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Prehosp Disaster Med ; 19(4): 318-25, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15645628

RESUMO

INTRODUCTION: In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico. METHODS: In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site. RESULTS: The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site. CONCLUSIONS: This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.


Assuntos
Pessoal Técnico de Saúde/educação , Competência Clínica , Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência/economia , Auxiliares de Emergência/educação , Adolescente , Adulto , Pessoal Técnico de Saúde/economia , Análise Custo-Benefício , Currículo/normas , Currículo/tendências , Países em Desenvolvimento , Avaliação Educacional , Feminino , Primeiros Socorros , Humanos , Masculino , México , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
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