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Cost-Effectiveness and Benefit of Alternatives to Improve Training for Prehospital Trauma Care in Mexico

Published online by Cambridge University Press:  28 June 2012

Carlos Arreola-Risa ,
Charles Mock ,
Alejandro J. Herrera-Escamilla ,
Ismael Contreras  and
Jorge Vargas
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Abstract

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 costeffectiveness 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]$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 $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.

Keywords

ambulancecost effectivenessdeveloping countryemergency medical servicesinjuryless-developed countryprehospital caretrauma
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 4 , December 2004 , pp. 318 - 325
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

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