This is a guest post by Jason Friesen, President/Founder of Trek Medics International. If you want to guest post on this blog, check out the guidelines here.
About two years ago, I really got interested in learning about how EMS worked in foreign countries – particularly in low- and middle-income countries – and as I began my research I quickly found that there wasn’t too much information available, and what little information that did exist was scattered, incomplete or tucked away inside other research articles.
Little by little, however, I started compiling a small collection of articles and internet sites on different systems. One of the places that provided a lot of great information was the World Health Organization (WHO), who had published a paper in 2005 entitled, “Prehospital Trauma Care Systems.” This paper was part of a greater effort by the WHO to address the rapidly growing problem of preventable death and disability in low- to middle-income countries. As a result of reading this paper, as well as others published by WHO”s Department of Violence and Injury Prevention, I discovered that there was in fact a significant amount of work being done to build a framework supporting prehospital system development across the globe, whether formal or informal. After that, it simply became a game of connecting the dots by using PubMed to do searches on the cited references from the articles to find more articles on the topic. It didn’t take long after that to realize that I had a small library of information that hadn’t been put together anywhere else, so I decided to do something with it.
In the end, I started the DIEMS Project (Database for International EMS Systems), whose basic idea was to provide something that didn’t previously exist – a resource for prehospital providers interested in international EMS efforts.
At the moment, it’s up to 26 countries, though I will be adding more in the next couple months and continue to add countries as I find more information. And while I wouldn’t want to dictate how the information I’ve collected should be used, I do have a couple ideas of how it might help EMS professionals further their career.
Expand and enhance career opportunities for EMS professionals.
I was once told that there were only four career opportunities for EMS professionals beyond the ambulance: the fire department, nursing, management or burn-out. While that definitely seems to have been the case in the past, I’m convinced that the future holds a lot of new, exciting opportunities for EMS professionals, but only if we are able to identify them, and then take hold of them.
As I mentioned above, prehospital systems are becoming a real big focus within the WHO. Morbidity and mortality from injuries is just this huge, growing menace in a globalizing world, and it tends to be most prevalent among young males – who also happen to be the economic base within any country. The emotional, societal and financial burdens placed upon a community by death and permanent disability is a huge impediment on a developing country’s progress. But whereas injury used to be considered the result of “accidents”, public health experts are now working to reverse this fatalistic approach and demonstrate how most of these injuries are preventable, and that the real accident is when a person actually dies from injuries that shouldn’t necessarily be fatal.
The issue is going to be trying to find innovative and efficient ways to bring prehospital care to different countries and cultures. It’s not like you can just replicate the Anglo-American or Franco-German EMS models anywhere in the world – nor would you want to. But at the same time, no one understands better how to operate in the prehospital field than us, the prehospital providers. Therefore, we, as a profession, need to be vigilant about making sure that we play an integral part in whatever initiatives are started – we can’t leave prehospital care solutions entirely to clinical professionals and academics. Because EMS professionals work on an ambulance, in the Fire and Police departments, in hospitals, and in the military, we offer an extraordinary amount of experience and multi-disciplinary talent that few other professions possess. So there has to be a holistic approach that takes into account this vast knowledge and experience we have in the prehospital field, but we can’t expect that these opportunities will just fall into our laps.
Inspire EMS professionals to start their own initiatives.
It’s also important to remember that we don’t have to wait around until someone comes knocking on our door asking for help. Anyone who’s been through an EMT-Basic course has the potential to make a huge difference. Injury, as everyone knows, does not require ALS interventions to be effective. Injury is all about the ABCs, and that’s pretty much the extent of it. All of the ALS trauma interventions we have are expensive and, truthfully, suspect.
Likewise, you don’t need a complex system with ambulances, dispatch, GPS, expensive equipment and all the other bells and whistles to save lives. In fact, most of that stuff will just end up wasting money without producing any real tangible outcomes.
One of the things that we’re working on right now is providing a BLS trauma course to a taxi co-op in Ghana. The basic question is: who’s most likely to come across an injury in the field and/or transport that trauma victim to the hospital? Find that group, and you’ve found the foundation of an informal, but highly effective EMS system. Of course, prehospital care is only as good as the hospital you’re transporting to, but there are a great deal of simple interventions that can be effective without a level-1 trauma center.
I first read about this idea from a gentleman named Dr. Charles Mock who gathered together a truck driver’s union in Uganda, trained them in BLS trauma care, and significantly raised patient outcomes, depending on the injury. His study proved that it’s easy to teach, and it isn’t dependent upon an expensive medical education – or even literacy – to be tremendously effective. Likewise, most of the BLS trauma equipment, like bandages, splints and c-collars, are easy to improvise with everyday items.
Expose EMS professionals to other systems and experiences to improve their own.
One of the things that I’ve noticed in my experiences with various EMS systems in the US and around the world, is this notion of “This is how we do it.” It kind of goes along the same lines as the argument, “I’ve been doing this for X years,” and it’s more likely to be encountered in certain environments than others. But the point is that people get set in their ways and assume that it must be the only way, and best way to do things simply because that’s the way they’ve always done it.
I don’t want to be misunderstood – experience is extremely important, and valuable. But it’s very important to remember that our singular experience can’t be the only one, and probably isn’t. This is especially true for US EMS professionals. The general sentiment I’ve experienced is that the US must have the “best” system by virtue of the fact that we had the first one. That’s a really dangerous way to think. Just take a look at the history of Brazilian soccer versus English soccer in the World Cup and you’ll see what I mean – the English may have invented it, but they’re certainly not the best team on the field. This same thinking can be further demonstrated by that old adage, “150 years of tradition unimpeded by progress.”
It’s also important to remember that even within the US, no two systems do it the same way – so why should we think that we can’t learn anything from anyone else? In fact, for developing systems, the US system is often used as an example of what NOT to do.
With that said, I really hope that the DIEMS project will foster a culture of sharing between different EMS providers, and ultimately create a sense of community that contributes to improved health care anywhere it’s offered.
To read more about the DIEMS Project, click here: http://www.emsresponder.com/features/article.jsp?id=14389&siteSection=5
Jason Friesen, NREMT-P, is the President/Founder of Trek Medics International. He is currently studying for a Master’s degree in Public Health at Columbia University’s Mailman School of Public Health in New York City.
