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Cost-Effectiveness and Benefit ofAlternatives to Improve Training for PrehospitalTrauma Care in Mexico

Published online by Cambridge University Press:  28 June 2012

Carlos Arreola-Risa ,
Charles Mock ,
Alejandro J. Herrera-Escamilla ,
Ismael Contreras  and
Jorge Vargas
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Abstract

Introduction:

In Latin America, there is a preponderance ofprehospital trauma deaths. However, scarceresources mandate that any improvements inprehospital medical care must be cost-effective.This study sought to evaluate thecosteffectiveness of several approaches toimproving training for personnel in threeambulance services in Mexico.

Methods:

In Monterrey, training was augmented withPreHospital Trauma Life Support (PHTLS) at a costof [US]$150 per medic trained. In San Pedro,training was augmented with Basic Trauma LifeSupport (BTLS), Advanced Cardiac Life Support(ACLS), and a locally designed airway managementcourse, at a cost of $400 per medic. Process andoutcome of trauma care were assessed before andafter the training of these medics and at acontrol site.

Results:

The training was effective for both interventionservices, with increases in basic airway maneuversfor patients in respiratory distress in Monterrey(16% before versus 39% after) and San Pedro (14%versus 64%). The role of endotrachal intubationfor patients with respiratory distress increasedonly in San Pedro (5% versus 46%), in which themost intensive Advanced Life Support (ALS)training had been provided. However, mortalitydecreased only in Monterrey, where it had been thehighest (8.2% before versus 4.7% after) and wherethe simplest and lowest cost interventions wereimplemented. There was no change in process oroutcome in the control site.

Conclusions:

This study highlights the importance of assuringuniform, basic training for all prehospitalproviders. This is a more cost-effective approachthan is higher-cost ALS training for improvingprehospital trauma care in environments such asLatin America.

Keywords

ambulancecost effectivenessdeveloping countryemergency medical servicesinjuryless-developed countryprehospital caretrauma

Information

Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 4 , December 2004 , pp. 318 - 325
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

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