Integrating public health in emergency medicine is critical

Annual Emergency Medicine Conference at Aga Khan University

KARACHI - “Emergency departments are critical parts of communities. Focusing on constantly improving emergency care that is available 24/7, 365 days of the year is essential for any sustainable healthcare gain,” said Dr Junaid Razzak, professor of emergency medicine at the Johns Hopkins University and the pioneer of Pakistan’s first emergency medicine residency programme.

Dr Razzak was speaking at the fourth Annual Emergency Medicine Conference (AEMC) at the Aga Khan University, recently. The forum was organized in collaboration with the National Institute of Health, Johns Hopkins University and the Fogarty JHU-Pak International Collaborative Trauma and Injury Research Training Program. 

This year’s conference focused on integrating clinical care and public health in emergency medicine. Under this wide umbrella were a variety of sessions from performance and predictors of emergency care to the basics of care physiology.

“Pakistan needs 15,000–30,000 trained emergency physicians today. But with only 2 programmes in the country, we are graduating just 6–10 emergency doctors a year,” Dr Razzak revealed. “We need to find ways to fill this gap through opening other programmes and finding ways to train people through shorter curricula.”

Meanwhile, Dr Adnan Hyder, professor of international health and director, International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, emphasized the global paradigm shift in emergency medicine and the need to integrate public health approaches to improve outcomes. He urged that a national task-force be established to develop an innovative road map to maximize the impact of emergency care in Pakistan.

Perhaps the strongest indicator for the need to revamp the emergency medicine (EM) system and move towards a holistic, integrated approach, was the heat wave crisis to strike Karachi this year.

“The number of patients affected by the heat wave was unprecedented and the current emergency care set-up was not adequately equipped to deal with this load,” said Dr Munawar Khursheed, assistant professor, department of emergency medicine, Aga Khan University (AKU), during a panel discussion on experiences of the heat-related emergencies in Karachi.  

“On June 21, we triaged more than 300 patients and on subsequent days hospital occupancy stood at 94 per cent. Not a single bed was available in the ICU or SICU,” he added. “And this was the similar situation in all emergency departments (EDs) in the city.”

The first day of the session also featured a talk by visiting clinician scientist, department of emergency medicine, General Hospital, Singapore Dr Marcus Ong, who shared his experiences of developing emergency medical services (EMS) in Singapore, and parallel sessions on infectious diseases, trauma emergencies and toxic hazards.

A strong sub-theme at the conference was violence—against women, against children and at the workplace—and the ensuing ethical issues.

“We have dealt with women in depressive stupors to those over-battered and beyond recognition. Even though you can see the physical evidence, the women will deny the abuse. They will rarely admit to what has happened,” said Dr Khushro Shamim, instructor, department of emergency medicine, AKU, in his talk on physical violence on women. “The usual response that we hear? I fell down.”

“As part of the healthcare system, the emergency department has a role in identification, reporting and management of cases of violence against women,” said Dr Shamim.

As Dr Murad Moosa Khan, professor, department of psychiatry, AKU, would opine in a session on bioethics and emergency medicine: “Work in emergency care settings can pose unique ethical challenges in patient care. These include management of patients who may or may not be in a position to give informed consent, and the need to maintain privacy and confidentiality.”

In Pakistan, “emergency healthcare professionals have to deal violence with little or no support from relevant agencies.”

For guest speaker- Dr Yasmin Zaidi, director of the Islamabad-based Center of Gender and Policy Studies; Standardized indicators are the need of the hour for any research on gender based violence to be representative and reproducible. At the Conference, she shared initiatives taken by the National Commission on the Status of Women to develop Pakistan-specific standardized indicators on violence against women.

Dr Asad I. Mian, associate professor and director of paediatric emergency medicine, AKU and a key organizer of AEMC 2015, gave an overview of paediatric emergency medicine in Pakistan.

“There is a need to reinforce paediatric trauma management services in EDs, including screening for potential physical, sexual and psychological abuse,” said Dr Mian. “From a public health perspective, primary prevention of child injury, like increasing safety in homes, schools and playgrounds, is really important. All emergency rooms where kids are being seen need to be child-friendly.”

He hoped that through AEMC 2015, the need to develop national level contingencies is emphasized as Pakistan needs to maintain registries that can provide surveillance data and allow for real time coordination among various emergency departments.

The second day of the conference featured parallel sessions on cardiac and cerebro-vascular accidents, health systems for acute care and seeking synergies, violence in the health care workplace, and quality and patient safety initiatives in emergency medicine.

Dr Nick Brown, Salisbury District Hospital UK; Syed Faisal Mahmood, AKU; Dr Shehla Zaidi, AKU; Dr Madiha Hashmi, AKU; Mr Zia Ahmed Awan, Advocate, Supreme Court of Pakistan; Dr Seemi Jamali, JPMC; Mohammad Jibran Nasir, Lawyer and political/human rights activist, Pakistan; Mr Johannes (Hans) Theodorus Kedzierski, AKU; Dr Zafar Fatmi, AKU; Dr Christien van der Linden, Medical Centre, Netherlands; Dr Amber Mehmood, International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, USA, among others, also spoke on the occasion.

The conference concluded with remarks by Mr Salim Hasham, vice president, health services, AKU.-PR