Guatemala

General

Capital – Guatemala City
Land Size – 107,159 sq km
Population – 13,550,440
Language(s) – Spanish 60%; Amerindian languages 40% (23 officially recognized Amerindian languages)

Prehospital Care Overview

• Until recently, prehospital care was provided solely by FD
  • Lacked formal medical education and had only basic equipment
  • Medical responses to frequent natural and man-made disasters best characterized by lack of preparedness and coordination
• In past decade, awareness of importance of EMS has increased dramatically
  • Aggressive efforts focused on development of prehospital care in general and disaster preparedness in particular.
  • Significant improvements already made in:
    • Training
    • Equipment
    • Standardization
    • Inter-regional Coordination
  • Recent gov’t initiatives hold promise of nationwide positive impact on emergency care delivery to population
• Future Challenges
  • Severe resource limitations
  • Continued improvements in quality care and access
    • Expansion of prehospital care training/certification (esp. rural)
  • Establishment of dedicated degree program in EMS training within local medical school
  • Reorganization of FD into three separate divisions of specialty:
    • Paramedic
    • Extrication
    • Firefighting

  • Obtain further funding to facilitate modernization of training/equipment
  • Increased collaboration between two existing FDs
  • Creation of centralized emergency dispatch system

History

• 1951 – Large fire consumed great portion of Guatemala City
  • No formal EMS or disaster planning system at time
    • Led to formation of Cuerpo Bomberos Voluntarios (CBV) by Chilean
      • Initially solely voluntary, funding from private donations only
      • Firefighting only
      • Sought First Aid Training from local MDs as need for medical attention on-scene and en route became apparent
      • Splints, basic First Aid kit
      • Eventually all members began serving as firefighter and medical providers
• 1957 – disagreements between founders of CBV
  • Led to formation of Bomberos Municipales (Municipal Fire Department)
    • Under jurisdiction of municipal gov’t – primary patron
  • Rivalry between two entities emerged
    • Subsequent intermittent conflicts and redundant use of resources
  • Only recent recognition of rivalry’s deleterious effects; causes two leaderships to increase cooperation in both training and operations
• Originally used modified pickup trucks to transport firefighting equipment
  • Eventually used for Pt transport as well
  • 1970 – First ambulance employed
    • Today all ambulances are almost exclusively used-vehicles by foreign donation
  • Modified pickup remains predominant transport vehicle
• Alerta Medica (1992) and Paramedic (2002)
  • Private, For-Profit
  • Dedicated solely to prehospital interventions
  • Care/Transportation provided only to subscribers (annual fee)
  • Operate primarily in Guatemala City
  • MD on-board
  • Uniformly more advanced equipment than public FDs:
    • ET Intubation and IV Access
    • Wide range of Meds
    • Immobilization
    • Cardiac Monitoring and 12-lead ECG
    • Defib
    • Portable Ventilators
    • Capacity to obtain cardiac enzymes on-scene

  • Serve less than 5% of population

Lead Agency

• Ministry of Health
  • Gov’t division ultimately responsible for provision of prehospital care
    • In past role has been limited by severe budgetary constraints
  • 1999 – created staff position directly responsible for emergency care development and disaster planning
    • Has taken increasingly active role in level of emergency care development, including:
    • Pre-/In-hospital Care
    • Disaster Preparedness
  • 2000 – sponsored first governmental workshop to educate Guatemala City Public ED staff in basics of trauma and critical care medical mgmt.
    • Led to collaboration with outside organizations to sponsor several emergency care and disaster conferences and training programs
    • Promoted atmosphere of cooperation w/in EMS structure
  • 2002 – Coordinadora Nacional para la Reducción de Desastres (CONRED – National Coordinator For Disaster Mitigation) created Comite de Asesonía Tecnico para Rescate y Emergencia Prehospitalaria (CATREP)
    • Committee to create and monitor EMS protocols

Funding

• Mixed healthcare system:
  • Private
  • Public:
    • Provided by Central gov’t
    • System of public hospitals and clinics
    • Social Security System for gov’t employees and independent military facilities

International Assistance

• Foreign NGOs have played important roles in EMS development due to economic restraints
• Agencies depend on foreign aid for equipment donations and for assistance with training initiatives
  • Partnerships are thought to have served as catalyst for developmental initiatives
• 1989 – US Office of Foreign Disaster Assistance/Latin America and the Caribbean (OFDA/LAC) has supplied resources for APAA to FDs
  • Primary goal of OFDA/LAC is to create self-sufficiency in disaster mgmt for countries w/in region by providing technical support of training for prevention/mgmt of disasters
• 1980’s – Miami-Dade Fire/Rescue paramedic system
  • Worked throughout Latin America on grant from OFDA/LAC
  • Train-the-Trainer Programs:
  • First-Responder
  • Fire-Fighting
  • HAZMAT Response
  • Courses designed so that local instructors can eventually teach independently
• Emergency International (EI)
  • US NGO that functions worldwide to assist local providers in advancement of emergency medical care (in Guatemala since 1991)
  • Aim to create cadre of local leaders to continue to advance field in future.
  • 1998 – Fundación Para el Desarrollo de la Medicina de Emergencia y Prehospitalaria (FUNDAMEP – Foundation for the Development of Emergency & Prehospital Medicine)
    • Provides training throughout country
    • 1997 – Organized first-ever Central American Conference on Emergency Medical Care
    • 1999 – Creation of Guatemala’s first-ever national licensing examinations for EMTs and Paramedics
    • Train-the-Trainer programs
      • Cardiac Care
      • Trauma
      • Maternal-Child Emergencies
      • Disaster Preparedness
      • Collaborations with local partners to implement/evaluate disaster drills

Levels of Care; Education & Training

• 1994 – independent Traumatologist began initiative for more formal medical training of FDs
  • Group of various MD specialists offered training in various courses (i.e., BLS, ATLS) to CBV.
• 1997 – with help of Emergency International (US NGO), CBV began first EMT training program (TUM)
  • Basic – 200h
  • Expanded to Intermediate and Advanced – 450h
  • Bomberos Municipales invited to join shortly afterward
  • First unified system of training between two org’s
• 1999 – First group of intermediate paramedics completed training
  • Certification by Universidad de San Carlos de Guatemala initiated
• 2000 – Initiation of new course: Curso de Asistente de Primeros Auxilios (APAA)
  • Intended to be more basic than TUM, eventual goal of being required for all FFs in country
  • 100h training over 14 days
  • Taught by CBV; only such program in existence in republic
• In past 3-5yrs, certification programs for more advanced modular courses:
  • ACLS
  • PALS
  • HAZMAT
  • Occur in piecemeal fashion with voluntary help of domestic MDs, Red Cross, several foreign NGOs
• Feb. 2003 – opening of first university-certified paramedic training program
  • 30mos part-time training
    • 120h/month practical training

Public Access Numbers

• No current integrated centralized system to initiate EMS or disaster systems
  • Separate numbers for police, each of the separate providers, as well as for each station.
    • FDs frequently called to same incident
    • Many authorities publicly state this dual system is benefit because rivalry reduces RTs
    • Ministry of Health beginning to recognize that integrated EMS system would greatly benefit country

Disaster

• See: “Lead Agency” & “International Assistance”

References

• https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html
• Hess A, Thomas T, Contreras R, Green GB: “Development of Emergency Medical Services in Guatemala” Prehospital Emergency Care 2004;8:308-12.