South of the Border
After the screening of our documentary Paramédico at EMS World Expo 2013, it seemed that enthusiastic praise for the film was unanimous. However, several medics from Mexico in the audience weren’t quite as thrilled. Given the naturalistic depiction of the Mexican medics we chose to present, this was not surprising. In both my book and film I try to convey a true picture of the Red Cross EMS in Mexico City, describing at length the passionate dedication of the staff and their hard work in extremely perilous conditions. So why would we undermine this heroic image with depictions of raunchy, dancing EMTs, ambulances running out of fuel and first aid kits stocked with bottles of tequila? This isn’t, I was told, what the vast majority of Mexican ambulance services really look like.
Herein lies a common problem of documentary filmmaking. Saying something about the whole picture is often best achieved by way of a snapshot—a simple narrative involving no more than a few characters. But a snapshot, by definition, can never be all-encompassing. The complexity of life often defies our need to boil things down. And complexity is the perfect word for describing Mexican EMS.
In the early 1900s the Red Cross in Mexico inherited the job of running civilian EMS from the military. Today, almost five-hundred delegations across the country provide ambulance services. These are staffed by a handful of poorly paid permanent staff and a majority of volunteers. Indeed, the strength of the Mexican Cruz Roja greatly depends on public donations and the altruistic spirit of medics who put in long hours each week for no financial compensation.
There are few other countries where NGOs like the Federation of the Red Cross bear the burden of providing free ambulance services outside of war or natural disaster. Such an exercise has proven to be extremely difficult and rarely profitable. A hundred years ago when the Mexican population was no more 13 million, the model may have worked. In 2014, with a population well over 120 million, the Mexican Red Cross struggles to meet demand. If given the choice again, it is doubtful the NGO would take on such a task, least of all in a nation that suffers one of the highest trauma rates in the world.
While filming Paramédico I was deeply impressed by the commitment of the volunteers. But the operational problems the Cruz Roja suffers from could not be disguised. Nor did the medics I rode with want to hide them. Paramedic Mitzi Rodriguez, the protagonist of my film, frequently told me, “This is the reality in Mexico, please show the world.” This “reality” included poor EMS governance and national standards, non-existent supplies, broken or outdated equipment and dismal response times.
Response times are as frustrating for the Red Cross medics as they are for the public waiting on ambulances. Lazaro Cardenas, the dense and impoverished colony of Zona Norte featured in Paramédico, has ambulance response times typically exceeding 20 minutes. No wonder Rodriguez told me she has “only done CPR four times in eight years.” The ambulance rarely arrives in time.
But this is not the case in every Mexican city. Indeed, the EMS reality for Rodriguez and her team is not necessarily the reality countrywide. Over the past decade, the unregulated EMS environment and the variable performance of the Red Cross ambulances has given rise to ambulance services run by the police and ministry of health, along with more than thirty private companies. While many of the latter generally provide basic life support (BLS), some of the more professional companies are staffed by extremely competent paramedics and produce very impressive results. In Monterrey, Mexico’s most developed city to the northeast with the highest per capita income in the nation, a service known as EMME (Emergencies Medicas) is boasting out-of-hospital cardiac arrest (OHCA) survival rates that rival those of London, New York and Sydney.
Some other cities are not far behind. According to Dr. Juan Manuel Fraga Sastrias, a professor of paramedical science in Queretaro, the development of Mexican EMS is speeding up. Last year in Guadalajara, Puebla and various parts of Mexico City, new government-based services helped increase cardiac arrest survival rates from 0% to 2-3% for the first time ever. Fraga says many other clinical outcomes are also improving.
Having more ambulances supplementing traditional Red Cross services means better response times across the board. The use of motorcycle medics, as in the 15-motorcycle fleet run by the Escuadron de Rescate y Urgencias Medica (ERUM) has also helped. Fraga believes there has also been a vast improvement in medic training over the past few years, with the benefits only now being seen in the figures.
Paramedic Fernando Aviles, a veteran paramedic and a Mexican delegate I met at last year’s EMS World Expo, is very optimistic about the future of EMS in his country. “It’s getting more technical, better regulated, more professional. We are feeling the digital age,” he says. On a recent holiday to Ecuador, Aviles noted the poor condition of the EMS there. “They seemed 25 years behind us, which made me realize that we are not so bad after all.”
Indeed, Mexico's ambulance and rescue services are a cut above the EMS in many other upper-middle income nations south of the U.S. border. “Still there is much to be done,” adds Aviles. “But I promise you, one day we'll have American-quality EMS all over Mexico.”
Benjamin Gilmour is author of the bestseller ‘Paramedico: Around the World by Ambulance’ (HarperCollins) and director of the film ‘Paramédico’ available for download at vimeo.com/ondemand/paramedico