Pre-hospital Emergency Medical Services, Phase I: Role of the Department of Community Health and Psychiatry

The Department of Community Health and Psychiatry was contracted by the Ministry of Health to assist with the implementation of a pilot programme in the Western Health Region to train fire fighters as basic level Emergency Medical Technicians (EMTs), and was responsible for its design, implementation and monitoring for first 18 months. The course was covered in 440 hours over a 10 week period, and included training in emergency medical response, driving an emergency medical vehicle, emergency medical despatching and inventory control. Of 76 fire fighters selected for training, 62 graduated, receiving Certificate of Merit from the Ministry of Health, Jamaica and were deployed into service on 17th April 1996. During the period 17 April to 31 December, 1996, the newly trained EMT's responded to 1,299 calls. Medical and surgical cases represented approximately 55 percent of all calls, followed by trauma (19 percent), motor vehicle accident (9 percent) and obstetric emergencies (8 percent). Between 15 percent and 20 percent of calls in Montego Bay and Negril involved tourists. This first group of EMT's has performed well and was well received by the communities and the persons who used the service.(AU)

Effect of basic prehospital trauma life support program on cognitive and trauma management skills

We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45 +/- 9.4 percent vs. 48.4 +/- 8.9 percent for groups I and II respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9 percent) than in group II (52.6 +/- 4.9 percent). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group II (range 8.0 - 11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p < 0.05) compared to 9.1 +/- 2.3 for group II. Pre-PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.(Au)

The challenge of delivering out-of-hospital emergency medical care - a Canadian experience - abstract

Two decades of experience with out-of-hospital delivery of Emergency Health Care will be examined with particular reference to the development in North America, of Emergency Medicine as a clinical specialty. The influence of this experience on pre-hospital Emergency Care in the Province of Ontario, Canada, will be discussed. References will be made to the roles played by such organizations as the St. John Ambulance Association, Canadian Heart Foundation, and the Canadian Association of Emergency Physicians. Pilot programmes instituted in the cities of Hamilton and Toronto for the training of paramedics will be described. The place of the Paramedic in the Emergency Medical System, as envisioned and as realised, will be discussed. Difficulties of assessing efficacy and efficiency of current paramedic performance, and constraints of economics on health care programmes will be shown to have bearing on future methods of pre-hospital care delivery. These, as well as geographical factors, necessitate modifications for Emergency Medical Care across the province, and some of these modifications will be discussed (AU)

Curriculum design and implementation for Jamaican ambulance personnel

A training programme for Jamaican ambulance personnel is described. The factors relevant to development of the curriculum are discussed, and the need for training this category of personnel is emphasised. The programme deals with first-aid along with basic life support measures. Its role in preparing the ambulance attendants for advanced training is noted (AU)