• two ambulances on the street

Respuesta post-siniestro

La atención oportuna y de calidad ante una emergencia puede marcar la diferencia entre la vida y la muerte. En la Región de las Américas, miles de personas enfrentan cada día situaciones críticas que requieren sistemas de atención de emergencias mejor preparados y coordinados. 

Un Sistema de Atención de Emergencias (SAE) es una red organizada de recursos, servicios y profesionales de la salud que actúa de manera integrada para responder eficazmente a situaciones que ponen en riesgo la vida. Incluye la atención prehospitalaria (cuidado en la escena, transporte y traslado), la atención en establecimientos de salud (desde el primer nivel, hasta hospitales especializados [cuidados críticos y quirúrgicos]), así como los mecanismos de preparación y seguridad ante emergencias. Su objetivo es garantizar que cada persona reciba atención adecuada en el lugar correcto y de manera oportuna, integrando organización, gobernanza, financiamiento, sistemas de información y la mejora continua de la calidad. 

Desde la Organización Panamericana de la Salud (OPS), con el apoyo del Fondo de las Naciones Unidas para la Seguridad Vial (UNRSF) y de múltiples socios estratégicos, impulsamos una agenda para fortalecer la atención de emergencias basada en los componentes esenciales del Marco de referencia del Sistema de Atención de Emergencias

  • 6 países (Belice, Bolivia, Costa Rica, Jamaica, Paraguay y Trinidad y Tobago) realizaron la evaluación del sistema de atención de emergencias y cuidados críticos (ECCSA, por sus siglas en inglés).
  • 13 países informan que cuentan con un número único de acceso a los servicios de emergencias con cobertura nacional. 15 países reportaron incluir una meta sobre el tiempo de respuesta en sus estrategias de seguridad vial.
  • Solo 2 países incluyeron una meta de tiempo de respuesta en minutos en sus estrategias de seguridad vial.
  • 7 de países (Argentina, Bolivia, Colombia, Costa Rica, Jamaica, México y Paraguay) han implementaron el programa de capacitación en cascada del curso de atención básica de emergencias (BEC, por sus siglas en ingles).
  • Belice implementó el Curso Básico de Cuidados Críticos.
  • Costa Rica ha implementado la prueba piloto del Curso de Respuesta de Primeros Auxilios en la Comunidad.

El compromiso internacional con la integración de la atención de emergencia, de cuidados críticos y de quirúrgicos se ha fortalecido en los últimos años.  

La resolución WHA76.2 (2023) de la Asamblea Mundial de la Salud, destacó la necesidad de integrar los servicios de atención de emergencias, cuidados críticos y quirúrgicos dentro de los sistemas de salud como elementos claves de la cobertura sanitaria universal y de la preparación ante emergencias. Ese mismo año, la Asamblea General de las Naciones Unidas aprobó la resolución A/RES/78/4, reafirmando el compromiso de los países para garantizar el acceso equitativo a servicios esenciales de salud. 

En 2024, la resolución WHA77.8 solicitó el desarrollo de una estrategia mundial 2026–2035 para integrar la atención quirúrgica, los cuidados intensivos y de emergencia. En la Región de las Américas, estos mandatos se traducen en la resolución CD61.R11 (2024), que aprobó la Estrategia de Integración 2025–2030, orientada a fortalecer los Sistemas de Atención de Emergencias en todos los niveles de atención. Esta estrategia orienta el trabajo conjunto con los países para consolidar sistemas de salud más resilientes, equitativos y preparados frente a emergencias. 

La OPS trabaja junto a los países de la Región de las Américas para fortalecer la capacidad de respuesta ante emergencias, promoviendo acciones coordinadas que salvan vidas. Entre las acciones que se realizan incluye el despliegue de asistencia técnica, la capacitación de profesionales de la salud, la generación de evidencia para la toma de decisiones y el impulso de reformas que mejoren la preparación y seguridad de los SAE.

The essential components of an emergency care system

Areas of work

PAHO supports countries in integrating emergency care into national health plans and consolidating integrated primary health care models. It also promotes the establishment of institutional structures and sustainable mechanisms to ensure the training and retention of specialized professionals. 

This work is aligned with intersectoral policies that engage ministries of health, finance, transport, and security, ensuring the necessary coordination for an effective response. Additionally, PAHO advocates for the adoption of international standards, the allocation of dedicated funding, and the establishment of clear regulatory frameworks to strengthen governance and reduce fragmentation. 

Recommended strategies: 

  • Ensure sustainable financing for the Emergency Care System (ECS). 

  • Integrate emergency care as a key component within national health plans or primary health care models. 

  • Designate an office or unit responsible for emergency care within the Ministry of Health. 

  • Create mechanisms to guarantee the sustainable training and retention of specialized professionals. 

To strengthen ECSs, it is essential to have national assessments that provide an objective understanding of system response capacity. Tools such as the Emergency and Critical Care System Assessment (ECCSA) offer a structured framework to evaluate essential system components, identify strengths, weaknesses, and critical gaps, and prioritize areas for improvement. 

