Planning emergency medical services for children in Bolivia - Part 2 - Results of a rapid assessment procedure

Objective: To obtain social and cultural data about factors affecting the development of Emergency Medical Services for Children (EMS-C) in La Paz, Bolivia. The points-of-view of potential consumers and providers were sought. Methods: A Rapid Assessment Procedure (RAP) was conducted. RAP is a qualitative ethnographic technique that permits delineation of social, cultural, and behavioral themes about a population based on members' lived experience. In-depth interviews and participant-observation provide rapid information and enhance the likelihood of successful implementation of interventions and services before major investments in infrastructure. Results: Information collected from providers, administrators, and consumers revealed 4 themes affecting EMS-C: (1) Nature of injuries and illnesses in the Emergency Department-root causes were held to be related to the physical and emotional effects of poverty; (2) "Inappropriate" use-health care providers and consumers differed in their identification of valid reasons for utilizing EMS-C; (3) Coordination, organization, and standardization of care-both groups keenly felt their absence; and (4) Training and specialization-particularly the provider respondents felt that EMS-C would require radical changes in the training system. An expected theme, Prevention and Advocacy, did not emerge; respondents did not appear to feel that health care providers had any role in affecting public policy. Conclusions: RAP methodology provided a detailed picture of current EMS-C in La Paz, including viewpoints from all major stakeholders. This information will be used to support the development of Emergency Medicine programs that are locally driven, culturally appropriate, and socially feasible.