9 / 180
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terms of reaching the United Nation’s Millennium Develop-
ment Goals (MDGs) (See Fig 3). The Chilean national report
yielded very positive results. Chileans met all the 2015 goals
well ahead of schedule except for gender equality (#3) and
combatting HIV/AIDS/malaria (#6) which are not prevalent in
Chile. One criticism of the MDGs is that they don’t provide any
comprehensive cross sectional health care data or any system
performance data beyond the specific health measures iden-
tified within the MDGs. Emergency medicine development is
not specifically articulated as a MDG (5).
tion via secondary private ambulance services emerged in
the urban centers in Chile including H.E.L.P., Unidad Coro-
naria Movile, and others via paid subscription and on-scene
payment. Thus the prehospital arena was then, and remains
now, relatively fragmented. At that time, some career inter-
ested emergency physicians worked for SAMU, and some
worked sporadically in both emergency rooms and critical
care settings. In Chile, firefighters are not cross-trained as
paramedics as they are in the U.S. and fire-related emer-
gencies are managed completely separately from medical
emergencies.
Currently, Chile lacks a formal regionalization of trauma care
and there is no national or metropolitan trauma registry
gathering medical injury data. The regionalization of trauma
care and concentration of trauma care resources in desig-
nated trauma receiving medical centers is an obvious need.
The larger public hospitals are the most obvious targets for
this evolution, and generally one trauma center is needed
per 1-1.5 million population (6). Trauma care in Latin America
will likely improve most by first improving prehospital and
emergency department care (7,8).
The argument in favor of developing EM that was presented
to the Chilean government and Ministry of Health in the
1990’s included the large number of national EM visits, long
waiting times in many public hospitals emergency rooms,
and the potential public health benefits related to rapid
identification and treatment of non-communicable disease
entities (9). Eventually this rationale was accepted and the
government embraced the concept of emergency medicine
as a specialty and began to fund training positions in the
country. Funding often had tied to it a public hospital service
commitment post-residency of 3-5 years. The length of
this commitment is a delicate issue for the specialty and
its survival (10). On the “pro-” side this commitment helps
to retain new EM residency training graduates in the public
hospital care arena and addresses the maldistribution of
physician resources. On the “con-” side if the “payback” is
too long or onerous, graduating medical students will have
a disincentive to consider EM as a specialty career choice.
Ultimately, EM development should remain as a public
health priority in Chile with local advocates, national, and
transnational/international groups in active dialogue with
Chilean health policy experts, health economists, and the
Ministry of Health to support Chile’s new emergency medi-
cine community (11).
As noted above, formal EM training began in 1994 at the
University of Chile. A few years later PUC, and the University of
FIGURE 3. THE UNITED NATIONS MILLENNIUM
DEVELOPMENT GOALS (MDG)
MODERN EMERGENCY MEDICINE IN CHILE
As of 1990, there was no EM specialty training in Chile, and
most emergency rooms were simply divided into a “medical”
side, a “surgical” side and a “pediatric” area. As noted above
there were some 18 million ED visits in 2005 and at that
time there were less than 50 trained emergency physicians.
There were very few career oriented emergency physi-
cians and most emergency care providers were younger
doctors often in transition to another specialty training
area or working in a locum tenens fashion. There was, at
that time already a public EMS/Prehospital Care system in
place (SAMU) with a universal access phone number (131),
but there was inadequate ambulance coverage of even the
urban areas of the country. Prehospital capacity augmenta-
[THE SPECIALTY OF EMERGENCY MEDICINE IN CHILE: 20 YEARS OF HISTORY - Mallon WK MD et al]