An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

Abstract

OBJECTIVE:To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life.METHODS:Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil.RESULTS:Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU.CONCLUSIONS:The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.

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“…7 Also physiologic scores, such as RTS have limitations because normal heart and respiratory rates in children are much higher than in adults 26 .…”

“…A study of medical pre-hospital system in Brazil showed that 51.5% of physicians feel unprepared to meet traumatized children; 34.9% have difficulties in pediatric semiology and 62.4% have difficulty pediatric advanced life support procedures 7 .…”

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“…They maintain a broad range of practice and are able to perform many emergent procedures that are above the scope of practice of a paramedic in the United States, such as pericardiocentesis, surgical airway, thoracocentesis, and central line access. A recent study indicates that only a small percentage of physicians working with SAMU have completed SAMU-specific or advanced prehospital training and many feel uncomfortable with the prehospital environment in the areas of pediatric trauma and surgical procedures (Tallo 2014). All physicians that we interviewed completed Advanced Trauma Life Support training and all prehospital care providers, including nurses and drivers, have completed PreHospital Trauma Life Support (PHTLS) training [19].…”

“…A recent study indicates that only a small percentage of physicians working with SAMU have completed SAMU-specific or advanced prehospital training and many feel uncomfortable with the prehospital environment in the areas of pediatric trauma and surgical procedures (Tallo 2014). All physicians that we interviewed completed Advanced Trauma Life Support training and all prehospital care providers, including nurses and drivers, have completed PreHospital Trauma Life Support (PHTLS) training [19]. The BLS unit consists only of a driver and nurse technician.…”

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“…The underfunding of this public system, the high cost of advances in medicine, the difficulty of retaining health professionals in small and distant towns, and the abandonment of hospitals and health facilities, often due to the diversion of resources in a country contaminated by corruption, all mean that health care provision is a serious problem in our midst. This is most evident in the area of emergencies, with overcrowded first aid centers, few diagnostic and therapeutic resources, lack of inpatient beds, inadequately trained medical teams, for both pre-hospital and in-hospital care, among many others problems 2 .…”