The current scenario of emergency care policies in Brazil

Abstract

BackgroundThe regulation of emergency care has featured prominently in Brazil’s federal health agenda since the 2000s. The aim of this study was to review up to the present day the implementation of the National Emergency Care Policy.MethodsThe methods employed were documental review, analysis of official data and 11 interviews conducted with federal, state and local managers. The results were analyzed using Giddens’ Structuration Theory, relating the cognitive abilities of the agents to their action strategies, in view of the structural dimensions, rules and resources provided by the federal administration.ResultsFederal policy for emergency care in Brazil can be divided into three stages: from 1998 to 2003, the initial regulation; from 2004 to 2008, the expansion of the Mobile Emergency Medical Services (SAMU, in Brazil); and from 2009 onwards, the implementation of stationary pre-hospital care facilities, known as Emergency Care Units (UPA). The structuration elements identified for the emergency care policy were the public health system guidelines, legislation, standards and federal financing. Significant restrictions were found such as lack of hospital beds and intensive care treatment, gaps in the information system for producing evidence for management, ineffective Management Committees, as well as a low degree of commitment among physicians to the services.ConclusionConsidering the financial constraints imposed on the SUS (Brazilian Unified Health System), emergency care was identified as a political priority with financial support. The individual actions by emergency care workers and governmental agents typified the first period of the policy, structuring the basis and producing changes in the circumstances of action. Federal strategies can be equated to the rules and resources provided to support the implementation process of the policy.

Gestão do trabalho nas Unidades de Pronto Atendimento: estratégias governamentais e perfil dos profissionais de saúde

“…Em que pese o desenho abrangente da Política Nacional de Atenção às Urgências, sua implantação caracterizou-se pela expansão de serviços específicos, marcada por três momentos: 1998-2002 -regulamentação inicial; 2003-2008 -ênfase nos Serviços de Atendimento Mó-vel de Urgência (SAMU); a partir de 2009 -ênfase nas Unidades de Pronto Atendimento (UPA), como componente fixo da atenção pré-hospitalar às urgências 3,4 .…”

Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan

“…Unfortunately, legislation and public policy around EMS is often absent or poorly enforced in LMICs [4] As in Punjab Province in Pakistan, the state of Gujarat in India, and the countries of Colombia, Romania and Brazil, appear to have ‘cemented’ structures and resources for EMS through legislation [4, 25, 26]. However, public sector support cannot be guaranteed, as seen in the case of Karachi, and there is therefore a distinct need for the private sector to fill these service delivery gaps, particularly for disadvantaged populations.…”

Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service

“…7 In emergency cases, two types of facility have been set up to receive patients: emergency care units, which deal with cases of intermediate complexity and are usually available in medium-size cities; and local hospitals, which are settings for dealing with cases of high complexity and are usually available in larger cities. 8 Regarding transportation of patients to proper facilities, Brazil used the French mobile emergency medical service as a template for developing its own mobile emergency medical service (Serviço de Atendimento Móvel de Urgência, SAMU). Currently, this model comprises a nationally standardized medical service that provides transportation and pre-hospital care for emergencies at any time on any given day.…”

“…Currently, this model comprises a nationally standardized medical service that provides transportation and pre-hospital care for emergencies at any time on any given day. 8 However, patients with emergencies sometimes seek assistance within the primary care setting for a variety of reasons. Firstly, the emergency services still suffer from highly restricted capacity.…”