Prehospital Cardiac Care Cuban Style

The Cuban national Integrated Medical Emergency System or ¡§Sistema Integrado de Urgencias Medicas¡¨ (SIUM) was formed in 1997. In 1998, the SIUM began an active out-of-hospital thrombolysis program using Heberkinasa, the only streptokinase obtained through recombinant DNA techniques, produced by the Cuban Center for Genetic Engineering and Biotechnology. An active community training program has also been implemented, standardizing training for the almost 20,000 members of the national emergency medical services.

Cuba is the largest island in the Caribbean. Eleven million inhabitants live within the 42,803 square miles that comprise the Cuban territory. Projected life expectancy at birth is 73.56 years for males and 77.51 years for females. Approximately 8% of the gross national product (GNP) is utilized in healthcare.3

The Cuban National Health System consists of a network of easily accessible institutions, which provide coverage to 100% of the population. This network consists of 281 hospitals, 11 research institutes and 442 polyclinics, with a total of 80,528 hospital beds or 7.3 beds per 1,000 inhabitants. In the U.S., there are three beds per 1,000 inhabitants.6,2

Cardiovascular Disease in Cuba

Cardiovascular disease is the leading cause of death in Cuba as in much of the world. Data from 1997 show a Cuban mortality rate from cardiovascular disease of 197.1 per 100,000 inhabitants, and 109.2 from acute ischemic heart disease. The U.S. has a rate of 525, while China scores the world¡¦s lowest recorded rate of just 116.3,1

In response to these findings, the Cuban government implemented the National Program for the Control of Ischemic Heart Disease. This program involved interventions that ranged from nutritional surveillance to out-of-hospital thrombolysis. Recent Cuban health statistics show that after the initiation of this project, there has been a reduction in morbidity and mortality secondary to heart disease.4

Cuban EMS

SIUM was formed in 1997 under a Franco-German model where a physician-based communication regulating system drives operations (rather than the EMT-based North American model), with physician-staffed emergency units being deployed under special situations.

There are 35 coordinating centers, serving 169 municipalities, and ambulances are activated and deployed by the designated community healthcare provider when a medical condition requires transport and further stabilization. The SIUM operates 600 basic ambulances, as well as 38 intermediate and 38 intensive care units, most of which are located in the capital city of Havana. These can be deployed when needed to provide transport at the municipal or ¡§inter-provincial¡¨ level.

The workforce consists of 1,009 physicians and 3,843 nurses. The main municipal prehospital coordinating center is the emergency unit at the regional polyclinic. On-site physicians offer emergency medical care, and BLS units located in each of the 169 municipalities provide transport.

An active community and provider life-support training program offered by the Education Branch of the SIUM has been implemented in Cuba to complete the circle for a national emergency medical system that comprises nearly 20,000 members. Thousands of laypersons, from school children to police officers and from teachers to workers, actively train to bring the ¡§chain of survival¡¨ to the community.

Here, training similar to BLS, ACLS and BTLS has been consolidated into a 21-day course called AVIPRE (short for Prehospital Vital Attention). Through this program the SIUM has achieved standardized training for most of its members. Additionally, individual life support courses are taught on an as-needed basis nationwide. The SIUM also has operational and education agreements with agencies outside of the National Health Ministry such as Civil Defense, the Red Cross and the Fire Department of the National Revolutionary Police (NRP). Basic and simple interfacility transport is performed at times by units operated by local Red Cross chapters.