Hsia Renee Y, Thind Amardeep, Zakariah Ahmed, Hicks Eduardo Romero, Mock Charles
UCSF Department of Emergency Medicine, San Francisco General Hospital, 1001 Potrero Avenue, 1E21, San Francisco, CA, 94110, USA,
World J Surg. 2015 Sep;39(9):2161-7. doi: 10.1007/s00268-015-2997-5.
It is increasingly understood that emergency care systems can be cost-effective in low- and middle-income countries (LMICs). The development of such systems, however, is still a work in progress. This article updates previous work in providing the most recent estimates of the burden of disease sensitive to emergency care, the current state of knowledge on the feasibility of emergency care, effect on outcomes, and cost-effectiveness in LMICs, and future directions for research, policy, and implementation.
We calculated the potential impact of prehospital and emergency care systems using updated and revised data based on the global burden of disease study. We then assessed the state of current knowledge and potential future directions for research and policy by conducting a review of the literature on current systems in LMICs.
According to these newest updates, 24 million deaths related to emergency medical conditions occur in LMICs annually, accounting for an estimated 932 million years of life lost. Evidence shows that multiple emergency care models can function in different local settings, depending on resources and urbanicity. Emergency care can significantly improve mortality rates from emergent conditions and be highly cost-effective. Further research is needed on implementation of emergency care systems as they become a necessary reality in developing nations worldwide.
Emergency care implementation in LMICs presents both challenges and opportunities. Investment in evidence-based emergency care, research on implementation, and system coordination in LMICs could lead to a more cost- and outcome-effective emergency care system than exists in advanced economies.
人们越来越认识到，在低收入和中等收入国家（LMICs），急救系统具有成本效益。然而，此类系统的发展仍在进行中。本文更新了之前的工作，提供了对急救敏感疾病负担的最新估计、急救可行性的当前知识状态、对结果的影响以及在低收入和中等收入国家的成本效益，以及研究、政策和实施的未来方向。
我们根据全球疾病负担研究，使用更新和修订的数据计算了院前和急救系统的潜在影响。然后，我们通过回顾关于低收入和中等收入国家当前系统的文献，评估了当前知识状态以及研究和政策的潜在未来方向。
根据这些最新更新，低收入和中等收入国家每年有2400万人死于紧急医疗状况，估计损失9.32亿生命年。证据表明，多种急救模式可以在不同的当地环境中发挥作用，这取决于资源和城市化程度。急救可以显著提高紧急状况导致的死亡率，并且具有很高的成本效益。随着急救系统在全球发展中国家成为必要现实，需要对其实施进行进一步研究。
在低收入和中等收入国家实施急救既带来挑战也带来机遇。对循证急救、实施研究以及低收入和中等收入国家的系统协调进行投资，可能会带来一个比发达经济体更具成本效益和结果效益的急救系统。
