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PSEM. A new chapter in emergency medicine.

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Professional societies have very important role to be performed. People look up to these societies to guide them or channelize the resources and also to develop ways to improve understanding regarding the profession. Our journey of emergency medicine reached an important milestone when our professional society got established. It is called Pakistan Society Of Emergency Medicine ( PSEM).

Emergency medicine has established roots in Pakistan for almost two decades. It was not an easy journey but persistent efforts of plenty of people at different levels made it a reality.

Our number of trainees has increased and so is the number of emergency physicians across Pakistan. Now the next phase for the emergency Medicine is underway. This step is to strengthen the society. The society was created for various reasons and some of those are listed here.

1. Creation of a common platform of emergency medicine for all to develop together.
2. Make emergency medicine development a combined goal rather than a personal achievement.
3. Help different institutions develop emergency medicine training programs to benefit our patients.
4. Propagate the understanding regarding the function of emergency departments and to increase proper utilization of emergency departments without wastage of resources.
5. Help create service standards and then clinical standards.
6. Help create educational standards for the emergency medicine trainings.
7. Help different organizations and entities deliver educational and training programs.

We are proud of our cohesiveness and also of being progressive in our conduct We love to collaborate and live to innovate. Our strength is in the mindset of not giving up, as we know that the path is quite difficult and task is too complex and huge yet we continue to move ahead day in and day out.

The work that is ahead of us as society is enormous and the society is getting ready for the task. We have started the membership drive and are aiming to gather around as many members as possible in a few weeks. Our training programs and trainees are enthusiastic in becoming part of PSEM. We will then initiate different committees to think, organize and work on the collectively agreed tasks to improve the emergency medicine for all the patients.

Collaboration with different entities will result in educational and training events for the trainees. Collaborators are both national and international with common goal of improving caliber of people providing care to the patients.

Research and guideline creation pertaining to local circumstances is also a great service that PSEM will take up. We have started a new journal which is the first one in Pakistan for the field of emergency medicine, and we are hopeful that the local researchers will trust us with their publications so that the journal will provide guidance to the people working in the emergency department across Pakistan.

We are strong believers of teamwork and would appreciate all the help extend it to us for emergency medicine development.

EMERGENY LIFE SUPPORT COURSE

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Abdus Salam Khan, MD FACP
April, 2019

 

Another Emergency Life Support (ELS) course is arranged to be delivered. Our Australian team is awesome in coming to Pakistan and helping us in equipping our physician and nurses to be ready for dealing with emergencies.

A structured emergency care is new to Pakistan. Our departments dealing with emergencies are not well staffed and neither well equipped. But more than that the people who run the emergency rooms have not gone through any training to deal with emergencies. They do their best and deal with enormous load of patients, but their lack of training makes it difficult at times to safely deal with situation at hand.
Emergency department work is teamwork and mind set. Team work is guided by structured approach to care delivery in the department. The care in emergency department is more than just few angles and only a structured approach would help deliver it safety.
Emergency life support course has developed one such approach and that is tested for quite some time. This approach is designed for resource poor or resource limited countries such a Pakistan. This has also been tested in Srilanka and also Australia. The team of Emergency Life Support (ELS) has been visiting Pakistan and with mutual agreement and cooperation. We agreed to equip emergency care providers in Pakistan with lifesaving skills.

Pakistan Society of Emergency Medicine (PSEM) is working as partner in this activity and the plan is that, this course will be handed over to Pakistan Society of Emergency Medicine (PSEM) for ultimate custody for the Country.

The collaboration is very important as Pakistan Society of Emergency Medicine (PSEM) is concerned with improving the emergency care provision in Pakistan, and the Australian colleagues also share this dream to help us in creating solutions for the less resourceful Country like Pakistan.

We have started delivering the courses and at the same time also making the trainers from local Physician to create the trainer force within Pakistan. We also try to rotate the venue for the course to have diversity in the different areas and also know what is happening on ground. Our present course location is Lahore and Gujrat. All faculty and the local physician are keen to make it a success and ultimately benefit the patients.
This is a small step in our journey to make emergency care available and safe for all the citizen of Pakistan.

