Skip to main content Accessibility help
×
Home

The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation

  • Luis Mauricio Pinet Peralta (a1)

Abstract

Introduction:

Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.

Objective:

The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.

Methods:

This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.

Results:

The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.

Conclusions:

Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Copyright

Corresponding author

Correspondence:Luis Mauricio Pinet Peralta 1009 Arion Park Rd Apt. 348 Baltimore, MD 21229 USA lpinet1@nmbc.edu

References

Hide All
1Instituto Nacional de Estadistica: Geografia e Informatica. (n.d.). Indicadores demograficos, estimaciones 2000-2030 [National Institute of Statistics, Geography and Informatics, Demographic indicators, 2000–2030 estimates]. Available at http://www.df.inegi.gob.mx-sociodem/espanol/demografico/dem_02.html. Accessed on 28 June 2004.
2Instituto Nacional de Salud Publica (n.d.): Núcleo de Acopio y Analisis de Información en Salud, Panorama Epidemiologico 1998–2002 [Center for health information collection and analysis, Epidemiologic “panorama” 1998-2002]. Available at http://sigsalud.insp.mx/naais/panorama.asp. Accessed on 11 April 2005.
3Instituto Nacional de Estadistica: Geografia e Informatica. (n.d.) Indicadores sociodemograficos por entidad federativa, D.F. Defunciones generales por principales causas de defunción, 2003. [National Institute of Statistics, Geography and Informatics. Sociodemographic Indicators by entity, Mexico City. General mortality and main mortality causes, 2003]. Available at http://www.inegi.gob.mx/est/contenidos/espanol/rutinas/ept.asp?t=mpob97& c=3844&e=09. Accessed on 12 August 2005.
4PanAmerican Health Organization: Situación general de México [General Situation of Mexico]. Health in the Americas, Washington, DC. Available at http://www.paho.org/english/HIA1998/mexico.pdf. Accessed on 28 June 2004.
5Instituto Nacional de Estadistica: Geografia e Informatica. (n.d.). Indicadores Sociodemograficos. Mortalidad, porcentaje de defunciones generales por grupos de edad y principales causas 1990-2003. [Nacional Institute of Statistics, Geography and Informatics. Sociodemographic Indicators. Mortality, percent of general mortality by age groups and main causes, 1990-2003]. Available at http://www.inegi.gob.mx/est/default.asp?c=2343. Accessed on 12 August 2005.
6Celis, A, Gómez-Lomelí, Z, Armas, J: Tendencias de mortalidad por trauma-tismos y envenenamientos en adolescentes. Mexico, 1979-1997 [Mortality tendencies for trauma and poisoning in adolescents]. Salud Publica de Mexico 2003;45, supl 1:s8–s15.
7Rodgers, A, Vaughan, P: Quantifying Selected Major Risks to Health. Chapter 4. In: The World Health Report, 2002. Reducing Risks, Promoting Healthy Life. World Health Organization. France. 2002. p 72.
8Krug, EG, Sharma, GK, Lozano, R: The global burden of injuries. Am J Public Health 2000;90:£523–526.
9Arnold, JL: International emergency medicine and the recent development of emergency medicine worldwide. Ann Emerg Med 1999;33:97103.
10Soberón-Acevedo, G, Frenk-Mora, J, Sepúlveda-Amor, J: La reforma de la atención a la salud en México: Antes y después de los sismos de 1985 [The reform of healthcare in Mexico: Before and after the earthquakes of 1985]. Salud Publica de Mexico 1986;28(5):568580.
11Soberón-Acevedo, G, Valdéz-Olmedo, C: A dos años: Reflexiones sobre los terremotos de 1985 [Two years after; Reflections about the earthquakes of 1985]. Salud Publica de Mexico 1987;29(5):448456.
12Mock, CN, Jurkovich, GJ, nii-Amon-Kotei, D, et al. : Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development. J Trauma 1998;44(5):804813.
13Arreola-Risa, C., Mock, C., Padilla, D, Cavazos, L, Maier, RV, Jurkovich, GJ: Trauma care systems in urban Latin America: The priorities should be pre-hospital and emergency room management. J Trauma 1995;39(3):457462.
14Arreola-Risa, C., Cantu, YG, Mock, C: Paramedicos en Mexico: Entrenamiento, experiencia y recomendaciones [Paramedics in Mexico: Training, experience and recommendations]. Trauma 2002;5:6974.
15Stout, JL: Public utility model revisited: Part 1—Origins. JEMS 1985;11(2):5563.
