Design a distinct uniform to identify professional EMS

[chaser]

OK DQ- what's with the uniform red bracelets?

[SSG G-man]

I am a volunteer, so we do not get "fitted" stuff. I have worn the jump suits, I like the fit and the pockets. They were very heavy and treated to for BSI purposes. We also have a two piece set that is pants and a jacket. They are are water and BBP resistent and very hot. Called "foul weather gear" by some at department. Both the uniforms have reflective striping on them. The foul weather stuff has more.

I guess since we are volunteer and only go out for calls, I do not mind the flight suit. I do agree that badges need to be done away with. Do not understand why FD has badges in the first place.

I do like the idea of hats. Some one said not ball cap style. Then what? The Bus Driver look? I have that with my Army Dress Blues and I do not think practical. BDU style hat in color to match uniform? May the cornered Marine style BDU cap?

Just my $.02

Sarge

[JPINFV]

Ah, Mexican EMS. I did a report on Mexican and US EMS for a Poli Sci class during my last quarter of undergrad.

Problems with Mexican EMS:

No one number like 911 in many places.

Lack of Emergency Physicians for oversight and system development [first EM residence started in 1986]

Lack of standardized EMS training [anywhere from 600 hours down to nothing]

Not considered a priority by the Mexican government.

Below was one of my main sources for the Mexican side of the paper.

[JPINFV]

Emergency Medicine in México

Carlos Garcia-Rosas MD*, Corresponding Author Contact Information and Kenneth V. Iserson MD, MBA†

†Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona

*Mexican Board of Emergency Medicine, México

Received 29 April 2005; revised 8 March 2006; accepted 25 May 2006. Available online 12 October 2006.

Introduction

México, a republic of 1,972,550 sq km (712,130 sq miles), borders Guatemala and Belize to the south and the United States to the north. With 101,842,000 people (2002 estimate), it has the third largest population in the Americas, after the United States and Brazil. Although México is not thought of as a large nation, its population is 35% that of the United States, more than three times that of Canada, 58% that of all South American countries, 2.76 times all Caribbean countries, and 2.9 times that of all Central America [(1), pp 70–76, 81].

With a birthrate of more than 22 live births/1000 persons/year, a death rate of 5.1/1000 persons/year, an emigration rate of 2.7/1000 persons/year, and a life expectancy at birth of 73 years, México’s population is growing at the rate of 1.6% annually. The country is skewed toward youth: 32.2% of the population is 0–14 years old; 62.9% is 15–64 years old; 4.9% is 65–85 years old; and only 0.4% is over 85 years old (1).

Medical services

Several sources provide funding for Mexican citizens’ health care: the Social Security Medical Services (60%), the Federal Secretary of Health (about 20%), and private physicians and hospitals (about 10%). Approximately 10% of Mexican citizens have no source of funding for their medical care other than the hospitals for indigents.

Family physicians and general practitioners provide primary care through family medicine clinics, rural clinics and general hospitals. They typically have walk-in times for semi-urgent or new problems, although they see most patients by appointment (2).

There are several types of hospitals: Social Security hospitals, such as those run by the Mexican Institute of Social Services (IMSS) and the State Workers’ Institute for Security and Social Services (ISSSTE), municipal public hospitals, military hospitals, state-run general hospitals, and private hospitals. In all cases, the range of services depends primarily on the institution’s size. Specialized hospitals provide ambulatory surgery, specialized intensive care, geriatric care, and rehabilitation.

The social security services (IMSS and ISSSTE) provide medical care using a tiered system. Their family medicine clinics offer primary care, preventive medicine programs, and minor emergency treatment. The next level is hospitals with basic specialties. Patients in need of special procedures or subspecialty care are sent to the third level, specialty medical centers. However, because Article 4 of the Mexican Constitution guarantees a person’s right to health care, patients who feel that they have an emergency can seek treatment at any hospital. If they have no insurance and they or their family cannot afford the care, they are transferred to a state-run general hospital (3).

