All emergency responses start the same way; with a phone call asking for help. One evening at 7:23pm in Cuenca, Ecuador, victims of a motor vehicle collision called into ECU 911, the new nationwide unified emergency response system. As an M1 observer from VCU School of Medicine, I listened in to this call alongside a Ministry of Public Health dispatcher.
A 46-year-old female with head injuries was the highest acuity patient in this call, along with two other passengers with collision-related injuries. A Red Cross ambulance was dispatched to the scene at 7:25pm. Within 4 minutes, the ambulance had arrived on the scene and, by 7:38pm had delivered the patient to the closest emergency department at Clinica España,. I eagerly sat at ECU 911, anticipating more information on this patient, but we heard little from that ambulance at the dispatch.
At 8pm, I left ECU 911, and went over to Hospital Vincente Corral Moscoso for my nightly observation there. At 8:27pm, a patient arrives via ambulance with no prior instruction or information,but fitting the profile of the MVC patient I had overheard being described at ECU 911. It had turned out that while en route, the patient was determined to be a critical trauma patient, requiring care at the Hospital Vincente Corral Moscoso (HVCM), the only trauma center in the region. Little communication had been made to either the dispatchers or the receiving hospital, so the trauma team I was working with found themselves with a critical head trauma and no prior preparation. Despite the best efforts of the trauma surgeons at HVCM, the patient died from the traumatic head injuries. Many on the trauma team felt that if the patient had arrived earlier, with adequate preparation she may have been saved.
This is how my experience in trauma systems development began as a first year medical student. A dramatic situation unfolded in front of me, revealing cracks in the revamped Ecuadorian emergency communications system. This was the first day of a summer filled with learning, cooperation, and intrigue into Ecuadorian trauma care.
My interest in global trauma and emergency care led me to the International Trauma System Development Program at the Virginia Commonwealth University. Theprogram boasts a long history of international collaboration between trauma surgeons throughout the Americas. With the help of Dr. Sudha Jayaraman and Dr. Michel Aboutanos, of VCU, and Dr. Juan-Carlos Salamea and Dr. Edgar Rodas Jr, of HVCM in Cuenca, we created a quality assessment/improvement project on trauma communication between pre-hospital and hospital in Cuenca. Like many global development projects, it was imperative to have local leaders guide the mission of new projects;this project was born out of the concerns of local trauma surgeons.
From Research to Collaboration to Friendship
This project began with observations of trauma communication, and grew with quantitative surveys and assessments, created by a group that included Ecuadorian medical students from the ‘Liga Académica de Trauma y Emergencias’ (LATE), our trauma surgery mentors, and me. The student research team was comprised of myself, Michael Rains from VCU, and four Ecuadorian medical students-Margarita Lituma, Paola Carrasco, Jaime Armijos, and Jennifer Caguana.
The project began in Richmond, Virginia with an assessment of a model EMS system, the Richmond Ambulance Authority (RAA).. Chief Operating Officer Rob Lawrence guided me through RAA’s method. To capture the voices of every stakeholder, we first met with the ECU 911 team and the EMS teams leaders to assess their opinions on the problems. Our trauma team at HVCM had already published prior evidence of communication system failures, so we spoke with other hospital staff to get a feel on what problems they faced. After an initial qualitative assessment, we surveyed EMS teams on their level of emergency care training and how they communicated with dispatchers and receiving hospitals.
But it wasn’t just research that we performed together. What began as collaborative meetings throughout the week with the students led to experiencing the trauma and emergency care medical education in Cuenca. I joined my partners in LATE events to teach basic first and trauma care to non-medical students, churchgoers, and even driving school participants. We shared on-call nights in the emergency department learning basic emergency care. During down time, we had impromptu lessons from our trauma surgery mentors.
I came to Cuenca with a working proficiency in Spanish, but initially struggled with the medical professional level of Spanish spoken amongst my peers and mentors. I often had to ask to slow down the conversation so I could learn at the same pace of other students. Luckily the Latin rooted medical jargon I knew from medical school stayed the same in Spanish, and filled the gaps in my proficiency with local language classes.
Nonetheless, the project continued and our team learned more of the challenges facing the city’s trauma system. Throughout this project, I learned how emergency care systems vary between Richmond, Virginia and Cuenca, Ecuador. I realized how true quality assessment/improvement projects require numerous stakeholders and mentors, each of whom has their own expertise. It showed me how inter-professional trauma and emergency care can be.
In addition, I learned the value of international collaboration and networking between budding surgeons. I learned not only about the lives of these medical students, but also their personal successes. The LATE group’s programs, for service and teaching emergency care to the community, inspired me to emulate their programs at VCU. Our VCU student group is working to teach community hands-only CPR to locals, and model our program after LATE to inspire students into trauma and emergency care.
I was fortunate enough to meet Dr Salamea and Dr Rodas again at the Panamerican Trauma Society (PTS) 2015 Congress in Bolivia, along with other LATE Ecuadorian students, to present our findings, further discuss our project and plan for further collaboration. At this Congress, numerous students from around Latin America who are equally enthusiastic in trauma and emergency care presented their research, collaborated on future exchanges and projects, and set up meetings to teach each other about pertinent issues concerning trauma in their home countries. Together we’ve created events for online teaching and collaboration throughout the year.
With the support of the Dean of VCU SOM and the VCU Global Education Office, I was able to engage in meaningful collaborative projects in global health and develop lasting friendships. It set me on a journey to continually connect with medical students interested in trauma and emergency care throughout the Americas. International experiences like mine should be encouraged throughout medical education. It can broaden a student’s mind regarding how medicine functions in various settings, and connect students to a network of like-minded leaders in other countries. Future physicians in nations that face a growing burden of disease from trauma and other surgical diseases can benefit from a global network for exchange and collaboration. It is up to my generation of medical students to strengthen and broaden that network, and I look forward to being a part of it!