EMS chaotic situation in Argentina 1/2
In my case, I was born in Israel but have been living in Argentina for the last 15 years. (I work counter-seasonally in the US). Since in EMT Life there are many experienced MDA (Magen David Adom) members I will stick to comment about Argentina’s EMS.
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In Argentina EMS is at a very improvable status. It is a bit better than in other South American countries but still… disastrous. It is called Sistema de Emergencias Medicas (Medical Emergencies System) instead of Servicio Medico de Emergencia (Emergency Medical Service). Some hospital now have signs that say Emergencias (Emergencies) but most still describe their areas equivalent to ERs as Urgencias (Urgencies). There are also public and private clinics that deal with medical emergencies. Their areas are usually called “Guardia” (guard / watch). The term is used since doctors and nurses are “on guard” / “on watch” (~ on call).
Budgets are a main problem but does not justify the low level of training on behalf of EMS personnel. Over 90% has knowledge under a USDOT FR level. It is rare to find a CPR Mask (Pocket Mask® or other brand on an ambulance that is over a year old) and Nitrile gloves are unknown to most, Latex gloves are still the ones in use.
Paperwork is still taken as a joke in some areas (non existent) and in others it is not taken very strictly.
ORGANIZATION
Ambulance services are provided by governmental agencies (mostly at the province government level, but there are a few municipal and national services), private companies and non-profit organizations.
Government departments and divisions are called ministries and secretaries and usually those in charge of Public Health operate public hospitals and ambulance services. Public ambulances are stationed at hospitals and respond to calls from there. Argentina has different emergency phone numbers that are used nationally:
1-0-0 = Fire
1-0-1 = Police
1-0-2 = Child abuse
1-0-3 = Civil Defense / Civil Protection / Municipal emergencies
1-0-5 = Environmental emergencies (Park Rangers)
1-0-6 = Nautical emergencies (Coast Guard)
1-0-7 = Medical emergencies (Ambulance)
In the last years some of Argentina’s largest metropolitan areas started using 9-1-1 as an emergency phone number parallel to the 1-0-1 since most people never got to learn the proper emergency numbers but knew the world famous 9-1-1 from movies and TV shows. The change is just in the number since it is still entirely operated by province or federal police and does not function as a central emergency system phone number.
In Argentina, Fire services are also in quite a chaotic situation. The only entirely professional firefighters are those few working for private fire squads at petrol-oil companies in the fields and refineries. Most fire services in Argentina are provided by Volunteer Firefighters Associations all at some point related to a National Federation. Then, law enforcement only exist at the Province and Federal levels. Non of Argentina’s municipal governments have their own police or fire agency. All provincial police agencies (equivalent to state police) have a firefighters division. These divisions only provide fire-rescue services to the province capital city and sometimes some other major cities. In a few provinces, all fire stations (even in rural areas) have a mixed staff. A commander / supervisor who belongs to the province police fire division and a crew of volunteer firefighters. There are also two federal law enforcement agencies that have their own fire divisions. One if the PFA (Policia Federal Argentina = Argentine Federal Police) and the PNA (Prefectura Naval Argentina = Argentine Naval Prefecture) which is the Coast Guard service provider. Then the APN (Administracion de Parques Nacionales = National Parks Administration) has in addition to its park rangers some brigades specialized in wild fires. Some provinces have their own wild fire brigades too.
A few fire services have their own ambulances, some (being imported) tend to be better equipped that those ambulances from public hospitals and private companies. However, they are usually only used as transport for lightly injured patients and transporting EMS equipment to MVAs and general rescues. On rare occasions they are used for transportation of patients in critical conditions or injured firefighters.
Private ambulance companies usually provide services in different categories: non-emergency patient transport, doctor house calls, emergency response to private business (from small stores to large shopping malls), highway emergency medical response (mostly for private toll / highway administrating companies), events (sport events, concerts, expositions, etc.), and (very few) emergency medical response calls through 1-0-7 (the public EMS). –The latter is similar to some areas in the US where private ambulance companies are contracted to provide a public EMS either in addition to governmental EMS or instead of (like in jurisdictions where there are non). In the event of a mass incident / disaster private ambulance companies have to render support (free of charge) in addition to public ambulance services by law.
Some private Health / Medical Insurance / Social Security (~ private “Medi-Care”) entities have their own ambulances which generally just function as non-critical patient transport. –Usually when one of their clients gets transferred from a public medical facility to a private clinic or when geriatrics (being their customers) need transport from or to a medical facility.
Non-profit organizations such as the Cruz Roja Argentina (Argentine Red Cross) and others have their own ambulances. These are few and rarely are used for actual emergencies. –Mostly for events, disaster relief and non-critical patient transport.
EQUIPMENT
Equipment wide, mostly are nothing else but a van or sometimes even a pick up truck with a camper on its box / bed, a stretcher and an old fixed Oxygen tank. Some others are elevated roof vans with basic trauma equipment, portable Oxygen tanks, defibrillator, etc… Then just in recent years full size nationally made ambulances have been customized in order to have a design similar to type III ones. Due to Argentina’s and Brazil strong automotive industries, there are very few imported ambulances. –Those few are mostly American types I, II and III (generally Ford F-350 / E-350).
STAFF & TRAINING
Ambulances are staffed by 2-3 people depending on the agency budget, jurisdiction, and location. Those that have only 2 crew members include a driver and a “camillero” (“stretcherer”). The driver only has to have a professional driver’s license and on occasions some first aid and basic CPR knowledge. The “stretcherer” usually only has first aid and basic CPR skills plus Oxygen administration –only sometimes.
In metropolitan and high-tourism-rural areas there’s a third crew member. A doctor. This doctor hardly ever has specialized training in emergency medical care (neither hospital nor pre-hospital) other than the one provided at University.
Pre-hospital emergency medical care in Argentina is still viewed by the general public and most medical professionals as “scoop and run” other than treat at scene and in transit. Hence the low probabilities of critical patients to survive. –A bad mix: poor quality pre-hospital emergency medical care and incredibly long response time frames. (Average in metropolitan areas: 20-30 minutes. Rural areas: 30 minutes to never / “no show”).
In the last years, thanks to organizations such as AHA (American Heart Association) and NAEMT (National Association of Emergency Medical Technicians) (among others) BLS, ACLS and PHTLS courses became a bit more known to EMS personnel. National organizations such as Cruz Roja Argentina (Argentine Red Cross) and Fundacion Cardiologica Argentina (among others) now provides nationally recognized CPR certification based on ECCs to a wider public.
A few universities started offering paramedic careers but due to the mostly European influenced medical / public health systems and resistance from doctors those careers are only valid at the province level and are not nationally recognized yet.
Some ambulance personnel, firefighters, military personnel, lifeguards, mountain guides, ski patrol staff, divers and park rangers obtain training from North American and European internationally recognized organizations in subjects such as BLS, ALS (ACLS / AMLS), PHTLS (formerly BTLS and ATLS), WFA, WFR, Oxygen administration and AED use, on their own (out of one’s pocket), or through their own agencies / organizations.
Lifeguards graduated from Superior Education Institutes and their lifeguard schools (only those either belonging to the Argentine Red Cross or in the Province of Buenos Aires) can work as crew members on ambulances –not as drivers (unless they posses a professional driver’s license). Also, some lifeguard schools are encouraging their students to take training in addition to their curriculum such as BLS (either from AHA, FCA, …) and PHTLS (from NAEMT).
CONTINUED BELOW>>>
Guri