Emergency medical system

Different groups provide pre-hospital care within México, with the most prevalent being the Red Cross (Cruz Roja), which is found throughout México, and the Escuadron de Rescate y Urgencias Medicas (ERUM), which is part of México City’s police department. The training these providers receive varies widely, from a 300- to 600-h Tecnicos en Urgencias Medicas (TUM) course to virtually no training, especially among the wide range of volunteers who supplement the pre-hospital care system. Occasionally, physicians staff ambulances. Physician-based emergency care is primarily provided by public hospitals, patients with less serious complaints being seen by general practitioners in small clinics or private hospitals (2).

For several years, México City had an emergency telephone service using “080” in a few areas. This access number has now been replaced with several different numbers to call the police or public ambulances; the Red Cross ambulance service has its own number. The country has yet to institute a national system such as exists in the United States and Canada, so the receipt of calls for an emergency ambulance service is often delayed, slowing patients’ arrival at the Emergency Department (ED).

Most large EDs see adults and children in separate areas or, in the larger cities, at different facilities. Whereas some de facto trauma centers exist in large cities, most large hospitals set aside two or more rooms for trauma patients (2).

The number of emergency physicians has increased dramatically from the initial 15 residency graduates from México City’s General Hospital of Balbuena in 1989. However, many EDs throughout México continue to be staffed not only by trained emergency physicians, but also by generalists, family physicians, general surgeons, pediatricians, and others. The number of trained emergency physicians has expanded more rapidly since 1991, when the Mexican Institute of Social Services (IMSS) initiated a network of Emergency Medicine residencies, accepting 150 residents per year throughout México into 3-year programs (4 and 5).

Emergency care

Mexican emergency medical care came of age in 1986 with the initiation of its first Emergency Medicine residency. Nearly all the nation’s EM residency programs started in 1991, so little more than a decade has passed since the first large wave of emergency physicians entered practice. During this time, the political situation spawned by a change of leadership and ruling parties in the Mexican government, coupled with the effects of currency devaluation, have greatly decreased the resources available to develop the specialty’s infrastructure. Over that period, the government has given spending priority for the country’s relatively limited health care resources to primary care and preventive medicine programs while providing insufficient funds to equip teaching EDs and residency programs (4 and 5).

Although México’s emergency physicians have worked to develop their emergency medical care system, the lack of national planning and a sense among governmental officials that developing such a system is not a high priority have limited their successes (6 and 7). Nevertheless, México has developed some elements of an effective Emergency Medical System (EMS) (communication, pre-hospital transportation and training, hospitals equipped for emergencies, and emergency physicians) that can act as the basis for future improvements. Much of the technical improvements are due to private sector funding, because they have more resources available than the local and national governments seem willing to allocate.

Emergency Medicine education programs

México’s Emergency Medicine residency programs are relatively new. The first Emergency Medicine residency program began at the General Hospital of Balbuena (a part of the Medical Services of Federal District, México City) in 1986, and the second was started in 1991 by the Medical Institute of Social Services (IMSS).

Institutions such as IMSS, the federal Sistemas Estatales de Salud (SESa), etc., offer Emergency Medicine training through their own programs with slightly differing requirements in each. As in other countries, many of the programs have their residents rotate through more than one of their hospitals to gain various types of experiences (4 and 5).

The Superior School of Medicine (IPN) recognizes the residency programs run by the IMSS, the SESa, the medical services of México City’s Federal District, and some others, such as the program in Monterrey. Other universities or state medical schools recognize the rest (4, 5 and 8). Graduates of all programs qualify to take the Emergency Medicine Board Examination (6).

As of 2004, there were 14 Emergency Medicine residency programs in México, 11 of which are run by IMSS, one by the México City Health Department, one by the Federal Secretary of Health, and one, started this year, by ISSSTE (Table 1). In the near future, the ISSSTE plans to open residency programs at the General Hospital First of October and at the General Hospital “Dario Fernandez” (4). To generate the patient volume necessary for training and to be located in large hospitals, all Emergency medicine residency programs are located in urban areas.

Table 1.

