Costa Rica is famous for coffee, bananas and their new number one industry — eco travel. Tropical rain forests and active volcanoes bring visitors from all over the world. Located between Nicaragua and Panama, Costa Rica is about the size of West Virginia with a population of about 4 million. It’s unique in that it’s the least impoverished Spanish-speaking country and the only country without a standing army. In fact, having a standing army is forbidden by the constitution.

The American Red Cross provides EMS out of 129 stations around the country. These 129 stations staff 600 ambulances with 1,000 salaried personnel and 5,000 volunteers. They have three levels of prehospital care that closely resemble our first responder, EMT and paramedic levels. They also have physicians working at some of the stations available to respond to the scene if needed and providing medical oversight. Costa Rican trauma care is garnering attention from doctors and prehospital care providers who are working to build trauma systems and train providers in the streets and the hospitals. These trauma systems will help healthcare providers give their trauma patients the best chance at positive outcomes.

EMS in Costa Rica is organized. The three levels of prehospital care providers include technical emergency medic (TEM), AEM or assistant emergency medic and APA. APA is their first responder level and, like the U.S. model, is about 40 hours of training. AEM is their EMT-level program and consists of about 200 hours of training. TEM, their paramedic level, takes two-and-a-half years to complete.

With paid and volunteer personnel, the Red Cross ambulances are provided by independent local Red Cross committees that do the fund-raising necessary to provide the equipment and people to do the job. They’re run as local independent charities but coordinate enough to have national dispatch oversight and regional deployable resources. Although many of these committees have physician oversight some do not. Response times in urban areas can be 10 minutes but can be worse during high traffic times. Traffic in urban centers like San Jose is pretty significant. While I was there, it seemed like rush hour ran from 8 a.m. to about 8 p.m. They do have helicopter transport but because of their unique weather patterns, it s tough to fly from May to November.

The schools that train the personnel are also local and independent. There is a national 9-1-1 system, but it has yet to achieve its full potential. Training hasn’t been standardized nationally, and no national legislation exists to license them.

The patients
In 2006, 687 people died from injuries sustained in motor vehicle collisions which is an increase of more than 10% over the previous year. Of these deaths, 82% were men with the 20- to 24-year-old age group being most affected. Homicide accounted for 318 deaths, nearly 90% of which were male.

The hospitals
There are no trauma centers per se in Costa Rica, but doctors at all hospitals are being trained in trauma care thanks to the ATLS program. Increasingly, the nation’s attention is turning to trauma centers and trauma systems. In talking to the doctors working on planning for their system they’re committees to designing the system before designating the centers.

Trauma training
In 2006, The College of Medicine and Surgery in Costa Rica under the direction of Dr. Jaimie Cortes conducted the inaugural ATLS course for doctors. Since the inception of their program that have trained 144 doctors. In February, they conducted their inaugural PHTLS program with plans to train EMS providers all over the country.

This group of doctors, nurses and medics is committed to making a difference in their country. They’re working to standardize education, licensure and practice and to provide national dispatch protocols that allow for common language exchange of information and resources.

It was a great learning experience for me working with my friends in Costa Rica over the past two years. I look forward to working with them again and watching their progress.