title: The prehospital emergency care system in Mexico City: a system's performance evaluation.
abstract: BACKGROUND
  Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.
  
  
  OBJECTIVE
  The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.
  
  
  METHODS
  This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.
  
  
  RESULTS
  The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available. There is no evidence of customer satisfaction data.
  
  
  CONCLUSIONS
  Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.
authors.affiliation: University of Maryland Baltimore County, Public Policy Doctoral Program, USA. lpinet1@nmbc.edu
authors.forename: Luis Mauricio Pinet
authors.initials: LM
authors.lastname: Peralta
mesh_terms: D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D008800:Mexico; D012189:Retrospective Studies; D014505:Urban Population