Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico

Prehosp Disaster Med. Oct-Dec 2004;19(4):318-25. doi: 10.1017/s1049023x00001953.

Abstract

Introduction: In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.

Methods: In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site.

Results: The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site.

Conclusions: This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Allied Health Personnel / economics
  • Allied Health Personnel / education*
  • Clinical Competence*
  • Cost-Benefit Analysis
  • Curriculum / standards
  • Curriculum / trends
  • Developing Countries
  • Educational Measurement
  • Emergency Medical Services / organization & administration*
  • Emergency Medical Technicians / economics*
  • Emergency Medical Technicians / education*
  • Female
  • First Aid
  • Humans
  • Male
  • Mexico
  • Middle Aged
  • Program Development
  • Program Evaluation