South of the Border

After the screening of our documentary ‘Paramedico’ at the EMS World Expo 2013 it seemed that enthusiastic praise for the film was unanimous. But several medics from Mexico in the audience weren’t quite as thrilled. Given the naturalistic depiction of the Mexican medics we chose to present, this was not surprising. In both my book and film I try to convey a true picture of the Red Cross EMS in Mexico City, describing at length the passionate dedication of the staff and their hard work in extremely perilous conditions. So why would we undermine this heroic image with depictions of raunchy dancing EMTs, ambulances running out of fuel and first aid kits stocked with bottles of tequila? This isn’t, I was told, what the vast majority of Mexican ambulance services really look like.

Herein lies a common problem of documentary making. Saying something about the whole picture is often best achieved by way of a snapshot – a simple narrative involving no more than a few characters. But this snapshot can never be an all-encompassing reflection because the whole picture is often more complex. And ‘complex’ is the perfect way to describe Mexican EMS.

In the early 1900s the Red Cross in Mexico inherited the job of civilian EMS provision from the military. Today, almost five-hundred delegations across the country provide ambulance services. These are staffed by a handful of poorly paid permanent staff and majority volunteers. Indeed, the strength of the Mexican Cruz Roja greatly depends on public donations and the altruistic spirit of medics who put in long hours each week for no financial compensation.

Mitzi Garcia Rodriquez of the Mexican Red Cross

There are few other countries where NGOs like the Federation of the Red Cross bear the burden of providing free ambulance services outside of war or natural disaster. Such an exercise has proven to be extremely difficult and rarely profitable. A hundred years ago when the Mexican population was no more 13 million, the model may have worked. In 2014, with a population well over 120 million, the Mexican Red Cross has struggled to meet demand. If given the choice again, it is doubtful the NGO would take on such a task, least of all in a nation that has one of the highest trauma rates in the world.

While shooting ‘Paramedico’ I was deeply impressed by the commitment of the volunteers. But the operational problems the Cruz Roja suffers cannot be disguised. Nor did the medics I rode with want to hide them. Paramedic Mitzi Rodriguez, the protagonist of my film, frequently told me, ‘This is the reality in Mexico, please show the world.’ This ‘reality’ includes poor EMS governance and national standards, non-existent supplies, broken or outdate equipment, and dismal response times.

Response times are as frustrating for the Red Cross medics as it is for the public waiting on ambulances. Lazaro Cardenas, the dense and impoverished colony of Zona Norte featured in ‘Paramedico’ has ambulance response times typically greater than 20 minutes. No wonder Rodriguez says she has ‘only done CPR four times in eight years’. The ambulance rarely arrives in time for resuscitation to be effective.

The author in a Mexican ambulance

But this is not the case in every Mexican city. Indeed, the EMS reality for Rodriguez and her team is not necessarily the reality countrywide. Over the past decade, the unregulated EMS environment and the variable performance of the Red Cross ambulances has given rise to ambulance services run by the police and ministry of health, along with more than thirty private companies. While many of the latter provide little more than basic life support (BLS), some of the more professional companies are producing very impressive results. In Monterrey, Mexico’s most developed city to the northeast with the highest per capita income in the nation, a service known as EMME (Emergencies Medicas) is boasting out-of-hospital cardiac arrest (OHCA) survival rates that rival those of London, New York and Sydney.

Other cities are not far behind. According to Dr. Juan Manuel Fraga Sastrias, a professor of paramedical science in Queretaro, the development of Mexican EMS is speeding up. Last year, in Guadalajara, Puebla and various parts of Mexico City, new government based services helped increase cardiac arrest survival rates from 0% to 2-3% for the first time ever. Fraga says many other clinical outcomes are also improving.

More ambulances supplementing traditional Red Cross services mean better response times across the board. The use of motorcycle medics such as the 15 motorcycle fleet run by the Escuadron de Rescate y Urgencias Medica (ERUM) has also helped. Fraga believes there has been an vast improvement medic training over the past few years too, with the benefits only now being seen in the data.

Paramedic Fernando Aviles, a veteran paramedic and a Mexican delegate I met at last year’s EMS World Expo, is very optimistic about the future of EMS in his country. ‘It’s getting more technical, better regulated, more professional. We are feeling the digital age.’ On a recent holiday to Ecuador, Aviles noted the poor condition of EMS there. ‘They seemed 25 years behind us, which made me realize that we are not so bad after all.’

Still, he points out, there is much to be done. ‘Luckily,’ adds Aviles, ‘Mexicans have the will power to do it.’

Benjamin Gilmour is author of the bestseller ‘Paramedico – Around the World by Ambulance’ (HarperCollins). This story published in EMS WORLD MAGAZINE Jan 2014

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