Emergency Medicine Program Sites and Sponsors4,5,10

El Instituto Mexicano del Seguro Social (IMSS) — in México City

Hospital General de Zona 1-A “Los Venados”

Hospital General de Zona No. 8, “San Angel”

Hospital General del Centro Medico Nacional “La Raza”

Hospital General Regional No. 25, “Zaragoza”

Hospital General Regional “Gabriel Mancera”

IMSS in other regions

Hospital de Especialidades, Centro Medico Nacional, Ciudad Obregon, Sonora

Hospital de Especialidades, Centro Medico Nacional, Puebla, Puebla

Hospital de Especialidades, Centro Medico Nacional, Veracruz, Veracruz

Hospital de Especialidades, Centro Medico Nacional, Torreon, Coahuila

Hospital General Regional No. 46, Guadalajara, Jalisco

Hospital General No. 33 Monterrey, Nuevo Leon

La Secretaria de Salud Federal

Hospital Dr. Gea Gonzalez (begun 2001)

Servicios Medicos del Distrito Federal

Hospital General de Balbuena

Instituto de Servicios de Seguridad Social para Trabajadores del Estado (ISSSTE)

Although the numbers fluctuate, on average, between 120 and 150 physicians enter Emergency Medicine residencies annually. Based on the available funding for all Mexican residency programs, this number relates to the approximately 3,500 physicians accepted annually into all Mexican residencies—about 12% of those who apply.

Emergency Medicine training

All Emergency Medicine residents must have a valid medical degree, obtained by completing 4 years of medical school, 1 year of “internado de pregrado,” and 1 year of social service. During the social service year, students must pass their professional examination to become a physician and obtain a “titulo,” a degree of “Medico Cirujano” (Physician and Surgeon). Once they obtain their “titulo,” individuals can take the Examen Nacional Para Residencias Medicas (ENPRM), which qualifies them to enter a residency program. This test, similar to the United States Medical Licensing Examination (USMLE) in the United States, is designed and approved by the Secretary of Health, the National University of México, and a committee composed of representatives from México’s private and public health institutions (the Inter-Institutional Committee of the Health Sector). Fewer than 15% of students pass this test. Some of those who fail find work in other health-related fields, whereas others leave medicine completely (4, 5, 6, 7 and 8).

In addition to passing the ENPRM, individuals must possess the academic prerequisites and personal qualities required to enter an Emergency Medicine residency. They include:

a Being registered to practice medicine in México in the National Register of Professions kept by the Public Education Secretary (SEP). To be registered, a graduate who studied medicine in México and is a Mexican citizen must also do a year of internship and a year of social service. Other physicians, such as those who studied outside México or are not Mexican citizens, must obtain a special work permit.

b Demonstrating a willingness to devote full time to the Emergency Medicine residency training program.

c Being physically and mentally healthy, and possessing a capacity to work under pressure. Both a psychological test and an English-language test are administered.

d Having a clear understanding of the mental and physical demands of a career in Emergency Medicine (7, 8 and 9).

Emergency Medicine residencies are not combined with any other specialty training. The residencies follow curriculums approved by the associated medical school, which monitors their compliance. The overall goals are for trainees to obtain the outlook, knowledge, and skills necessary to carry out the diagnostic and therapeutic procedures required in clinical practice, to acquire the administrative skills to manage an ED and the emergency medical system, and to be able to access and appropriately apply published research to Emergency Medicine practice. In essence, at the end of their training, Emergency Medicine residents should have the clinical skills necessary to deliver good care to patients with an acute illness in any ED in México (4, 5 and 8).

Emergency Medicine specialization in México requires a minimum of 3 years of training. During their training, Emergency Medicine residents take examinations every 2 or 3 months and at the end of each training year. If they pass all the examinations and also demonstrate that they practice excellent Emergency Medicine in their clinical evaluations, they receive the “Medico Especialista en Medicina de Urgencias” (Emergency Medicine Specialist) diploma from their training institution and the affiliated medical school (4 and 5).

