The DIEMS Project--for Database for International EMS Systems--is an attempt to create the most comprehensive international EMS database available on the Web. So far it contains information on systems in more than two dozen countries. Here the founder and president of Trek Medics International, Jason Friesen, BA, NREMT-P, a medic living in Connecticut, explains the basics of the project and how interested readers can help it grow.
What is the DIEMS Project?
The DIEMS Project is an attempt to create a single, comprehensive resource for information on international EMS efforts--in whatever shape or size they may come. The overall vision is to create a database that is both academic and community-driven. The "hard" information and data is taken only from reputable medical publications or system executives, while we encourage photos, links and first-person testimonials from field providers. Sometimes we get lucky and have both at the same time. This was the case with the Greece page, for instance, as we found an American named John Antoniades who was both a paramedic and the EMS director in Athens.
How did the DIEMS Project start?
The idea came about at the same time, and in the same way, that Trek Medics International (a nonprofit dedicated to developing EMS in underserved countries) did: a lack of resources, knowledge and opportunities to get involved in foreign EMS systems. Healthcare, like law and education, is one of those "backstage passes" that can help you get a job anywhere in the world. This should be especially true for EMS providers, considering the high incidence of road traffic injuries in low-income countries and the proven effectiveness of BLS trauma care. I recently read that low-income countries own 48% of the world's vehicles, but carry 90% of the global burden of road traffic injuries. These are really frightening statistics for countries that are trying to progress and develop. But the truth is that there are only a few global health initiatives involved in prehospital trauma care, despite the fact that injury is one of the leading causes of death worldwide. The majority of the initiatives are dedicated to HIV/AIDS, malaria and TB, which are noble causes, but not the entire story.
I started doing research on international EMS systems through PubMed and Medscape and was able to come up with some articles, but often I would only find a paragraph or two about prehospital capabilities in an article on a country's emergency medicine program. Then I found the World Health Organization's Essential Trauma Care Project, and the accompanying paper on prehospital trauma care systems, and it was like I had struck gold. I just started finding all these references and citations, on top of all the information in those papers, and then those sources would lead to more references or links, and soon I had a small library of really useful, fascinating information. So I started to take notes and organize it. Pretty soon it became obvious I was putting together a database--just bringing all this scattered information into one place. So I kept with it, but never had the time to actually put it all together till this summer. At 26 countries I thought, That's enough to put it up, but I got maybe 20 more, and I hope the launch will bring in more.
What do you hope will come out of this?
I have a couple of ideas, but I'd hate to decide its function on my own. I'm excited to hear what other people will do with it, what other ideas might come up. Nothing else exists like it, so who knows?
For my own part, I'm hoping it will help in documenting all the many variations and creative solutions different countries and cultures have adopted to best serve their publics. On the same note, I hope it will also discourage prospective systems from making the mistakes other countries have made. In fact, the Pan American Health Organization published an entire book on this very topic, Emergency Medical Services Systems Development: Lessons Learned From the United States of America for Developing Countries. It does a great job laying down a blueprint for developing an EMS system, and also pointing out the flaws in our system that could save other countries a lot of wasted time, effort and money--countries that can't afford to throw away money like we do.
Another thing I'd love to see happen from this (though it's a real long shot) is the development of EMS exchange programs. Developed EMS systems could share a lot with each other. For example, South Africa has perhaps the most advanced EMS system in the world, where the paramedics operate much like PAs. Looking at the aging population here in the U.S., and the way healthcare is changing, we might be able to pick up a few things from them. Another great exchange program would be with Israel. I'm not sure if there's anyone who has more experience in MCIs than the Israelis. They could teach us a lot about MCI management, rapid triage and even disaster relief with their field hospitals. Indonesia, too, seems to have a lot of great experience in disaster response, but they don't have the access to resources developed countries have. So another type of exchange program, and one that already exists in some respects, would be to bring medical or emergency management students from low-income countries to ours to help them learn and foster effective, successful prehospital systems in their home countries. I'd also love to see EMS management programs be offered at the graduate level, but that will need far more than a database to happen.
But these are all just a couple of dead-shift daydreams. I'm really looking forward to seeing what other people can do with this--how it helps them develop or improve their own prehospital systems and capabilities. Whatever comes of it, I hope to see it grow, and maybe even generate some work for Trek Medics.
Trek Medics International founder and president Jason Friesen, BA, NREMT-P, has worked as a paramedic instructor and instructor of medical Spanish, as well as contributing to EMS publications. He is currently studying for a master's in public health at Columbia University's Mailman School of Public Health.