Stress Management

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Abdus Salam Khan, MD FACP
March, 2019

Stress is a daily routine in emergency departments all around the world. People who work in emergency department are exposed to various degrees of stress all along their duty timings. Let us delve into this subject and try to create some understanding about stress and practical ways to deal with its effects and ultimately the recommendations to make the work place healthy for the people.

Stress in its basic form is the force that causes all responses. It can also be seen as the body’s response to any challenge or demand. So, at this basic level stress is a good thing which makes us do the job required. It also results in high level performance, creates healthy competition and so on and so forth.

So when is the stress a bad thing? It is, when it is more than anyone can take it, or for a sustained period of time. So if anyone is exposed to any excessively traumatic event, that person will show the effects of that event in the behavior and the state of mind. Similarly when a normal or acceptable level of stress gets prolonged beyond certain the person’s capabilities, then that person will also show the effects of the sustained stress.

Emergency department by its design and working has both types of stresses, and the people that work in ED are prone to get exposed to both type of stress.

While I was looking at the literature it was interesting to note that very insignificant amount of work has been done to quantify the problem, as it is hard for the people to talk openly about it. Mostly because they feel it will be seen at weakness and may result in far reaching consequences.

In Pakistan the culture of pretending that we should be strong and macho results in no one admitting that they have problem dealing with stress. It then causes issues both at personal level and also on the working and safety of the department that those people are working for.

The burnout is a term that is used quite constantly now when the constant stress on a person makes then have emotional and physical exhaustion. It’s the end of the spectrum for the person in dealing with the stress and can result in people committing suicide or going into extreme depression. These people also are prone to make more mistakes and have low self esteem and improper communication with the patients and colleagues. Dealing with the burnout is important but preventing it is rather more effective strategy for the department.

Looking at the model of response to a disaster, we can stipulate that stress when excessive or prolonged can result in different phases manifesting the individual who is exposed to the high level of stress. Sometimes these phases overlap and sometimes one phase may skip, but it is still worthwhile to understand the dynamics.

Impact Phase:

It is short lived and starts immediately after exposure to stress. It can resolve in 1-7 days depending upon the cause and magnitude of the stress. The example of stress may be a wide spectrum ranging from a difficult colleague to an unexpected death of a patient especially young.

Its manifestations include disbelief, numbness, fear and possible confusion.

Crisis Phase:

• It lasts a variable period but not very prolonged.
• Patients show sign /symptoms in this phase which stem from the feeling of denial or hyper arousal.

Patient may feel: Fatigued, dizzy, headache, nausea, irritability, apathy, social withdrawal and also being angry at colleagues.

Resolution Phase:

It can last up to almost a year.
It results in grief, gilt and depression

Reconstruction Phase:

People who go through effective resolution of the stress are the ones who are able to successfully reconstruct their life for themselves.

They learn and successfully integrate event into their new self-content, and develop skills to deal with the stress better.

How do we deal with stress?

The medical community is now thinking beyond treating people exposed to stress and now they are inventing ways to either

• Prevent stress
• Make physicians resilient to minimize the impact on them.

It is important that we took into stress and stress related issues as early as possible. So early identification is the key to tackle with the stress issues in any department and especially in the emergency department.

1. Prevent Stress:
It is utmost important to develop the system that prevent excessive stress, as it protects the people working in the department. The department has to have a system of support for all the people to feel safe while working, and ultimately people will also be safe when they interact. The department should:

1. Provide educational support
2. Provide administrative support
3. Provide supervisory support
4. Have a system of fair reporting and audit.
5. Have a balanced system of tackling of error done by staff.

2. Resiliency Culture:

The work in emergency department can never be stress free or error proof, so the people working in emergency department have to work on themselves to guard against becoming victim of stress. How one can develop themselves to become resilient?

1. Being self-critical.
2. Work on your relationships.
3. Know your work system well.
4. Give yourself time off.

The most important defense against stress related burnout in emergency department is a person who knows the strength and weakness of self and the system and work within it. If you know when to ask for help and your system is quick in providing it then you won’t see increased burnout in your department.

More on the topic later. You can reach me at askhan65@yahoo.com.