Candidates take their Board examination in Emergency Medicine once they have successfully completed residency training. To become a recognized specialist in Emergency Medicine, the graduate must then take the Emergency Medicine specialty board examination administered by the Mexican Board of Emergency Medicine. Founded in 1992, the Board has administered this specialty examination, equivalent to specialty board examination in other countries, to about 2000 physicians, with pass rates varying between 70% and 85% (6 and 9). Approximately 95% of these physicians continue to practice Emergency Medicine.

Between 30% and 35% of all physicians working in Mexican EDs have taken the Board examination. They average 30 years of age. In accordance with Mexican law, physicians generally retire at age 60 or after 28 years in practice in the IMSS system; emergency physicians are expected to follow this model. If they wish, they can still work in the private sector. As of yet, however, Emergency Medicine is still too new in Mexico to have such retirees among residency graduates.

After an additional 2 years of study through IPN and some other schools, Emergency Medicine graduates (as well as internists, pediatricians, etc.) can obtain a masters degree in Toxicology and qualify to take the subspecialty examination, leading to the Diploma of Toxicology (10). Emergency Medicine graduates can also do subspecialty training in resuscitation (reanimatology), although only the Superior School of Medicine (IPN) recognizes this subspecialty (10).

Alternative Emergency Medicine Training: Diplomado

For physicians who practice or want to practice Emergency Medicine, but who have not completed an Emergency Medicine residency program, an alternate educational route exists. Through the Comité Mexicano para el Cuidado del Corazon y Trauma and the Escuela Superior de Medicine del Politecnico Nacional (a México City medical school), physicians can enter a “Diplomado in emergency medicine and trauma” program. The program consists of 200 h of didactics in 20 modules and 10 workshops. A 1-day animal (dog) laboratory allows trainees to practice venous access, placement of thoracostomy tubes, and to perform cricothyrotomy, tracheostomy, peritoneal lavage, thoracotomy, and other procedures. The course, 10 h a week, lasts 5 months. In 2004, other medical school sponsors began teaching the same course in México City (11).

This course is only open to physicians in general practice, family medicine, and other medical and surgical specialties. Those in Emergency Medicine residencies go through the normal Board examination process.

Although this course does not allow these physicians to be recognized as Emergency Medicine specialists in México or to sit for the Mexican Board of Emergency Medicine examination, it provides concentrated continuing medical education credits focused on Emergency Medicine, which is generally the field in which they work. Through 2004, about 200 generalist and non-Emergency Medicine specialist physicians have completed the Diplomado course in Emergency Medicine.

Teaching faculty

Currently, many faculty members in Emergency Medicine residencies are not residency trained in Emergency Medicine. Most are internists, intensivists, pediatricians, surgeons or other specialists. Ideally, at least the residency director should be residency trained and Board certified in Emergency Medicine; this is currently not the case for all programs (8). In addition to excellent clinical and teaching skills, the teaching faculty at Emergency Medicine residencies must have good communication skills, good relations with their colleagues and students, and be emotionally stable, with the capability of providing support to the residents.

As in other specialty residencies, Emergency Medicine faculty are tasked with ensuring that all the residents receive complete training and the best possible opportunity to develop their skills in their chosen specialty (4, 5 and 8).

Emergency Medicine organizations

Aside from the Mexican Board of Emergency Medicine, several national Emergency Medicine organizations exist in México. The first, formed in 1989, was the Sociedad Mexicana de Medicina de Emergencia (SMME), which now has about 700 members. About a decade later, graduates of the IMSS residencies began the Sociedad Mexicana de Medicos Urgenciologos (SMMU), which now has about 400 members, and the Comité Mexicano para el Cuidado del Corazon y Trauma which has about 300, members all are headquartered in Mexico City. In addition, México is a part of the International Federation of Emergency Medicine (IFEM) and “cosponsor in Europe” for the Federation’s second meeting in Emergency Medicine (7 and 9).

Organizations also exist for those involved in pre-hospital care. They include national groups, such as Cruz Roja Mexicana, S.0.S., and Cruz Ambar; the México City-based Escuadron de Rescate y Urgencias Medicas; and various other local police and civil defense/rescue squads (2 and 8).

