5) Description of health product/service offering: Emergency Department in Guanajuato Mexico: The development, promotion and implementation of short training and certification courses in key areas on emergency medical care under the direction of highly trained clinical educators with a commitment to community based learning and which transform the practice environment in a manner responsive to local needs. The promotion of Community Oriented Emergency Medicine (COEM) as a supplement to metrocentric / academic models that can leverage emergency medicine care in less developed areas. The PACE Courses (http://www.pacemd.org/id107.html) are as follows: PACE-1 (Core) Emergency Nursing (Training and empowering of nurses) Emergency Trauma, Cardiac, Pediatrics and Medical Emergencies PACE-2 (Core) Emergency Medicine (Basic training for physicians who work in emergency departments) Emergency Trauma, Cardiac, Pediatrics and Medical Emergencies PACE-3 (Core) Emergency Paramedicine/Ambulance (Upgrade paramedic skills) Emergency Trauma, Cardiac, Pediatrics and Medical emergencies PACE-4 Community Emergency Care (CPR, First Responder and Basic Life Support, Wilderness Medicine) PACE-5 Advanced Emergency Medicine Practice (Advanced emergency medicine for emergency practioners) Advanced Airway Management, FAST Ultrasound, Cardiac, Wound Management (May be integrated with PACE 2 in the future) PACE-6 Toxicology / Disaster / Hazrdous Materials / Burn Management PACE-7 (Core) Women and Children Emergency Care (Advanced Life Support for Obstetrics, Sexual Assault Nurse Examiner Program) Advanced Life Support for Obstetrics. This will have a MAJOR impact on maternal and neonatal mortality and morbidity. We will be the first ALSO center in Mexico and plan to train 60 providers and 12-16 instructos August 2007. http://www.aafp.org/online/en/home/cme/aafpcourses/clinicalcourses/also.html PACE-8 Pediatric Emergency Medicine: Emergency Nurse Pediatric Care, Advanced Pediatric Life Support for Physicians, Neonatal Advanced Life Support. PACE-9 Emergency Medicine Management: Will provide Emergency Department, Emergency Medical Services, Disaster Management tools and concepts including Medical Informatics, Community Oriented Emergency Medicine tools (public health/epidemiology) as well as Quality Assurance programs. PACE-10 MedSpanish and the Geographic Emergency Medicine Service (GEMS) – These are our international exchange programs

6) Description of innovation: The innovation is a comprehensive, replicable service to improve emergency care in Mexico and Latin America by developing collaborative public health models in emergency medicine (“Community Oriented Emergency Medicine”). We will pilot the program for the rest of Mexico and Latin America, begining in the State of Guanajuato for various well considered strategic reasons. The program develops along 6 major lines: 1) The development of the Community Oriented Emergency Medicne (COEM) paradigm: The fusion of Emergency Medicine and Public Health, especially in less “metro centric areas”. 2) The development of state level professional societies for well trained emergency medicine speciallists who are interested in the application of emergency medicine in their states at the pre-hospital and hospital level and to provide medical direction over training. The Colegio is a resource to government, universities and the voluntary sector and has a significant offical capacity under State laws. The PACEMD Program founded the Colegio Medico de Urgencias del Estado de Guanajuato (www.urgenciologos.org) 3) The development of a comprehensive range of accredited, modular training certification programs which have emergency medicine specialists (from the Colegio) as Medical Directors. These course target emergency medicine practicioners (doctors, nurses and EMTs) who are poorly trained and are designed to trasform the context in which emergency care providers operate. The program has developed the PACE Program (Programa de Acutalizacion en Emergencias Medicas). (http://www.pacemd.org/id107.html) 4) The Colegio forms inclusive Centro de Colaboración en Emergencias Medicas (PACE Centers), where training can be applied locally and where stakeholders can provide direction using public health, health service and other community input. (http://www.pacemd.org/id50.html) 5) Dissemination / Propagation – Other PACE Centers are being planned in the State of Guanajuato. We will diseminate the program through professional conferences and public relation events and campaigns. The Colegio in Guanajuato encourages other states in forming state professional organizations (Colegios) for its emergency physicians, providing a replication model. A national emergency medicine conference is being co-sponsored by the PACEMD program and its partners in Guanajuato in May 2007. We propose a “the propagation wave” for development of community based emergency medicine. http://www.pacemd.org/id95.html 6) International and regional exchange programs such as the MedSpanish and GEMS programs which ultimately trade medical information and skills for Medical Spanish, International Health and Cultural Awareness training for US health practitioners.

