Abstract
Mobile prehospital care is a key component of emergency care. The aim of this study was to analyze the implementation of the State of Rio de Janeiro's Mobile Emergency Medical Service (SAMU, acronym in Portuguese). The methodology employed included document analysis, visits to six SAMU emergency call centers, and semistructured interviews conducted with 12 local and state emergency care coordinators. The study's conceptual framework was based on Giddens' theory of structuration. Intergovernmental conflicts were observed between the state and municipal governments, and between municipal governments. Despite the shortage of hospital beds, the SAMUs in periphery regions were better integrated with the emergency care network than the metropolitan SAMUs. The steering committees were not very active and weaknesses were observed relating to the limited role played by the state government in funding, management, and monitoring. It was concluded that the SAMU implementation process in the state was marked by political tensions and management and coordination weaknesses. As a result, serious drawbacks remain in the coordination of the SAMU with the other health services and the regionalization of emergency care in the state.
Highlights
The State of Rio de Janeiro’s SAMU was implemented in two stages: the first between 2004 and 2010, which comprised of the implementation of the metropolitan SAMUs SAMU Metropolitano I, SAMU Metropolitano II, and SAMU Rio; and the second that began in 2011 with the implementation of SAMUs in three periphery regions - SAMU Baía de Ilha Grande, SAMU Centro-Sul, and SAMU Médio Paraíba
Despite being a relatively new service, it could be said that the SAMU has played a key role in shaping emergency care in Brazil
The findings of this study reveal a number of advances, limitations, and organizational challenges facing mobile prehospital emergency care related to the political and institutional context, coordination with other services, and emergency care network management
Summary
A fundamental part of health systems, has been a priority in Brazil since 20031, as provided in the National Emergency Care Policy (Política Nacional de Atenção às Urgências – PNAU)[2].The implementation of Brazil’s National Emergency Care Policy can be divided into three main stages: 2000 to 2003 – initial regulation; 2004 to 2008 – expansion of the Mobile Emergency Medical Service (Serviço de Atendimento Móvel de Urgência -SAMU), the mobile component of prehospital emergency care; and 2009 – implementation of the fixed component of prehospital care, 24-hour Emergency Care Units (Unidades de Pronto Atendimento – UPA)[3].International literature shows that prehospital care[4,5], that became a policy priority in Brazil in 2004 through the expansion of the SAMU, yields important results. A fundamental part of health systems, has been a priority in Brazil since 20031, as provided in the National Emergency Care Policy (Política Nacional de Atenção às Urgências – PNAU)[2]. The decision to begin the implementation of the National Emergency Care Policy through this service was justified based on its importance for assuring reduced response time and regular delivery of emergency care. The SAMU is a nationally-standardized care model, geared towards delivering 24-hour emergency care to homes, the workplace, and thoroughfares. It is aimed at guaranteeing care delivery, appropriate transport, and patient referral to the Unified Health System (Sistema Único de Saúde - SUS). Official documents highlight the potential of the SAMU for organizing the care network[6,7]
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