16Sierra, A: Sorprenden costos de ambulancias [They are surprised by costs of ambulances]. Reforma en linea. Available at http://reforma.com.mx. Accessed on 10 September 2003.
17Ferrer, G: Señalan irregularidad de ambulancias [Ambulance irregularities pointed out]. Reforma en linea. Available at http://reforma.com.mx. Accessed on 10 September 2003.
18Gobierno de la Republica: Norma Oficial Mexicana NOM 020-SSA2-1994: Para la prestación de servicios de atención medica en unidades móviles tipo ambulancia [Mexican Oficial Norm NOM 020-SSA2-1994: for delivery of medical care on mobile units of the ambulance type]. Mexico, D.F, Mexico.
19Consejo Nacional para la Prevencion de Accidentes: Secretaria de Salud (n.d). Proyecto de modificacion de la Norma Oficial Mexicana NOM-020-SSA2-1994 [Modification Project for the Mexican Oficial Norm NOM-020-SSA2-1994]. Available at http://conapra.salud.gob.mx/archivos/proy_atn_prehosp.pdf. Accessed on 03 April 2005.
20Secretaria de Salud: Ley General de Salud. Direccion General de Asuntos Juridicos, legislación vigente. [Ministry of Health. (2005). General Health Law, General Direction for Legal Affairs, current legislation.] Available at http://www.salud.gob.mx/unidades/dgaj/archivos/archivos/legislacionvigente/LeyGeneral.htm. Accessed on 12 August 2005.
21Rodríguez-Ortega, MF, Delgadillo-Gutiérrez, S, Basilio-Olivares, A, LópezCastañeda, H: Experiencia de 11 años en la atención del paciente politraumatizado en la Unidad de Trauma-Choque de la Cruz Roja Mexicana [Experience of 11 years in the treatment of politraumatized patients in the shock-trauma unit at the Mexican Red Cross]. Anales Médicos; 2003;48(1):1823.
22Illescas-Fernández, GJ: Epidemiología del trauma en la ciudad de México [Epidemiology of trauma in Mexico City]. Trauma 2003;6(2):4043.
23Rivera-Arroyo, E: El manejo prehospitalario de la crisis hipertensiva [Prehospital management of the hypertensive crisis]. Revista Mexicana de Enfermeria Cardiologica 2002;10(1):2732.
24Instituto Nacional de Estadistica, Geografia e Informatica. (n.d.). Porcentaje de defunciones generales por sexo y principales causas, 1990–2002 [General mortality percentage by gender and main causes, 1990–2002]. Available at http://www.inegi.gob.mx/est/contenidos/espanol/tematicos/mediano/med.asp ?t=mpob45&c=3222. Accessed on 09 July 2004.
25World Health Organization: Quantifying Selected Major Risks to Health. In: The World Health Report, Geneva. (2002) pp 4998.
26Organization for Economic Co-operation and Development (2001): International Road Traffic and Accident Database (IRTAD). Paris. Available at http://www.bast.de/htdocs/fachthemen/irtad/english/englisch.html. Accessed on 19 Nov 2003.
27Mock, C., Jurkovich, GJ, nii-Amon-Kotei, D, Arreola-Risa, C., Maier, RV: Trauma mortailty patterns in three nations at different economic levels: Implications for global trauma system development. J Trauma 1998;44:804–13.
28Stout, J. System Design. In: Kuehl, AE (ed): Prehospital Systems and Medical Oversight. St. Louis, MO, Mosby Life-line, 1994; p 89.
29Ali, J, Adam, RU, Gana, TJ, Bedayse, H, Williams, JI: Effect of the prehospital trauma life support program (PHTLS) on prehospital trauma care. J Trauma 1997;42:786790.
30Hutton, DW: The Change Agent's Handbook: A Survival Guide for Quality Improvement Champions. Milwaukee: ASQ Quality Press, pp289306.
31Asociancions, paramedicos.com.mx.portal (n.d.). Mexico D.F. Available at http://paramedicos.com.mx. Accessed on 05 March 2006
32American Ambulance Association: Guide for Contracting Emergency Ambulance Services: Guide to Effective System Design. Sacramento, CA: American Ambulance Assocation. 1994.
33Arreola-Risa, C., Mock, C., Wheatly, LL, et al. : Low-cost improvements in pre-hospital trauma care in a Latin-American city. J Trauma 2000;48(11):119123.
34Fraga-Sastrías, JM, Stratton, S, Asensio, E, et al. : Estatus de los técnicos en urgencías médicas en Mexico en comparacion con Estados Unidos: Se debe hacer énfasis en el entrenamiento y estado laboral [Status of emergency medical technicians in Mexico compared to the United States: Emphasis should be on training and working conditions. Trauma 7(1):1523.
35Hanashiro, R: The price of just a few seconds lost; People die. Available at http://www.usatoday.com/news/nation/ems-main.htm. Accessed on 04 July 2004.