7) Operational model: Community Oriented Emergency Medicine (COEM) is the philosophical framework developed by the PACEMD program which combines the clinical practice of emergency in community hospitals, with a strong Public Health perspective. We have developed a method to disseminate quality emergency care through collaborative mechanisms. It is the type of emergency medicine that is most appropriate for developing systems.

Examples of Public Health perspectives in the clinical emergency medicine:

1) The understanding that effective emergency medical care increases the overall well being in society improves healthcare manpower usage and fosters economic growth and social development.

2) Epidemiologic surveillance for emerging infections diseases, both naturally occurring and bioterroristic in nature.

3) Surveillance of other public health hazards such as bad intersections (accidents), infusion to the community of pure or contaminated drugs (overdoses) or hazardous materials.

4) Surveillance of health care manpower needs. A community with few pediatricians will see many more children in the emergency departments, for example, and can be used for manpower development plans. 5) The development of training programs which respond to needs identified in of ER based epidemiologic surveys. 6) Health Service Administration screening for occurrences such as returns within 24 hours, surgical complications, etc.

7) Screening for threats and referral to "safety nets" for high vulnerability targets: Domestic Violence and Child Abuse, Sexual Assault, Elder Abuse, Children at risk for nutritional deficits, Drug and Alcohol abuse / interdiction.

8) Injury Prevention and control

9) The development of poison control programs and poison control prevention programs

10) The development and management Pre-hospital systems of Disaster Management programs and teams

11) Community based education for lay people in CPR and as first responders as well as for more advanced emergency medicine training for health care workers using training systems developed and supervised by residency trained emergency physicians.

12) The development and recognition emergency medicine as department based and a single specialty which has a central role to play in pre-hospital care, toxicology, and disaster medicine.

13) The development of simple, effective medical informatics systems which can be used in triage, patient registry, case management and as a medical reference source.

14) The provision of culturally competent care and knowledge of the culture specific risk factors and various cultural models of wellness and disease. In the United States, this includes the recognition that Medical Spanish is an essential acquirable skill, especially in emergency departments where Llatinos disproportionately receive acute and sub-acute care.

8) Human resources: We have a core administrative team that is the MedSpanish Staff and which has promoted emergency medicine dissemination in Mexico and Latin America. We coordinate collaborating organizations and individuals as well as MedSpanish students (Health Professionals from the United States) who come to Mexico for Spanish, International Health and cultural training. We pay stipends / honoraria for qualified lecturers in emergency medicine and related topics

9) Key operational partnerships: PACEMD Mexico – AC has partnered with the following organizations through the Collaborative Center. A) PACEMD USA – A Non profit which is being formed in the United States to support our efforts. B) MedSpanish Agency, LLC – A US based company that coordinated training for US personnel in Mexico in Medical Spanish, International Health and cultural literacy. C) Colegio Medico de Urgencias del Estado de Guanajuato - The Emergency Medicine professional organization that we founded and which interfaces with all other professional organizations and official entities in Mexico. D) Sistema de Urgencias del Estado de Guanajuato (SUEG) - the Branch of the Health Ministry that is responsible for all prehospital care for the State Health Ministry E) The University of Guanajuato School of Medicine F) The University of New Mexico Health Sciences Center G) The Red Cross of the State of Guanajuato H) Other partnerships are rapidly forming…

