Why it is necessary to improve the emergency care, and how can we do it.

Abdus Salam Khan, MD FACP
September, 2018


Since the change in power has taken place in Pakistan, every concerned citizen has hope that a change in government will bring more possibilities for the improvement. We as the torchbearers of emergency care in Pakistan also are hopeful for the change. We feel that improving emergency care is in the best interest of the citizen of Pakistan and is a genuine demand from the new government. Being the president of the society of emergency medicine I am giving these suggestion with the benefits insight that are not just far reaching but also very workable and basic in nature.

Almost all of us has the uncomfortable experience of visiting the emergency room some times in our life time. I talk to plenty of people and it is easily understood that the experiences of people across Pakistan are more or leas the same when it comes to emergency care. The day that someones gets sick to the point that a mere visit to the local doctor is not enough and the specialist can not be seen is usually a dreadful day. Not because of the disease process but the ordeal that the patient and the attendants have to go through. The long line and the wait, then the junior most doctor treating without proper manners of care. The lack of staff and the lack of concern. This list is quite exhausting. Now rather than looking into the culprits and wasting our energies we should look at the ways to improve this system.

We at the level of society have discussed these issues and have good grasp on what can be done. We will give a workable outline for anyone to pick these and start building on it. These points are mostly known to the world and have been tested and have proven value.

Although there can not be two opinions regarding the need for the trained people looking after the sick in the emergency department, but where would those people come from. A massive reverse brain drain is not unthinkable but not practical as monetarily we are not able to attract physicians who are trained. We also can not ignore the current work force providing the care presently in our emergency departments. We need to think about short courses, medium courses and regular length courses in emergency care. These courses will be easy to built and be delivered across different modalities of teaching like lectures over internet, web sessions and podcasts. This way we can have a quick update in the capacity of our emergency room doctors. This will utilize our current staff and thus will lead to improved satisfaction of already working but neglected physicians.

The second yet most effective intervention is triage. A triage when done by trained nurse is the most effective tool to minimize the risk. It improves the satisfaction and decreases the risk of bad outcome by early recognition and providing care to the most sick. It has been shown that death of an untreated patient is the most devastating event that the emergency departments deal with. So picking these patients quickly and treating them not just improves the outcome but also results in increased level of trust and satisfaction regardless of the outcome. And the best way of sorting people out is triage whether we follow American system or the British.

After these important interventions we can think about other ways to improve emergency care in Pakistan. It includes but not limited to:

  1. Attracting emergency physicians from outside world with attractive salary packages.
  2. Improving district and tallaqa level Hospitals emergency department by staffing trained nurses and providing them with basic equipment which should be clearly defined at the highest level.
  3. Routine data collection of the workload including the severity of the patients presented to the emergency departments to adjust the equipment, supplies and the personnel serving at these hospitals.
  4. Supporting City area Government Hospitals in their bid to start the residency of Emergency Medicine. Help them have the manpower in the emergency department to achieve this level.
  5. Help incorporate emergency medicine into undergraduate level education, so awareness is created regarding the emergency care.
  6. Start mandatory audit is all emergency departments, across the nation. Begin with basic level audit and then start with a bit more complex ones.
  7. Do patient care surveys and the patients opinion survey to see the level of satisfaction. This is to motivate the emergency staff and then show if there is any improvement at the care improve the satisfaction level.
  8. Take the consultation from the thought leaders of the emergency medicine in Pakistan including the Society of Emergency Medicine. (PSEM)

There can be plenty of suggestions that can be put out, but all require persistent and Government level efforts with input from the people working in the field. It is doable and has been done at the private institution level. Support at the education and training front is extremely important and is the need of the hour. My hope is that the new Government will see this as an opportunity to bring Pakistan ahead in the emergency care among the SAARC countries and become a leader. We have a reasonably good chance in leading our region when it comes to emergency medicine.

I can be reached at askhan65@yahoo.com.


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