• T D Kirsch, W K Hilwig, Y Holder, G S Smith, S Pooran, and R Edwards.
• Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
• Ann Emerg Med. 1995 Sep 1;26(3):361-7.

Study ObjectiveTo analyze the emergency medicine system in a developing country and identify areas of need and potential collaboration.DesignConvenience sample surveys of all emergency visits over a 2-week period, hospital admission and health department statistics, and interviews with government officials, health providers, and EMS managers.SettingPort of Spain General Hospital, Trinidad and Tobago.ResultsThe ED has more than 100,000 visits per year. No records are kept. No physician in this study had emergency medicine training; only one had completed any residency. The survey included 3,710 patients: 40.5% were admitted, and .3% died. Injuries accounted for 41.6% of all visits, asthma 7.8%. The mean time elapsed before a patient was seen was .5 hour; mean time to discharge, 1.9 hours. In only 9% of patients were laboratory tests performed. Prehospital providers had limited equipment and training.ConclusionThe ED and prehospital systems provide high-volume and often high-acuteness care. Barriers to improved care include limited specialized training and lack of medical records.

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