Ramanujam P, Aschkenasy Miriam
Department of Emergency Medicine, University of California - San Diego, CA 92103-8676, USA.
J Assoc Physicians India. 2007 Jul;55:491-5.
Increasing industrialization in the developing world has contributed to an epidemiological transition in disease pattern from infectious disease as a primary cause of morbidity and mortality, to more chronic illness such as heart disease and trauma. This study was done in order to assess the effectiveness of pre-hospital and emergency care as the health care needs of the population changes and to make recommendations to meet the growing need for organized emergency services in that community.
Sundaram Medical Foundation Hospital in the town of Annanagar, Chennai, India was our study site. Statistics describing the health status, demographic, and socio-ecoomic profiles of the community were obtained from a published community survey. Information regarding availability of resources in the hospitals for management of trauma and cardio-vascular emergencies was obtained from unpublished survey results of the local hospitals. Retrospective data was obtained from trauma and ambulance registries regarding trauma related admissions, death and pre-hospital assistance.
Data analysis revealed increasing mortality from trauma and cardiovascular etiologies. Hospital statistics showed that 1/3 of the annual hospitalizations were from trauma and acute coronary syndromes. Half the trauma victims had no formal prehospital intervention. Standard of care in the emergency departments varied considerably with less than half of them carrying defibrillators and only a third of them carrying defirbillators and only a third of them carrying intubation equipment.
As developing countries begin to urbanize and grow, so do their health care needs. The current system does not meet the needs of increased mortality from trauma and cardiovascular disease. We have suggested necessary changes for establishment of emergency medical services to meet the evolving health care needs.
发展中世界工业化进程的加快导致了疾病模式的流行病学转变，即从传染病作为发病和死亡的主要原因，转变为心脏病和创伤等更多的慢性病。开展这项研究是为了评估随着人群医疗保健需求的变化，院前和急诊护理的有效性，并提出建议以满足该社区对有组织的紧急服务日益增长的需求。
印度钦奈安娜纳加尔镇的桑德拉姆医学基金会医院是我们的研究地点。描述该社区健康状况、人口统计学和社会经济概况的统计数据来自一项已发表的社区调查。有关医院处理创伤和心血管紧急情况资源可用性的信息来自当地医院未发表的调查结果。从创伤和救护车登记处获取关于创伤相关入院、死亡和院前援助的回顾性数据。
数据分析显示，创伤和心血管病因导致的死亡率在上升。医院统计数据表明，每年住院患者中有三分之一来自创伤和急性冠状动脉综合征。一半的创伤受害者没有接受正规的院前干预。急诊科的护理标准差异很大，不到一半的科室配备除颤器，只有三分之一的科室配备除颤器且只有三分之一的科室配备插管设备。
随着发展中国家开始城市化和发展，其医疗保健需求也在增加。当前系统无法满足创伤和心血管疾病导致的死亡率上升的需求。我们已建议对建立紧急医疗服务进行必要的变革，以满足不断变化的医疗保健需求。