Emergency Medicine’s impact

In México today, Emergency Medicine residency graduates have become chiefs of their departments throughout the country, hospital administrators and directors in a position to exert greater influence, and taken positions in the government, such as the coordinator of hospital groups. On the education side, residency graduates are now coordinating medical school Emergency Medicine curricula and directors of medical education in major teaching hospitals.

The future

In the coming decade, the hope is that Mexican Emergency Medicine will continue to improve and to meet the following goals:

1 Guarantee quality care in any ED in México to patients with an acute illness or injury.

2 Create a standarized residency training program in Emergency Medicine throughout México with the cooperation of academic hospitals and the faculties of medicine in coordination with the Mexican Board of Emergency Medicine and Mexican Academy of Emergency Medicine.

3 Assure that all Emergency Medicine residency training programs provide their graduates with the skills and knowledge necessary to give care in any Mexican ED at any level.

4 Upgrade pre-hospital care, including the implementation of a national telephone access number, improved and standardized training for ambulance personnel, and close cooperation with hospital EDs.

References

1 Pan American Health Organization, Health in the Americas, Pan American Health Organization, Washington, DC (2002).

2 Plan Nacional de Salud. Secretaria de Salud. 2000.

3 Constitución de los estados unidos mexicanos, articulo 4.

4 Programa de Curso de Especialización en Urgencias Medico-Quirurgicas. Instituto Mexicano del Seguro Social 1991–94.

5 Programa del Curso de Especialidad en Urgencias Medico-Quirurgicas, Servicios Medicos del Departamento del Distrito Federal, Mexico City, Mexico, 1986–89.

6 Estatutos del Consejo Mexicano de Medicina de Urgencia a,c. Enero 1991.

7 Estatutos de la Sociedad Mexicana de Medicina de Emergencia a,c. Enero 1989.

8 C.A. Garcia, La enseñanza de la medicina de urgencia en México, Panam J Trauma 2 (1990), pp. 39–43.

9 Archivos del Consejo Mexicano de Medicina de Urgencias, Mexico City, Mexico, a,c. 2002.

10 Programas de Postgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.

11 Estatutos del Comité Mexicano para el cuidado del corazon y trauma, a,c. 1997.

1. This is one of the sources I used for the Mexican part of my report.

2. I would have posted a link to it, but I needed to get in via VPN to get the whole article.

[WendyT]

And I knew my old radio shack hat would be usefull glad I never chunked it. says spenac

Chunked it what is chunked mean, :shock:

Oh you mean chucked it :wink: Gotcha.

[CBEMT]

Polo shirts... these can be decent looking when in a conservative colour and worn with fitted slacks (as opposed to MC Hammer looking BDU britches). Unfortunately, there is a tendancy to make them clown red or a dingy (din-gee, not ding-ee) grey colour that looks like crap. And the cut of Polo shirts is not very conducive to the wearing of body armour, which would be a mandatory requirement in my agency. And I dunno about where everybody else is, but all the cops are starting to wear white polo shirts around Texas in the Summer. Consequently, there goes the whole purpose of the distinct uniform. Consequently, no Polo shirts.

As long as the polo shirts aren't white, what difference does it make? How many people are REALLY going to say, "He's wearing a polo shirt, he must be a cop." Come on.

Around here EMS (fire or otherwise) either wears light blue two-pocket uniform shirts, or dark blue polos. Three of the privates wear white uniform shirts, one blue, one baby-blue polos, two have cranberry polos.

The cops are pretty much universally wear dark/navy blue uniform shirts, the staties have grey but their uniform is EXTREMELY distinctive. They don't get mistaken for anybody.

Worcester MA EMS wears light brown shirts with dark brown pants. Kinda ugly but distinctive. Boston's EMTs wear brown/brown, the medics white/brown.

I used to work for a private that had brown shirts with black pants when I started. We later switched to light blue. As much as we hated the brown (insert any Boy Scout joke you can think of), I have to say that once we switched to blue, all of a sudden none of the hospitals recognized us- even though none of the other privates wore blue. The brown definitely made us stand out.