The situational analysis becomes a key instrument to translate findings into concrete actions that enhance coverage, accessibility, and quality of emergency care across the Region of the Americas. 

Recommended strategies: 

  • Conduct a standardized national assessment of emergency care, including legal and regulatory frameworks, to identify areas for improvement. 

PAHO provides technical cooperation to countries to review, update, and harmonize laws, regulations, and protocols governing emergency care. This support aims not only to modernize legal frameworks but also to ensure alignment with international standards and national health priorities. 

Strengthening regulatory frameworks improves institutional capacity to manage critical resources, such as prehospital transport, supply chains for medicines and equipment, critical and surgical care, workforce certification, and referral and counter-referral protocols. These actions promote legal certainty, accountability, and service sustainability, consolidating emergency care as a national health priority. 

Recommended strategies: 

  • Explicitly include emergency care (prehospital, hospital, critical, and surgical) within national health plans or strategies. 

  • Review and, where necessary, improve "Good Samaritan" protection laws for bystanders providing first aid. 

  • Review and improve regulations for standardized clinical documentation in prehospital and emergency unit settings. 

  • Review and establish triage systems, clinical protocols, and referral/counter-referral pathways, including "no-refusal" policies. 

  • Review and establish a single national emergency number for ECS activation. 

  • Develop national standards for ambulance types, equipment, medicines, and personnel. 

  • Develop national standards for emergency units, including staffing, equipment, and essential medicines. 

Timely access to organized and efficient prehospital services is critical to saving lives and reducing complications in emergencies. PAHO promotes the Prehospital Toolkit, designed to standardize on-scene care protocols and optimize the work of first responders. This practical resource supports hands-on training and ensures that initial procedures are performed consistently, in alignment with international standards. 

The approach also promotes integrated coordination systems, including dispatch centers, transport protocols, and referral mechanisms, ensuring continuity of care from the site of the event to hospital-based services. 

Recommended strategies: 

  • Ensure access to organized prehospital emergency care, including a single emergency number and a coordination center with real-time mapping of available resources.

  • Establish community-based first response training programs. 

PAHO promotes the consolidation of 24/7 emergency units, ensuring continuous operation and strengthening both clinical and management capacities. These units are essential to guarantee immediate, safe, and effective care for emergency cases. 

Support includes the implementation of training tools such as the Emergency Unit Management (EUM) course, which optimizes organization and management of emergency services, and the Basic Critical Care (BCC) course, which provides essential competencies for managing critically ill patients. Both initiatives contribute to standardizing clinical practice, improving the quality of care, and ensuring continuity. 

PAHO also fosters the strengthening of infrastructure, strategic supplies, and evidence-based protocols, improving the responsiveness of emergency units. This includes patient flow management, referral system coordination, and linkage with prehospital networks for timely and safe transfers. 

Recommended strategies: 

  • Ensure that all hospitals have emergency units or areas available at all times.

Developing professional competencies is a cornerstone for ensuring the delivery of quality emergency care. In this regard, the Pan American Health Organization (PAHO) promotes the regular updating and certification of emergency care providers to maintain up-to-date clinical and management competencies. 

This process includes the implementation of standardized and internationally validated courses, such as the Basic Emergency Care (BEC) course, the Basic Critical Care (BCC) course, and the Community First Aid Response (CFAR) course, among others. These trainings not only strengthen technical knowledge but also foster teamwork and inter-institutional coordination. 

Professional capacity strengthening is further complemented by the establishment of accreditation mechanisms and networks of local and regional instructors, which ensure the sustainability of installed capacities. This approach helps ensure that knowledge and skills are institutionalized within national health systems, rather than relying exclusively on external actors. Through these efforts, PAHO supports countries in developing a skilled and up-to-date health workforce, capable of providing effective and safe emergency and critical care. 

Recommended strategies: 

  • Integrate specific training on emergency and trauma care into medical and nursing curricula. 

  • Implement ongoing training and periodic refresher programs for all frontline providers. 

  • Establish pathways for regular certification of prehospital and hospital emergency care personnel. 

PAHO promotes the strengthening of reliable and standardized information systems that enable the monitoring of the performance of emergency and critical care services. To this end, PAHO advocates for the use of harmonized registries, facilitating data comparability across institutions and supporting evidence-based decision-making. 

A central component of this effort is the consolidation of key indicators, such as response times, quality of care, and health outcomes, which inform planning processes and resource allocation. These indicators help identify gaps in service delivery and form the foundation for continuous quality improvement programs, including clinical audits, accreditation processes, and ongoing training of health personnel. 

PAHO encourages the integration of data collection and analysis into the strategic management of health systems, ensuring a dynamic process of institutional learning. In this way, data are used not only to evaluate performance but also to optimize processes, strengthen governance, and continuously improve the quality and safety of emergency care. 

Recommended strategies: 

  • Develop standardized protocols and ensure their consistent implementation. 

  • Establish information systems that integrate essential emergency care data. 

  • Analyze health system performance in key areas of emergency care delivery (e.g., response times). 

  • Promote continuous quality improvement programs, using available data and international guidance to strengthen emergency and trauma care. 

  • Document and disseminate successful experiences. 

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