Project Update

We have been collecting data for just over a week now, and a research update is much overdue. 

Stage 1: Assessing MIVT from Ambulance Presentation at the Hospital

For the last week much of our focus has been on observing the presentation of MIVT upon arrival of ambulances at the emergency room. We have been splitting shifts with the LATE students, who are currently in the middle of finals, and have someone waiting at the ER for ambulances for 4 or more hours per day from about 3-11pm. While we are focused on trauma and medical emergencies arriving via ambulances, there are many who come to the ER by a family car or taxi. And even then, there are others patients that utilize the ambulances for transfers to the regional hospital, but are outside the scope of our study. These transfer ambulances cannot be distinguished from the ones we are looking for (and they seem to come more often), so we have had to learn not to get too excited when we see the red and blue lights pulling up. While the ER is consistently busy, we have been a little concerned by the lack of data points we have been able to collect for this stage of the project (on average one data point for almost every 3 hours). As researchers we would love to have more data considering our timeframe, but as humans we realize our limitation is just the norm for our location.

A well-used checklist to assess MIVT (used at every leg of the communication tree)

Stage 2: Assessing MIVT from ECU911 Central to ECU911 at the Hospital 

Normally, an ECU911 employee at the hospital presents a form (from information received from ECU911 central) to the doctor informing him/her of an incoming patient, and the doctor signs the sheet. This information is eventually stored in a database. We initially hoped to gather data from this database, but were recently informed that information was sometimes written in later in the day. As such, it makes more sense for our purposes to collect the information soon after it is received, and are currently making those adjustments.

The form used by ECU911 representatives at the hospital to inform doctors of an incoming ambulance

Stage 3: Assessing MIVT from Ambulance to Doctor at ECU911 Central

Our tour of ECU911 Central this last week gave us more insight into the Ecuadorian emergency system. Housed in ECU911 central is a massive dispatch room with all the public services—police, military, fire, EMS—with the EMS dispatchers sitting in the back row. These agencies include MSP (Ministry of Public Health), IESS, firefighters, and the Red Cross. MSP and IESS, the government public health services, each have a doctor and paramedic that help triage and relay information received from ambulances to their receiving hospitals. Whereas in Richmond, Virginia ambulances call in directly to the hospital, in Ecuador, the ambulances usually only contact ECU911 central (who then relays the message to their representatives at the hospital). There have been a few snags with permission, but we plan to use the LATE students at this station to listen in to the radio calls from the ambulances starting this weekend.

Following our first tour at ECU911

Stage 4: Training Course for EMS Personnel

Yesterday we went with Dr. Salamea to present our project and implementation plan to all of the government services at ECU911 central (including the police, firefighters, military, EMS, and the director of ECU911 in Cuenca). We were well received by the group, but as in any bureaucracy, progress can be slow. The director of MSP EMS in Cuenca had been planning on conducting a course for EMS personnel, but following a 5 minute meeting with Dr. Salamea in the hallway, he was able to push for the addition of an MIVT course to the training...and for it to start next week (we should have the presentation complete by the end of the week). There are still a few hoops to jump through, but we should be conducting training courses with the LATE students by next week for about 400 EMS personnel around Cuenca. Amazing.

Following our meeting at ECU911 with (from left to right) Mark, Jeremy, Dr. Salamea, Elissa, Emmy, Dr. Martinez