Emergency Medicine Planning and Preventive Measure in Trinidad and Tobago?

Posted May 19th, 2008 by Taran

Yesterday, I was up on the Northern coast of Trinidad; I stopped by The Cask in Maraval to say some customary hellos when suddenly I saw a Police 4x4 running Code 3 (Lights and Sirens) with a pickup following toward, I supposed, the hospital. In the back of the pickup was a woman. As I walked in, I mentioned it to a few people around and they said it was the third run for the morning. I shook my head. Many people don't know how to driver properly on the old World War II, American built roads that meander along the Northern Range of Trinidad. I grew up driving every weekend on those roads, even once seeing a car driven off the cliffs. At the beach, people typically drink alcohol as well - and impaired driving ability combined with a lack of familiarity with the road are bad enough. Toss in poor driving habits, such as over braking (use your engine to brake instead of the brakes, people...) lead to brake failures on the hills themselves. In fact, on the way out I saw one Mitsubishi L200 Turbo with smoking front pads...

The road, itself, is a bit of a hazard. I stopped at the Crested Orependola Bar to take some pictures and ran into the Good Samaritan who was driving the pickup with the woman in the back. Mr. De Verteuil, a person who is fairly well known, was the driver of the pickup and told me that she was pronounced dead on arrival at the hospital. We sat quietly and discussed what happened - me, the former EMT and Navy Corpsman, and he, the person who has seen many such situations in Trinidad and Tobago. We agreed that emergency medicine had come a long way in Trinidad and Tobago, but it had a long way to go.

Unsurprisingly, the Trinidad Express had a front page article on the accident today - 'Death Plunge: Woman killed, 3 injured in North Coast accident' by Darryl Heeralal. In the article, the woman gained a name (Heidi McClutchie) and a story. Yet in the story, one of the problems with the North Coast Road leaps out:

...The corner where the accident took place still has the cable railing built by the Americans during World War II.

In most places, the cable has burst, like the area where the car went down.

Solomon said they have asked the authorities to put up a new iron railing, but they have so far refused.

Refused? I don't know that anyone would refuse to fix the road - they probably have done what they are pretty good at: collectively losing the requests through the bureaucracy. Be that as it may, a preventative measure would in fact be making the rails functional. After all, the beaches along the Northern Coast, on the Southern side of the Caribbean Sea, are a popular destination for just about everyone. This would include tourists. Why the Ministry of Tourism hasn't seen fit to address the problem is pretty obvious: no tourists have fallen off the hill that I know of. Maybe tourists have special powers, such as flight.

So yes, a preventative measure. But there's something else that is simply astounding and that hasn't been mentioned by anyone that I have spoken with. It is the need for a trauma center and perhaps even an emergency medicine area in the area, as well as helicopter support for medevacs. Not only do people visit the Northern Coast, there are also those that live there. There are fishermen. There are recreational divers, surfers, and other watersports. The road out of the area, through the hills, is not only one which is slow to traverse - it is also a road which would probably complicate injuries due to the sharp turns and a funny little thing called inertia. So a medical center on the North Coast - perhaps even on Maracas Bay itself (the Ministry of Tourism has already 'developed' the area 'so much'...) makes sense, if only as a forward area to stabilize patients for transport to another facility. The beach also has a lot of space where a helicopter could land - and if worse came to worse, there is also Maracas Lookout which is a perfect spot for a smaller helicopter to do a run to the hospital.

But does Port of Spain General Hospital have a helicopter landing pad? Probably not, though I am not sure. It could, if it has a parking area. Toss a few of the parking spaces for a pad. The Police are supposed to have GPS systems. So is the Coast Guard. Call in a medevac on the coordinates and toss a smoke grenade when the helicopter gets there. You can even see how to do it in movies these days. This is not, by any stretch, bleeding edge.

I don't know who runs things in Trinidad and Tobago when it comes to such things - allegedly it is the Ministry of Health - but much of this transcends any single Ministry. But as someone who has worked with the elite of military medicine, I end up shaking my head more often than not on how the quality of life is diminished for trauma and other patients. I'm not a doctor; I know a few and the doctors I know seem to try to change the system as well - maybe with better ideas than my own.

But emergency medicine infrastructure and preventative measures are not a priority, it seems. It seems a victim of economic triage, and one has to wonder with the consistent escalation of crime in Trinidad and Tobago coupled with half measures when it comes to saving lives... does the Government of Trinidad and Tobago value the lives of citizens and visitors, much less the quality of life?

Until then, we will continue to need the assistance of Good Samaritans to try to make the best of a poor situation. A hat tip to Mr. De Verteuil; I hope he finished his original mission.