INTEGRATION OF UNITED-STATES EMERGENCY-MEDICINE CONCEPTS INTO EMERGENCY SERVICES IN THE NEW INDEPENDENT STATES

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and th e Emergency Hospital of Yerevan, Armenia, to improve emergency and tra uma care in that city. Fifty-five individuals have traveled to and fro m the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma ce nter and as base for the Yerevan ambulance system. A curriculum (text and slides) has been developed and translated into Armenian and Russia n. To date, the Armenian EMSI has trained nearly 300 emergency medical personnel: physicians, nurses, drivers, and first responders. The Arm enian EMSI faculty have received training in directing instruction of emergency care providers. Plans are in place to begin training in Arme nian cities outside of Yerevan and in neighboring republics. An emerge ncy medicine residency program received ministry approval and was begu n with six resident physicians in January 1995. To date, 45 nurses hav e graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health car e system. Officials of the partner hospital requested assistance in up grading the skills of its abundant emergency care workforce, citing ca rdiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia, Because the Armenian partners' needs in em ergency medicine and trauma coincided with the US partners' areas of g reatest expertise, it was clear that meaningful progress was possible. The centralized emergency medical system designed by the former Sovie t Union produced nearly identical systems in the republics (including Armenia) that now form the New Independent States (NIS). The opportuni ty of reaching a broad base by means of development of a standardized curriculum was presented and acted on. In this report we describe and discuss our experience and provide an interim report of the effort. Th is project has demonstrated the feasibility of out-of-hospital emergen cy medicine training efforts in the NIS. The transfer of clinical know ledge, skills, systems approaches, and pedagogic techniques between un like health care settings is possible if ministerial, municipal, and p rovider institutions themselves participate in the effort. The EMSI pr ovides a model for EMS advancement and training that can be extended t o other areas in the NIS.