; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000191:economics* / Q000193:education*; D005260:Female; D005392:First Aid; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation