Lakeside Emergency Response System

Most people do not know how the Emergency Response System functions in the Lake Chapala area, and many are completely confused and unprepared when a serious emergency arises. There are various legal, cultural, language, and regional factors involved. However the emergency response system worked in your home country, it is probably different here. This post and flowchart explain how the system functions, and with regards mostly to the Cruz Roja in Chapala, so that everyone has the opportunity to be prepared in case of a medical emergency.

I am not going to discuss all the clinics simply because I do not have involvement with all of them them. The two clinics that play the largest role in emergencies here are the Cruz Roja and the Clinica Municipal in Chapala, and the main ambulance services being the Cruz Roja, Clinica Municipal, Bomberos (Fire Department) of Chapala, and the ambulance of Ixtlahuacan. The main ambulance service for home calls being the Cruz Roja with four ambulances - three in Chapala, and one at the sub-station in Ajijic, and multiple EMT teams 24 hours a day. It is also the main, but not the only, ambulance service for auto accidents.

First, who do you call? There are two options. You can call 065 and the information will reach us indirectly, or the better option is to call the Cruz Roja directly at (376) 765-2308. If there is no answer, it is because they are talking on the line (with call waiting, there is no busy signal). Just call back. We need to know the nature of the problem, but keep it short. Make sure we can find you. Have your house number clearly marked and illuminated. If your street has no street sign, get one. If your street is three parts that do not connect, changes its name at some point, or #527 comes between 600 and 700 on your street, we need to know that, too.

Whether you are brought in by ambulance, walk in, or are carried in, we try to do the best we can do for each patient. However, sometimes special medical attention is needed such as emergency surgery or advanced laboratory or image (CAT scan, MRI, etc) exams that are not available here. This is not as simple as in the USA, or many other countries. The flowchart shows the path for options A, B, C, D, and E. Unfortunately, many people want, and even expect option E, although here, it is illegal. Option A covers all the options of a typical ambulance call. First the EMTs evaluate the patient. Not everyone needs or wants more treatment. If medical treatment is needed, there are two options at this point. Be brought by ambulance to the Cruz Roja for treatment, or if you and your personal doctor already know you need hospitalized, you can pay for private transport to a private hospital in Guadalajara (keep in mind that private hospitals want proof you can pay). Also, if the patient goes to the Cruz Roja, and it is determined that the patient needs hospitalization, the same applies in that you can go to a private hospital. You can also sign a release and go to a government-subsidized hospital by your own personal transportation or taxi. However, taking you to a government-subsidized hospital such as Hospital Civil by ambulance is not an immediate option because it is illegal without permission by S.A.M.U. (Servicio de Atencion Medica de Urgencias). We must be given a permit number to take any patient to any government-affiliated hospital. There are more people needing “free” emergency care than there are doctors and hospitals to treat them. S.A.M.U. determines who gets permission based on need and ability to benefit. Those with government insurance get permission fast because there are simply more insurance hospitals. IMSS has 7 major hospitals in Guadalajara, ISSSTE has one, etc. Without insurance most everyone will go to one of the two Civil Hospitals, and space is limited. Those who would die without rapid attention, and who will probably live after treatment are at the top of the list. Non-emergencies and patients with chronic conditions, who would probably die even with rapid treatment, are near the bottom. Everyone else is somewhere in between, but not at the top, and depending on your condition and how many new patients make the top of the list while you are waiting, the waiting time could be hours, days, or weeks.

Everyone needs to have a plan. The flowchart lists your options. Know which options will apply to you, and plan accordingly. Consider the role of insurance, your private doctor, and communicate with family and friends regarding what you want them to do for you, or you for them, in case of a serious medical emergency.

Hospitals of interest for the non-insured are:

Hospital Civil "Fray Antonio Alcalde" (Viejo)
Calle Hospital #278 (urgencias adultos)
Calle Hospital #310
Calle Coronel Calderón #777 (urgencias pediatría)
Colonia Centro, Guadalajara

33 3614 5501
Urgencias Adultos: ext. 174
Urgencias Pediatría: ext. 201

Medicina Interna Adultos: ext 212
Terapia Intensiva Adultos: ext. 201
Consulta Externa: ext. 226
Cardiolgía: ext. 212
Trabajo Social: 33 3614 5801 ext. 177


Hospital Civil "Dr. Juan I. Menchaca" (Nuevo)
Salador de Quevedo y Zubieta #750, S.L.
Guadalajara

33 3618 9362



For trauma, you can also go to one of two Cruz Verdes that offer orthopedic and trauma service.

Cruz Verde - Francisco Ruíz Sánchez
Antonio Tello Nº 215 (entre calle 52 y Medrano)
Col Medrano
Zona Olímpica
Guadalajara

33 1201 8401


Cruz Verde - Jesús Delgadillo Araujo
Mariano Barcenas Nº 997 Esq. Privada Veracruz
Col. Alcalde Barranquitas
Zona Centro
Guadalajara

33 1201 7200


For Poisoning and overdoses, there is a special Cruz Verde. While the Cruz Roja does handle overdoes, scorpion stings etc., this Cruz Verde does only intoxication (drugs, scorpion, spider, snakes, etc). At this moment, the Cruz Roja (and Clinica municipal) do not have any spider antivenom, thus you would go to this place:

Centro Regional de Información y Atención Toxicológica (C.R.I.A.T.)
Av. Los Angeles, esq. Analco
Unidad Administrativa Reforma, Col. Las Conchas
C.P. 44460, Guadalajara, Jalisco
México
Contacto Institucional
Dr. Alberto Iram Villa Manzano
Tel. Directo (333) 669.1338
Tel. Conmutador (333) 669.1320 al 25, Ext. 1338
Email: criatguadalajara@usa.net <mailto:criatguadalajara@usa.net>

If Cruz Roja is called directly at (376) 765-2308 - do they understand English?

Thank you so much, Dr. Sam, for this extensive explanation of Lakeside Emergency Response. Any chance do you know if/when advanced cardiac care might be available at Cruz Roja? I know that time is of the essence is treating a cardiac event and is a great concern to those of us with heart disease. If one suspects one is having a heart attack, would you suggest going to Cruz Roja first, or going directly by private auto to a private hospital such as Hospital Bernadette? Thanks in advance.

Thanks for the great info Dr. Thelin. I have embedded the chart below:

First question, if or when we will have advanced cardiac care: If you are simply talking about EMTs with ACLS training, it could happen this year. If you are talking about at least having at least one of the thrombolytics such as streptokinase, alteplase, anistreplase, reteplase, or tenecteplase at the Cruz Roja, it would be nice to at least have streptokinase (the cheapest option) available in the near future. Due to the time required to get to Guadalajara, having a thrombolytic here could save someone's life. This would be a factor of having the extra money to buy it, and training everyone how to use it. It would also be nice to have a lab to detect cardiac muscle enzymes. However, having anything more advanced would require a higher level hospital, which we are not.

Second question, to bring them the the Cruz Roja or take them to a private hospital. Assuming that we do not have any thrombolytics, and assuming money is not an issue, taking them directly to a private hospital with cardiac care would be the best option. Depending on stability of the patient, it may be better to take them by car or by ambulance. By car eliminates the wait for the ambulance, but if the ambulance can get to you in 10 minutes or less (are you close, are you easy to find, is the ambulance immediately available), paying the Cruz Roja for private transport th Guadalajara would be the best option (onboard medication, defibrillator, etc).
Assuming money is an issue, bringing them to the Cruz Roja for primary evaluation may be more feasible. We can take en electrocardiogram and a chest x-ray. The chest x-ray can show differential diagnostics of pneumothorax, pneumomediastinum (such as from esophageal rupture), pleural effusion, or infiltrates, and we can also see things like loss of lung volume or unilateral decrease in vascular markings may suggest pulmonary embolism, or if there is dissection of the aorta. Of course, although not a heart attack, all of these would also require hospitalization, but having the findings could help us get permission to take the patient to a government hospital. Likewise, the electrocardiogram can tell us if there is a heart attack, but it cannot tell us that you are not having a heart attack (around 20% of heart attack patients have a normal electrocardiogram), and further studies would still be needed.

Irish Gal wrote:Thank you so much, Dr. Sam, for this extensive explanation of Lakeside Emergency Response. Any chance do you know if/when advanced cardiac care might be available at Cruz Roja? I know that time is of the essence is treating a cardiac event and is a great concern to those of us with heart disease. If one suspects one is having a heart attack, would you suggest going to Cruz Roja first, or going directly by private auto to a private hospital such as Hospital Bernadette? Thanks in advance.

Thanks again, Dr. Sam.

Dr. SAM... Would you please address my question above:

"If Cruz Roja is called directly at (376) 765-2308 - do they understand English?"

I already did right after you originally asked the question. Unfortunately the forum never posted it. It said there had been two posts in this thread since I started writing my reply, and asked if I wanted to modify my response. I clicked "no", and I guess that was the wrong answer or something.

If you called yesterday, you would have talked to an EMT that speaks perfect English, and every third day you will get her if you call. The other days, you will get someone that speaks very basic English. Sometimes they hand the cordless handset to me if I am there, or someone that speaks more English if possible. If they understand you is partially a factor of how you talk. If you speak clear, formal English, you have a better chance of being understood. If you say, "The person has vomited 8 times in the last hour after a fall and hit to the head" you will be understood better than "He's been throwing up like crazy". They will understand the word vomit before they will understand "throw up" which could be more likely taken to mean tossing something up in the air. Think about how crazy some of the English slang and two-word verbs are. Do not use slang and two-word verbs. Things like "come over", "right away", are better replaced with "come" and "as soon as possible".

The Cruz Roja has printed Spanish phrase cards to post near the phone, and have the basic words you would need to use in an emergency. At worst, know how to say your address, and they will send the ambulance.

oatsie wrote:Dr. SAM... Would you please address my question above:

"If Cruz Roja is called directly at (376) 765-2308 - do they understand English?"

Thanks.... Where can we get the printed Spanish phrase card?

Could it be reproduced and posted here - as the chart above was?

You could buy my book, Oatsie. . .

Emergency Medical Spanish

Trailrunner has written an excellent book called Emergency Medical Spanish which can be found on Amazon dot com. Here is the link:


http://www.amazon.com/Emergency-Medical-Spanish-Travelers-ebook/dp/B004Y5FSGS/ref=sr_1_1?s=books&ie=UTF8&qid=1307806595&sr=1-1

I never leave home without it! It's in the car all the time.

Trailrunner wrote:You could buy my book, Oatsie. . .

Emergency Medical Spanish

Is a hard copy available to examine and buy locally?

1. I will get one of the cards and scan and post it here.

2. It would be well worth it to buy Trailrunner's book so you can learn some more phrases (the card is very basic).

3. The book could be printed and sold. It is up to Trailrunner.

From the Cruz Roja - Chapala website. http://www.cruzrojachapala.com/

http://www.cruzrojachapala.com/emergency_phrases.pdf

It is very, very basic. Someday when I have more time I will write a longer one.

oatsie wrote:Thanks.... Where can we get the printed Spanish phrase card?

Could it be reproduced and posted here - as the chart above was?

Thank you Dr Sam and Trailrunner. Good info.

De nada, Grizzy!

I wrote a flow chart and information prompter several years ago, I'll see if I can resurrect it but it was written in an older desktop publishing program that may not transfer well. Vamos a ver.

Ok, I tried to copy/paste the card but it didn't work. Additionally, I run Chrome as an browser and the hosts of this forum will not accept my photos (and may only accept photos from IE) which is why I had to have CBob post the photos of Dr.Garcia's facility.

For the most comprehensive information, buy the book Emergency Medical Spanish. http://www.amazon.com/Emergency-Medical-Spanish-Travelers-ebook/dp/B004Y5FSGS/ref=sr_1_1?s=books&ie=UTF8&qid=1307806595&sr=1-1

Dr. Sam, your the best....also thanks for telling me about this site. Excellent information...Gracias....also people should know that you will be presenting on this topic at Lake Chapala Society for Cruz Roja, March 13, at 3 pm...with excellent handouts, and it is free.