Emergency care and referral among isolated island populations in the Bahamas

Brett D Nelson; Roy Ahn; Vince Markovchick; Rosemary A Hines; Alexandre R Lauretti; Julien R Lauretti; Merceline Dahl-Regis; Thomas F Burke

doi:10.1016/j.jemermed.2014.09.069

Emergency care and referral among isolated island populations in the Bahamas

J Emerg Med. 2015 Mar;48(3):356-65. doi: 10.1016/j.jemermed.2014.09.069. Epub 2014 Dec 19.

Authors

Brett D Nelson¹, Roy Ahn¹, Vince Markovchick², Rosemary A Hines³, Alexandre R Lauretti³, Julien R Lauretti³, Merceline Dahl-Regis⁴, Thomas F Burke¹

Affiliations

¹ Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
² Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.
³ Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Ministry of Health of the Government of the Bahamas, Nassau, Bahamas.

PMID: 25534899
DOI: 10.1016/j.jemermed.2014.09.069

Abstract

Background: Isolated island populations face unique health challenges. In the Bahamas, the islands of Mayaguana, Inagua, Crooked Island, Acklins, and Long Cay-referred to as the MICAL Constituency-are among the most isolated.

Objectives: Our objective was to better understand regional emergency care needs and capabilities, and determine how emergency care can be optimized among island populations.

Methods: During the summer of 2013, the project team conducted semi-structured key-informant interviews and small-group discussions among all health care teams in the MICAL region, as well as a community-based household survey on the island of Mayaguana. The interviews and small-group discussions consisted of open-response questions related to health care services, equipment, supplies, medications, and human resources. The community-based survey examined the prevalence of chronic noncommunicable diseases (CNCDs) and associated risk factors affecting the inhabitants of the region.

Results: The average number of annual emergency referrals from each of the MICAL islands was approximately 25-30, and reasons for referrals off-island included chest pain, abdominal pain, trauma, and dysfunctional uterine bleeding. Traditional prehospital care is not established in the MICAL Constituency. Providers reported feelings of isolation from the distant health system in Nassau. Whereas most clinics have a well-stocked pharmacy of oral medications, diagnostic capabilities are limited. The household survey showed a high prevalence of CNCDs and associated risk factors.

Conclusion: Ongoing in-service emergency care training among MICAL providers is needed. Additional equipment could significantly improve emergency care capabilities, specifically, equipment to manage chest pain, fractures, and other trauma. Community-based preventive services and education could improve the overall health of the island populations.

Keywords: Bahamas; emergency medicine; emergency referral; island populations; isolated populations.

MeSH terms

Abdominal Pain / etiology
Adult
Aged
Bahamas / epidemiology
Chest Pain / etiology
Chronic Disease / epidemiology*
Diagnostic Services / supply & distribution
Education, Medical, Continuing
Education, Nursing, Continuing
Emergency Medical Services / supply & distribution*
Equipment and Supplies / supply & distribution
Female
Health Care Surveys
Health Services Accessibility
Health Services Needs and Demand*
Humans
Interviews as Topic
Male
Middle Aged
Needs Assessment*
Pharmaceutical Preparations / supply & distribution
Prevalence
Referral and Consultation*
Risk Factors
Rural Health Services / supply & distribution*
Uterine Hemorrhage / etiology
Uterine Hemorrhage / therapy
Workforce
Wounds and Injuries / therapy

Substances

Pharmaceutical Preparations