EPIDEMIOLOGY AND PRACTICE OF EMERGENCY-MEDICINE IN A DEVELOPING-COUNTRY

Study objective: To analyze the emergency medicine system in a developing country and identify areas of need and potential collaboration. Design: Convenience sample surveys of all emergency visits over a 2-week period, hospital admission and health department statistics, and interviews with government officials, health providers, and EMS managers. Setting: Port of Spain General Hospital, Trinidad and Tobago. Results: The ED has more than 100,000 visits per year. No records are kept. No physician in this study had emergency medicine training; only one had completed any residency. The survey included 3,710 patients: 40.5% were admitted, and .3% died. Injuries accounted for 41.6% of all visits, asthma 7.8%. The mean time elapsed before a patient was seen was .5 hour; mean time to discharge, 1.9 hours. In only 9% of patients were laboratory tests performed. Prehospital providers had limited equipment and training. Conclusion: The ED and prehospital systems provide high-volume and often high-acuteness care. Barriers to improved care include limited specialized training and lack of medical records.