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Effect of emergency medical technician certification for all prehospital personnel in a Latin American city.

BACKGROUND
In Mexico and most other Latin American countries, many emergency medical services (EMS) systems rely on employees and volunteers with only on-the-job training and without formal Emergency Medical Technician (EMT) certification. This study sought to evaluate the costs and effectiveness of providing EMT certification to all personnel working in an EMS service in a Mexican city.


METHODS
At baseline, only 20% of the prehospital personnel (medics) working for the EMS service in Santa Catarina, Nuevo Leon, Mexico had EMT certification. During a 14-month period, all such medics obtained EMT certification. The process and outcome of trauma care were assessed before and after this training.


RESULTS
Mortality among persons treated by this EMS service decreased from 1.8% Before to 0.5% after the training. The injury severity, as reflected by the prehospital index (PHI), was different between the two periods. Hence, adjustment for PHI by logistic regression was performed. The PHI- adjusted odds ratio for death in the after period was 0.55 compared with the before period, representing a 45% reduction in risk of death after EMT training.


CONCLUSIONS
These data support the promotion of policies that require and enable EMT certification for all prehospital care providers in Mexico and potentially also in other Latin American and other middle-income developing countries.