Department of Emergency Medicine, Los Angeles General Medical Center, University of Southern California, CA.
Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa.
Surgery. 2024 Jul;176(1):217-219. doi: 10.1016/j.surg.2024.02.024. Epub 2024 Apr 10.
The World Health Organization recognized timely healthcare as a human right and called for the expansion of two-tiered prehospital and out-of-hospital emergency care systems in low- and middle-income countries. Tier-1 systems involve community-based first responder care, and Tier-2 systems involve more formalized emergency medical services designed as a sustainable system of services, including dedicated ambulances, personnel, and equipment. Tier-2 systems can play a crucial role in reducing mortality and disability due to emergency medical and surgical conditions worldwide. However, the implementation and operation of robust Tier-2 systems in low- and middle-income countries face significant challenges. This article examines the current state, challenges, and opportunities of Tier-2 system development and operations in low- and middle-income countries, highlighting the limited coverage and resourcing of existing systems. The challenges faced in developing Tier-2 systems in low- and middle-income countries include a lack of global awareness, financial constraints, regulatory and planning issues, cultural appropriateness, and workforce shortages. Additionally, the availability and maintenance of equipment, technology, transportation, facilities, and interfacility transfers pose significant hurdles. Localized adaptation of emergency medical services models to suit the diverse contexts of different low- and middle-income countries is critical, as are community partnerships in navigating the complexities of specific communities. Furthermore, Tier-2 systems in low- and middle-income countries should prioritize alignment with national policies and integration into their broader healthcare systems. There is also a need for innovative financial sustainability approaches, such as private-public partnerships and cost-sharing schemes, to overcome the upfront costs of establishing Tier-2 system infrastructure. Additionally, strategies for strengthening the emergency medical services workforce, including targeted recruitment and training, are explored. By addressing these challenges and opportunities, Tier-2 systems in low- and middle-income countries can better operate within their available resources and potentially contribute to improved healthcare outcomes. The sharing of best practices and collaborative networks between systems in low- and middle-income countries will also be critical for the development of Tier-2 system infrastructure in these areas.
世界卫生组织承认及时的医疗保健是一项人权，并呼吁在中低收入国家扩大两级院前和院外急救护理系统。一级系统涉及基于社区的第一响应者护理，二级系统涉及更正式的紧急医疗服务，旨在作为一种可持续的服务系统，包括专用救护车、人员和设备。二级系统在全球范围内对降低因紧急医疗和外科条件导致的死亡率和残疾率发挥着至关重要的作用。然而，在中低收入国家实施和运营强大的二级系统面临着重大挑战。本文探讨了中低收入国家二级系统发展和运营的现状、挑战和机遇，突出了现有系统覆盖范围和资源有限的问题。在中低收入国家发展二级系统面临的挑战包括全球意识不足、财务限制、监管和规划问题、文化适宜性以及劳动力短缺。此外，设备、技术、交通、设施的可用性和维护以及机构间转移也面临重大障碍。本地化适应紧急医疗服务模式以适应不同中低收入国家的多样化背景，以及在特定社区中应对复杂性的社区伙伴关系至关重要。此外，中低收入国家的二级系统应优先与国家政策保持一致，并整合到更广泛的医疗保健系统中。还需要创新的财务可持续性方法，例如公私伙伴关系和成本分担计划，以克服建立二级系统基础设施的前期成本。此外，还探讨了加强紧急医疗服务劳动力的战略，包括有针对性的招聘和培训。通过应对这些挑战和机遇，中低收入国家的二级系统可以更好地在其现有资源范围内运作，并有可能为改善医疗保健结果做出贡献。中低收入国家系统之间共享最佳实践和合作网络对于这些地区二级系统基础设施的发展也将至关重要。
