Association for Academic Surgery (AAS)

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From the Outside Looking In: The Prehospital System of Lima, Peru

Beginning as young children in the United States, we are taught that the universal number to call for help during an emergency is 911 – and this number is the same nationwide. Now imagine if the emergency number was different in each state… in each county… in each neighborhood, and there was a distinct number based on the type of insurance you have. This is the experience for the people living in Lima, Peru.

After completing my first year of medical school in Wisconsin, I spent two months doing a mixed-methods, in-depth needs assessment research project focused on the prehospital system in Lima, Peru. To better understand the key stakeholders and overall perceptions of the prehospital system, I spoke with trauma patients and multidisciplinary providers, so I could gain an appreciation of how the system is organized, the care it can provide, and the personal experience of trauma patients within this system. Through this exposure, I had the incredible opportunity to not only learn the strengths and weaknesses of Lima’s prehospital system but also witness the effect is has on trauma patients. Though I recognize that two months is an inadequate duration to fully comprehend the system and as a U.S. Citizen without previous work experience in the prehospital system, I know I bring my own inherent biases and professional ignorance to this study. Nevertheless, I do consider my encounters and experiences in Lima to be valid in providing insight into the Peruvian prehospital system and to further juxtapose it with the system I am familiar with in the United States.

As alluded to previously, a unified prehospital system does not exist in Lima. Thus, when a patient suffers a traumatic injury in the street, they can call one of several entities to get help – the serenazgo (public safety), the police, the state ambulance, the volunteer firefighter’s ambulance, or any of the various private ambulances – all of whom have varying levels of medical competence, training, and abilities. After speaking with over ninety trauma patients across three different hospitals, I learned that while this patient population may be transported to the hospital by any of these services; one third of patients still use either a personal vehicle or taxi. This mostly occurred for two reasons. First, ambulance services were often delayed; thus, patients resorted to seeking faster transportation methods, such as taxis and mototaxis (three-wheeled motorcycles). Patients and providers both noted that ambulance delays are often due to insufficient ambulance numbers for the massive population in Lima, and this is compounded by the dense city traffic and lack of traffic etiquette giving ambulances and emergency vehicles the right-of-way. The second reason patients may forego ambulance services in an emergency is that they may not know the number to call, which can be due to a general lack of knowledge or inaccessibility of emergency service contact information. Some patients explained that while they knew the emergency services’ numbers in their hometown, they suffered their injury while in a different district and did not know the corresponding number for that location.

Among the many patient experiences I encountered in Lima, one remains particularly vivid: a young man who suffered a gunshot wound to the abdomen. He recounted a hazy memory of laying on the cold ground and overhearing someone shouting for an ambulance. As time passed without any sign of emergency services, a bystander eventually flagged down a mototaxi and helped him into it. I often reflect on the sheer panic he must have endured in the back of that mototaxi with uncontrolled bleeding, lack of any immediate medical attention, and no emotional support.

“It was ugly, I felt like I was going to die. When I was on the floor, I heard ‘Someone call an ambulance’ but they stopped a mototaxi and I got in because it was faster”
~ 20-year-old male; gunshot wound

Over two months, I gathered data, listened to testimonials, and engaged in discussions about Lima’s prehospital system with numerous patients and medical personnel. These interactions highlighted the challenges patients face in a fragmented prehospital care network, prompting conversations about potential solutions. Looking to the future, I aim to maintain and develop the relationships I’ve formed in Peru. My goal is to collaborate on the design and implementation of potential interventions, deemed feasible by Lima’s healthcare providers, to improve prehospital care for trauma patients.

I am grateful to have had the opportunity to work with and alongside patients and providers in Lima, as I have not only been able to learn about their prehospital system, but also have noted the immense flexibility and problem-solving capacity these providers possess as they care for trauma patients.

“So maybe one of our other strengths is that we’re prepared for everything.”
~ Fourth-Year Emergency Medicine Resident; prior general physician in the Lima prehospital system

Allison Dentice

Allison Dentice

Allison is a second-year medical student at the Medical College of Wisconsin, where she is actively engaged in research focused on the prehospital healthcare system in Lima, Peru, as part of a comprehensive, multifaceted study. Originally from Hartford, Wisconsin, she graduated with a Bachelor of Arts in Spanish from the University of Wisconsin-Madison in 2021. Allison is passionate about global health and is dedicated to leveraging her language skills to mitigate language barriers in medical practice. While she has not yet decided on a specific medical specialty, she is exploring several areas of interest.
Allison Dentice

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Jaclyn Gellings

Jaclyn Gellings

Jaclyn is a global surgery research fellow and categorical general surgery resident at the Medical College of Wisconsin. Her research focuses on implementation of safe surgical care both domestically and abroad. She works with hospital and prehospital systems in Lima, Peru to improve communication and coordination of care for the prehospital phase of care for patients who sustained traumatic injuries. Her local research focus involves determination of the barriers to surgical care for uninsured patients, and design of systems for improvement. Jaclyn was born and raised in Milwaukee, Wisconsin, and plans to pursue a fellowship in Trauma and Critical Care following completion of her residency. She is passionate about improving surgical access and designing systems for surgical care integration.
Jaclyn Gellings

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