Emergency Care and Referral Among Isolated Island Populations in the Bahamas

• Published in: The Journal of emergency medicine Vol. 48; no. 3; pp. 356 - 365
• Main Authors: Nelson, Brett D., MD, MPH, DTM&H, Ahn, Roy, MPH, ScD, Markovchick, Vince, MD, Hines, Rosemary A., BA, Lauretti, Alexandre R, Lauretti, Julien R, Dahl-Regis, Merceline, MD, Burke, Thomas F., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015
• Subjects: Abdominal Pain - etiology; Adult; Aged; Bahamas; Bahamas - epidemiology; Chest Pain - etiology; Chronic Disease - epidemiology; Diagnostic Services - supply & distribution; Education, Medical, Continuing; Education, Nursing, Continuing; Emergency; Emergency Medical Services - manpower; Emergency Medical Services - supply & distribution; emergency medicine; emergency referral; Equipment and Supplies - supply & distribution; Female; Health Care Surveys; Health Services Accessibility; Health Services Needs and Demand; Humans; Interviews as Topic; island populations; isolated populations; Male; Middle Aged; Needs Assessment; Pharmaceutical Preparations - supply & distribution; Prevalence; Referral and Consultation; Risk Factors; Rural Health Services - manpower; Rural Health Services - supply & distribution; Uterine Hemorrhage - etiology; Uterine Hemorrhage - therapy; Wounds and Injuries - therapy; Bahamas; isolated populations; emergency medicine; emergency referral; island populations; Bahamas
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2014.09.069

Abstract Background Isolated island populations face unique health challenges. In the Bahamas, the islands of Mayaguana, Inagua, Crooked Island, Acklins, and Long Cay—referred to as the MICAL Constituency—are among the most isolated. Objectives Our objective was to better understand regional emergency care needs and capabilities, and determine how emergency care can be optimized among island populations. Methods During the summer of 2013, the project team conducted semi-structured key-informant interviews and small-group discussions among all health care teams in the MICAL region, as well as a community-based household survey on the island of Mayaguana. The interviews and small-group discussions consisted of open-response questions related to health care services, equipment, supplies, medications, and human resources. The community-based survey examined the prevalence of chronic noncommunicable diseases (CNCDs) and associated risk factors affecting the inhabitants of the region. Results The average number of annual emergency referrals from each of the MICAL islands was approximately 25–30, and reasons for referrals off-island included chest pain, abdominal pain, trauma, and dysfunctional uterine bleeding. Traditional prehospital care is not established in the MICAL Constituency. Providers reported feelings of isolation from the distant health system in Nassau. Whereas most clinics have a well-stocked pharmacy of oral medications, diagnostic capabilities are limited. The household survey showed a high prevalence of CNCDs and associated risk factors. Conclusion Ongoing in-service emergency care training among MICAL providers is needed. Additional equipment could significantly improve emergency care capabilities, specifically, equipment to manage chest pain, fractures, and other trauma. Community-based preventive services and education could improve the overall health of the island populations.