36 XE Ingeniería Médica (n.d.): Mexico D.F. Available at http://www.xemedica.com/pages/5/index.htm. Accessed on 04 July 2004.
37Metro Care: SPAM (n.d.) Mexico D.F. Available at www.ambulanciasspam.com.mx. Accessed in 04 July 2004.
38Ambulance Department, Dalinde Medical Center, Mexico City. 07 May 2004. (personal communication).
39Secretaria del Trabajo y prevision social (n.d.): Registro de capacitadores externos. Direccion General del Trabajo [External training registry. General Labor Direction]. Mexico, D.F. Available at http://www.stps.gob.mx. Accessed on 21 July 2004.
40Secretaria de Educacion Publica. (n.d.): Catalogo Laboral, Direccion de Planeacion, Programacion y Presupuesto [Professional training, particular services. Workplace catalogue, Planning, Programming and Budget General Direction]. Mexico, D.F. Available at http.www.sep.gob.mx. Accessed on 21 July 2004.
41Federal District Ministry of Health: Practical evaluation for approved personnel at the essential first aid level voluntary registry for prehospital care professionals, approved listings. Available at http://www.salud.df.gob.mx/educacion_medica/lugar.html. Accessed 12 August 2005.
42National Highway Traffic Safety Administration (NHTSA): A Leadership Guide to Quality Improvement for Emergency Medical Services (EMS) Systems. Publication DOT HS 808 623. US Department of Health and Human Services, Public Health Service. Available at http://www.nhtsa.dot.gov. Accessed on 03 July 2004.
43International Federation of the Red Cross and Red Crescent Societies (n.d.): Partnerships in Profile, 2000–2003. Mexican Red Cross. Available at http://www.ifr.org/cgi/pdf_profile.pl?mxprofile.pdf. Accessed on 04 July 2004.
44Cmdte. Gral. Lic. Alejandro Segura Millan Blake: Chief of EMTs and first responders, Mexican Red Cross-Mexico City Chapter. (Personal communication, 14 July 2004).
45Insitiuto Nacional de Estadistica: Geografia e Informatica (n.d.): Expenses by the federal government from 1997 to 2002, Chart 2.2.1. Direct communication with INEGI customer service center at atencion.usuarios@inegi.gob.mx. Received 24 February 2004.
46Merino-Juáez, MF, Sesma-Vázquez, S (n.d.): Síntesis ejecytiva: Gasto publico en salud 1999–2000. Coordinatión General de Planeación Estratégica, Dirección General de Información y Evaluación del Desempeño. Secretaría de Salud.
47National Highway Traffic Safety Administration (NHTSA). National Research Agenda, EMS. Publication DOT HS 809 674. US Department of Health and Human Services. Available at http://www.nhtsa.dot.gov. Accessed on 03 July 2004.
48National Highway Traffic Safety Administration (NHTSA): Trauma Systems: Agenda for the Future. Publication DOT HS 809 675. US Department of Health and Human Services. Available at http://www.nhtsa.dot.gov. Accessed on 03 July 2004.
49American Ambulance Association: Achieving a balance. Guide for Contracting Emergency Ambulance Services; Guide to Effective System Design. 24. Chapter 2 (p 24.25). Sacramento, CA: American Ambulance Association. 1994.
50Inzunza, A: Pediatrics divided for lack of resourses. Available at http://www.reforma.com.mx. Accessed on 03 July 2003.
51Bordon, A: Paramedics turn against hospitals. Available at http://www.reforma.com.mx. Accessed on 03 July 2003.
52Redaccion, Grupo Reforma: They joke with emergency phones. Available at http://www.reforma.com.mx. Accessed on 03 July 2003.
53Magallanes, C (n.d): Dies in the street waiting for assistance. Available at http://www.elnorte.com.mx. Accessed on 03 July 2003.
54Sanchez, K: Ambulances respond to four emergencies per day. Available at http://www.reforma.com.mx. Accessed on 03 July 2003.
55Perez, JA: ERUM is given incomplete ambulances. Available at http://www.reform.com.mx. Accessed on 03 July 2003.
56Hernandez, M: Ambulances interfere with medical attention. Available at http://www.reform.com.mx. Accessed on 03 July 2003.
57Narad, RA: Coordination of the emergency medical services system: An organizational theory approach. Prehosp Emerg Care 1998;2:145152.

Keywords

The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation

  • Luis Mauricio Pinet Peralta (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed