University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin.
West J Emerg Med. 2022 Sep 12;23(5):746-753. doi: 10.5811/westjem.2022.7.56258.
Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population.
We performed an exhaustively sampled cross-sectional survey of all healthcare facilities providing urgent and emergent care in the four largest cities surrounding Lake Atitlán using the Emergency Services Resource Assessment Tool (ESRAT).
Of 17 identified facilities, 16 agreed to participate and were surveyed: nine private hospitals; four public clinics; and three public hospitals, including the region's public departmental hospital. All facilities provided emergency services 24/7, and a dedicated emergency unit was available at 67% of hospitals and 75% of clinics. A dedicated physician was present in the emergency unit during the day at 67% of hospitals and 75% of clinics. Hospitals had a significantly higher percentage of available equipment compared to clinics (85% vs 54%, mean difference 31%; 95% confidence interval (CI) 23-37%; P = 0.004). There was no difference in availability of laboratory tests between public and private hospitals or between cities. Private hospitals had access to a significantly higher percentage of medications compared to clinics (56% vs 27%, mean difference 29%; 95% CI 9-49%; P = 0.024).
We found a high availability of emergency services and universal availability of personal protective equipment but a severe shortage of critical medications in clinics, and widespread shortage of pediatric equipment.
获得紧急医疗服务是卫生系统的重要组成部分。改善中低收入国家（LMIC）获得紧急服务的机会可以降低死亡率并减少全球差距；然而，很少有研究评估过 LMIC 紧急服务资源。为了指导未来护理的改进，我们对危地马拉一个农村社区的紧急服务能力进行了全面评估，该社区主要为土著人口提供服务。
我们使用紧急服务资源评估工具（ESRAT）对围绕阿蒂特兰湖的四个最大城市中提供紧急和紧急护理的所有医疗设施进行了全面抽样的横断面调查。
在确定的 17 个设施中，有 16 个同意参与并接受了调查：9 家私立医院；4 家公立诊所；和 3 家公立医院，包括该地区的公立部门医院。所有设施都 24/7 提供紧急服务，67%的医院和 75%的诊所设有专门的急诊单位。67%的医院和 75%的诊所白天有专门的医生在急诊室。医院的设备可用率明显高于诊所（85%比 54%，平均差异 31%；95%置信区间[CI] 23-37%；P = 0.004）。公立和私立医院之间以及城市之间实验室检测的可用性没有差异。私立医院可获得的药物比例明显高于诊所（56%比 27%，平均差异 29%；95%置信区间[CI] 9-49%；P = 0.024）。
我们发现紧急服务的可用性很高，个人防护设备普遍可用，但诊所严重缺乏关键药物，儿科设备广泛短缺。