[rock_shoes]

I would say Polo shirts are a big no no. They just aren't enough of a professional look for EMS. A standardized uniform should improve public perception of EMS workers not tarnish it by having them look like they were just on the golf course. Blue or black are both out because of the LEO look they produce. Brown is out because EMS workers shouldn't look like they're out making deliveries for UPS.

[croaker260]

RE: Scrubs: Yes the are common in the medical profession..Nurses, Doctors..but also the Janitors, CNA's, Lab techs, etc.

No, Scrubs are not professional.

RE: Flightsuits/Jumpsuits- To look good you must 1- Not be grossly Obese, otherwise you look like a piece of chocolate in a bright reflective wrapper. Two- It must be properly sized. The cost of a custom sized uniform (so it doesnt look like you dropped a load in your shorts) is many times the cost of a regular uniform.

There is something to a "command" style uniform..When you have to take command, it helps the masses to listen when you have a uniform that commands resect. Remember that cops and FF don't model their uniforms after each other, they model them after the military, and so should we. Crisp, Functional, Sharp. That is professional. Badge or not. If you look like the business man, the doctor, the nurse, all skilled professions, but not IN CHARGE in a crisis in the streets.

just my 0.02 ...as someone who is not trying to be a cop or FF...but is former military, and appreciates a good sharp military like uniform.

And no, I am not talking about saggy BDU pants and bloused boots.Im talking about a crisp UNIFORM.

BTW, we wear white two pocket button up shirts, badges, blue pants. The only peopel who think we are cops are kids. No one thinks we are FF's (when they see us that is), not because of our colors, but because we don't have wrinkled worn uniforms under our turnouts going on medical calls.

[Richard B the EMT]

I think I am finally going to chime in on several topics covered in this string.

1) Scrubs: I see all types of people wearing scrubs, the majority of which are not even employed by a hospital. They tell me they wear it strictly for comfort.

2) Jumpsuits: My old VAS used to wear a kelly green one. Made us quite popular at the local Saint Patrick's Day parade.

When we were in internal discussion as to go jumpsuit or not, the topic of jumpsuit color was raised. As in this string, red was rejected, due to the FD association, likewise blue as PD. Yellow? "Are youse freakin' kidding?" Orange was rejected, due to belief of that being the color of a Bureau of Prisons "guest" (supporting that, there has recently been a YouTube video, showing some prison in possibly the Philippines, where the entire prison yard is full of orange clad prisoners dancing to Michael Jackson's "Thriller").

3) Jackets: Uniforms are meant to look alike, and the jackets and coats needed sometimes by those of us in colder climates are usually lookalike to each other. I am aware there are some here live in warmer climates, and have never experienced being on standby at a multiple alarm fire, with the wind blowing almost a blinding amount of snow in off of the ocean, where warm uniforms are a must. Society, at least that in which I live, has no restriction on how much clothing one can add when it is cold, but does have restrictions on how much you can take off when it is hot.

4) Polo shirts: my preference is no, they don't have pockets, and I [s:66b2aff091]use[/s:66b2aff091] need my shirt pockets.

5) Star of Life or Red Cross on uniform backs: Just something to have the bad guys spot you in their crosshairs of their guns. I now rate such as a bad idea, for that reason.

6) "Fire Engine Lime Green Chrome" uniforms: After the London Subway bombings, I noted on American TV coverage, most of the emergency responders, especially the LEOs, were wearing jackets in a checkerboard design of that color. They stood out, but I was unable to tell which of those wearing them were LEOs, FD, or EMS.

7) Badges: I like them as a quick on-scene ID. As for those who say that wearing a badge is going to attract gunfire from those thinking the wearer is a LEO, these miscreants will probably blast away at anyone approaching wearing anything bright on the left side of the chest, even if it is reflected light off some religious medallion, or a shiny shirt button. Some would fire at anyone approaching, period.

[frontcrawl]

Badges for quick on-scene ID? What? How does a badge ID you as anything? Everybody has the damn things, if you are going to get close enough to figure out whether the thing reads "Paramedic", "Building Inspector" or "Notary Public" you may as well read a patch or ID card or lettering on the uniform or whatever. Honestly, what does the badge add?