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: The program teaches the PACE courses and charges tuition which is often reimbursed by the sponsoring agency (the Red Cross, the Health Ministry, etc.) The MedSpanish program also charges tuition to its participants from Medical Schools, Residency Programs and for physicians seeking Continuing Medical Education. The MedSpanish students from the US pay tuition which supports the Emergency Medicine Dissemination Center. Occasionally, these students obtain scholarships. As the program expands, we expect to have an additional economy of scale which should help reduce the price further. The programs are validated through a variety of channels and thereby provide the continuing education units required by professionals in practice or in training.

          • Earned incomes as a percentage of operating costs: 75%

          • Other funding sources: It is difficult to calculate because the programs are expanding rapidly. It is hoped that some income can eventually be used to support the (up to now) voluntary directors position.

          • Strategy for long-term sustainability: The PACE courses will be offered to a more people and will increase revenue. We plan to open 3 more Collaborative Centers in the State of Guanajuato and will begin teaching the PACE courses to more people , generating more revenue. Expansion of the MedSpanish and the GEMS program will create a more stable platform for the PACE programs by increasing the multinational exchange dimension of the program, further making the programs self supporting. We will also apply for specific grants.

11) Current and Future Impact

          • Total number of clients: 1,500 physicians in the Health Ministry who may provide direct or in direct emergency care to the general population.

          • Clients in the past year: 250

          • Percentage of low-income clients: NA. We train trainers and providers of emergency health care that work in the public sector. Our Emergency Medical Technicians and nurses probably qualify as “low income”.

          • Impact: The above figures are extremely rough estimates and misleading. We train PROVIDERS who, in turn, better provide care for marginalized populations. Therefore, the impact is very difficult to quantify. The numbers given above are both US and Mexican health care providers.

          • Overall "market": All Latin American Countries and Latinos in the US (which, on its own, qualifies as the 5th most populated Hispanic population in the world).

12) Scaling up strategy

          • Stage of the initiative: Start Up stage.

          • Expansion plan: Expansion of PACE training centers throughout Guanajuato and then later to "las provencias" in Mexico and Latin America as we organize the emergency medicine and health care communities around emergency medicine courses and infrastructure development. MedSpanish (www.MedSpanish.Com): This exiting program brings physicians, nurses and medical students from the United tates to Guanajuato Mexico to learn Medical Spanish (how to communicate with patients), International Medicine as well as cultural awareness. The participants (from all specialties) go through our MedSpanish “Speed Learning System” and spend approximately 7 hours a day in Hospitals, community clinics, rural mobile health units and Red Cross ambulances. About half are emergency medicine oriented and this aspect of the program has provided much of the infrastructure support for the PACEMD program and well as providing a mechanism for knowledge exchange and transfer.

Geographic Emergency Medicine Service (GEMS): (http://www.pacemd.org/id31.html) This existing program is formed as a physician group in the United States that is an "alternative practice model" allowing physicians with an interest in internacional emergency medicine and internacional health to work part time in the United States and spend the rest of their time pursuing international interests. We hope that service will evolve into a "Doctors without Borders" type organization.

13) Policy change: An understanding of Community Oriented Emergency Medicine and the importance of Emergency Medicine standards and practice in primary care and the development of Collaborative Centers for Emergency Care.

14) Origin of the initiative: • http://www.pacemd.org/id51.html • http://www.ashoka.org/fellows/viewprofile3.cfm?reid=147691

Contact Information:
Haywood  Hall
Ashoka Fellow
Director
Pan American Collaborative Emergency Medicine Development (PACEMED) Program / MedSpanish
(NGO)
1327 E Washington Ave, #315, Harlingen Texas, 78550
Mexico
Tel: 800 770 6853
Fax: 800 770 6853
Email: Haywood@pacemd.org
Website: www.pacemd.org