Medical emergencies occur in every country regardless of its level of socio-economic development. Little comparative data are available which define the characteristics of the system by which some emergencies are managed. Without such comparisons, it is difficult for countries to establish appropriate priorities within their geographic, cultural, and economic constraints. In an effort to gather some of these needed data, a survey was distributed to the participants in an International Conference on Emergency Health Care (EHC) Development convened in Washington, D. C, in August 1989. Each country participating was classified as Industrialized (INDUS), Developing (DC), or Least Developed (LDC) in accordance with World Health Organization definitions. Responses are expressed as proportion of total participants.
There were 450 participants from 74 countries. Only 17% of the surveys were returned. The sample included 78 participants from 40 (57%) countries. (INDUS: 30%; DC: 48%; LDC: 22%). All showed considerable dependence on ambulance services, but DC and LDC indicated substantial reliance on friends, neighbors, community health workers, and physician's offices. Prehospital EHC services were available to 93% of INDUS, 63% of DC, and possibly one-third of the LDC. Emergency Health Care is taken to the patients in the same proportions as noted above. The types of manpower dispatched varied widely with a great proportion of the respondents from DC and LDC indicating that care was delivered by non-professionally trained individuals. Interestingly, INDUS had the greatest proportion of volunteers. Response and transport times were shorter for INDUS than for DC. When no prehospital EHC services were available, patients reached the receiving facilities by alternate means such as walking (33%), private automobile (48%), or public transportation (33%). Central emergency access was available for 80%. Considerable variation exists as to the mechanisms by which such services are financed: poorer countries depend more on government support than do INDUS who rely heavily on donations and fee-for-service. Lastly, regardless of level of economic development, cardiovascular disease, trauma, and medical illness comprise the most important reasons for accessing the EHC systems.
This preliminary study points to the need for individualizing EHC systems in concert with the priorities of the country for which they are designed. Direct application of operational systems across countries does not seem an appropriate mechanism for the development of EHC. However, the delivery of EHC must be made an important element of overall health care in all the countries of the world.
