title: Emergency care and referral among isolated island populations in the Bahamas.
abstract: BACKGROUND
  Isolated island populations face unique health challenges. In the Bahamas, the islands of Mayaguana, Inagua, Crooked Island, Acklins, and Long Cay-referred to as the MICAL Constituency-are among the most isolated.
  
  
  OBJECTIVE
  Our objective was to better understand regional emergency care needs and capabilities, and determine how emergency care can be optimized among island populations.
  
  
  METHODS
  During the summer of 2013, the project team conducted semi-structured key-informant interviews and small-group discussions among all health care teams in the MICAL region, as well as a community-based household survey on the island of Mayaguana. The interviews and small-group discussions consisted of open-response questions related to health care services, equipment, supplies, medications, and human resources. The community-based survey examined the prevalence of chronic noncommunicable diseases (CNCDs) and associated risk factors affecting the inhabitants of the region.
  
  
  RESULTS
  The average number of annual emergency referrals from each of the MICAL islands was approximately 25-30, and reasons for referrals off-island included chest pain, abdominal pain, trauma, and dysfunctional uterine bleeding. Traditional prehospital care is not established in the MICAL Constituency. Providers reported feelings of isolation from the distant health system in Nassau. Whereas most clinics have a well-stocked pharmacy of oral medications, diagnostic capabilities are limited. The household survey showed a high prevalence of CNCDs and associated risk factors.
  
  
  CONCLUSIONS
  Ongoing in-service emergency care training among MICAL providers is needed. Additional equipment could significantly improve emergency care capabilities, specifically, equipment to manage chest pain, fractures, and other trauma. Community-based preventive services and education could improve the overall health of the island populations.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.
authors.forename: Vince
authors.initials: V
authors.lastname: Markovchick
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Hines
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Lauretti
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Julien R
authors.initials: JR
authors.lastname: Lauretti
authors.affiliation: Ministry of Health of the Government of the Bahamas, Nassau, Bahamas.
authors.forename: Merceline
authors.initials: M
authors.lastname: Dahl-Regis
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D001444:Bahamas / Q000453:epidemiology; D002637:Chest Pain / Q000209:etiology; D002908:Chronic Disease / Q000453:epidemiology*; D003954:Diagnostic Services / Q000600:supply & distribution; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D004632:Emergency Medical Services / Q000600:supply & distribution*; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D004364:Pharmaceutical Preparations / Q000600:supply & distribution; D015995:Prevalence; D012017:Referral and Consultation; D012307:Risk Factors; D019035:Rural Health Services / Q000600:supply & distribution*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy; D000078329:Workforce; D014947:Wounds and Injuries / Q000628:therapy
chemical_list: D004364:Pharmaceutical Preparations
keywords: Bahamas; emergency medicine; emergency referral; island populations; isolated populations