INTEGRATION OF UNITED-STATES EMERGENCY-MEDICINE CONCEPTS INTO EMERGENCY SERVICES IN THE NEW INDEPENDENT STATES

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system. A curriculum (text and slides) has been developed and translated into Armenian and Russian. To date, the Armenian EMSI has trained nearly 300 emergency medical personnel: physicians, nurses, drivers, and first responders. The Armenian EMSI faculty have received training in directing instruction of emergency care providers. Plans are in place to begin training in Armenian cities outside of Yerevan and in neighboring republics. An emergency medicine residency program received ministry approval and was begun with six resident physicians in January 1995. To date, 45 nurses have graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health care system. Officials of the partner hospital requested assistance in upgrading the skills of its abundant emergency care workforce, citing cardiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia, Because the Armenian partners' needs in emergency medicine and trauma coincided with the US partners' areas of greatest expertise, it was clear that meaningful progress was possible. The centralized emergency medical system designed by the former Soviet Union produced nearly identical systems in the republics (including Armenia) that now form the New Independent States (NIS). The opportunity of reaching a broad base by means of development of a standardized curriculum was presented and acted on. In this report we describe and discuss our experience and provide an interim report of the effort. This project has demonstrated the feasibility of out-of-hospital emergency medicine training efforts in the NIS. The transfer of clinical knowledge, skills, systems approaches, and pedagogic techniques between unlike health care settings is possible if ministerial, municipal, and provider institutions themselves participate in the effort. The EMSI provides a model for EMS advancement and training that can be extended to other areas in the NIS.