[accordion] [acc_item title=”General”] Capital – Beirut
Land Size – 10,230 sq km
Population – 4,125,247
Language(s) – Arabic; French, English, Armenian
[/acc_item] [acc_item title=”Overview”]

  • Ÿ“In 2002, Lebanon spent approximately 11.5% of its [GDP] on health, which is believed to be among the highest in the world … Nevertheless, health outcomes in Lebanon are actually below average when compared to many countries with comparable levels of health expenditures, and even when compared to neighboring countries with lower health expenditures” (Bayram, 217)
  • Ÿ“Inverted health structure” (Bayram, 218)
    • Resources concentrated in tertiary rather than secondary and primary care levels”
    • Fragmented primary health care lacking continuity with other levels
    • Small percentage of physicians focused on primary health care
  • Ÿ“The development of a comprehensive national emergency system remains an important and arduous task requiring the resolution of a set of complex problems on several levels” (Bayram, 218)
[/acc_item] [acc_item title=”EMS System Model”]
  • Ÿ“The pre-hospital system in Lebanon is convoluted” (Bayram, 218)
    • Predominantly volunteer-run
      • Correlating problems with commitment, professionalism and continuity.
  • ŸEMS Providers
    • Lebanese Red Cross
      • “Leading pre-hospital provider and is relatively more organized and better equipped” (Bayram, 218)
      • Non-paid volunteers
    • Civil Defense
      • Paid, by state
    • Other Providers
      • “Minor agencies representing different social, political, religious, and charitable groups operate ambulances” (Bayram, 218)
      • “Very small number of private for-profit ambulances” (Bayram, 218)
  • ŸCommunications
    • No base hospital resources in use
    • Ambulances rarely give advance notice of arrival to destination EDs
      • EDs do not inform agencies of “bypass” status
    • Red Cross and Civil Defense operate on same VHF radio system, though they seldom communicate with each other
[/acc_item] [acc_item title=”Lead Agency”]
  • ŸMinistry of Health
    • Provides some monies in budget to Lebanese Red Cross
  • ŸPre-Hospital National Committee
    • Committee to govern all ambulance agencies still in conceptual stages (2007)
      • “This issue is highly political and overtly sensitive, as the two main pre-hospital agencies insist on retaining totally independent operations and administrations” (Bayram, 218)
[/acc_item] [acc_item title=”Funding”]
  • ŸApprox. 40% of population has no medical coverage
    • 60% with coverage
      • 23% have emergency coverage whether or not admitted to hospital
      • 37% have emergency coverage only if admitted
  • Ÿ“Anti-dumping” laws exist, not enforced
[/acc_item] [acc_item title=”Levels of Care”]
  • ŸFocus on transport, interfacility transfer, as opposed to providing medical intervention
    • “Functions such as tasking and recording vital signs, establishing intravenous access, and administering medications are not performed” (Bayram, 218)
  • ŸInsufficient numbers of ambulances for population size
    • Very small percentage of critical cases transported by ambulance; majority transported by private vehicle
  • ŸPersonnel receive only Basic training
  • ŸEquipment
    • “Type, quality, quantity, and placement differ largely among various ambulance agencies, and occasionally within the same agency” (Bayram, 219)
      • No ALS response ambulances
      • The few ALS ambulances that do exist are used for critical interfacilty transfers, and are pre-paid.
[/acc_item] [acc_item title=”Education and Training”]
  • ŸNo standardized training, certification or CME programs
    • “In fact, there is currently no certification required to operate ambulances in Lebanon” (Bayram, 219)
  • ŸLebanese Red Cross – 80-90hrs training
  • Civil Defense – 3-month training period
[/acc_item] [acc_item title=”Medical Direction”]
  • ŸNone
    • Ÿ“There is a need for physicians to oversee care; either on ambulances, or by directing on-line operations, or through the development of standing medical orders for ambulance operations” (Bayram, 219)
[/acc_item] [acc_item title=”Dispatch”]
  • Ÿ140 – Lebanese Red Cross
  • Ÿ125 – Civil Defense
    • Reporting party is not aware of each agency’s proximity; may result in response delays and/or resource redundancy
[/acc_item] [acc_item title=”Emergency Medicine”]
  • Ÿ1993 – Emergency Medicine is recognized as a specialty
    • “Criteria for registration as a physician specialist in Emergency Medicine in Lebanon do not require the completion of a residency program in that specialty. A minimum of 2 years training in emergency-related areas is sufficient” (Bayram, 219)
      • ŸNo Emergency Medicine residencies offered yet (2007)
      • Ÿ“The only qualification needed for a physician to work in the ED is a degree in medicine” (Bayram, 220)
        • “Of the 4000 praciticing nurses, approximately 1500 have not yet received any form of professional training” (Bayram, 220)
  • ŸEDs predominantly serve as triage units, where critical patients are immediately transferred to specialty units prior “initial stabilization or provisional diagnosis”
  • No designated Trauma Centers “that are readily recognized by pre-hospital agencies” (Bayram, 220)
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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