Low-cost improvements in prehospital trauma care in a Latin American city

Objective: Prehospital care is a critical component of efforts to lower tra uma mortality, In less-developed countries, scarce resources dictate that a ny improvements in prehospital care must be low in cost. In one Latin Ameri can city, recent efforts to improve prehospital care have included an incre ase in the number of sites of ambulance dispatch from two to four and intro duction of the Prehospital Trauma Life Support (PHTLS) course. Methods: The effect of increased dispatch sites was evaluated by comparing response times before and after completion of the change. The effect of PHT LS was evaluated by comparing prehospital treatment for the 3 months before initiation of the course (n = 361 trauma patients) and the 6 months after (n = 505), Results: Response time decreased from a mean of 15.5 +/- 5.1 minutes, when there were two sites of dispatch, to 9.5 +/- 2.7 minutes, when there were f our sites. Prehospital trauma care improved after initiation of the PHTLS c ourse. For all trauma patients, use of cervical immobilization increased fr om 39 to 67%. For patients in respiratory distress, there were increases in the use of oropharyngeal airways (16-39%), in the use of suction (10-38%), and in the administration of oxygen (64-87%), For hypotensive patients, th ere was an increase in use of large-bore intravenous lines from 26 to 58%. The improved prehospital treatment did not increase the mean scene time (5. 7 +/- 4.4 minutes before vs. 5.9 +/- 6.8 minutes after). The percent of pat ients transported who died in route decreased from 8.2% before the course t o 4.7% after. These improvements required a minimal increase (16%) in the a mbulance service budget. Conclusion: Increase in sites of dispatch and increased training in the for m of the PHTLS course improved the process of prehospital care in this Lati n American city and resulted in a decrease in prehospital deaths. These imp rovements were low cost and should be considered for use in other Less deve loped countries.