Guidelines Designed For Improved Emergency Medicine Programs Around The World

1-14-98
Hershey, Pa. --- With many companies setting up international offices and an overall rise in global travel, more attention is focused on medical facilities around the world.

"Many people would be surprised to learn that emergency programs in Europe and throughout the world have a mortality rate often three and four times higher than in the United States. That means if you are in a car accident or trauma situation in another country, your chance of a successful recovery are much lower," says James Holliman, M.D., professor of surgery at Penn State's College of Medicine. "In comparison, we have a 4 percent trauma mortality rate at the Hershey Medical Center."

Holliman, also a physician with the Penn State Geisinger Health System, and his colleagues have written guidelines to help physicians evaluate emergency programs throughout the world. The paper, titled, "Guidelines for Evaluation of International Emergency Medicine Assistance and Development Projects," was published in the December 1997 issue of the journal, Annals of Emergency Medicine.

He says many countries have plenty of skilled physicians and the resources for good trauma care, but in most instances lack good organization.

"This is much more basic than some high-tech procedures. Often, physicians only need a few days of intensive study to know proper emergency procedures. Things like fracture management, wound care and airway management are relatively simple for physicians. It is often a matter of having a plan in place and developing proper procedures," says Holliman.

In many countries, simple services like transportation are poor. Holliman says a delay in getting someone to a hospital can often result in the injury developing into something worse than it should have been if proper ambulance transportation were in place.

Holliman hopes other physicians use his guidelines to evaluate emergency programs in other countries and hopes it improves those programs. Some of those guidelines include:

** Be aware of the host country's culture. Things that may be acceptable in the United States simply may not be somewhere else.

** Conduct a specific needs assessment and provide programs that are essential, rather than those you think might be good to include.

** Get significant local input and control for the planning and implementation of a project.

** Complete a written description with timetable for all aspects of the project including goals, and include funding sources.

** Ensure long-term continuity with frequent follow-up information to make a project proceed.

"Several years ago in Croatia, while a civil war was going on, thousands of blankets were donated. While this was a well-intentioned project, it ruined the only local industry, which is blanket-making. This is an example of not being aware of the local culture. Help to this region should have come in other forms," says Holliman.

Holliman believes good emergency care can be implemented in most countries with minimal investment. He says it is a matter of U.S. physicians providing good planning advice for many programs and implementing training programs as needed to improve care. Improvements in emergency care will ultimately benefit patients in the form of quicker recovery times and overall improved care.

**hmc**

CONTACTS:
Leilyn Perri (717) 531-8604 (o) leilyn.perri@hmc.psu.edu
M. Steven Bortner (717) 531-8607 (o) (717) 838-5910 (h)