An emergency is a situation that poses an immediate threat to life, health, property, and environment. Emergencies, particularly health emergencies, are nothing new to mankind and over time we have developed means to deal with these situations with the knowledge and resources available. Assisted by research, this has eventually been organized into a systematic approach combining experience, knowledge, and need. Treatment approaches such as herbal, homeopathy, allopathy, and several other forms of alternative medicine for emergency management have been developed. As allopathy treatment system is the most widely used, I will primarily talk about it.
According to the World Mortality 2017: Data Booklet of United Nations, globally 156,000 deaths and 360,000 births occur every day. A considerable number of the 156,000 deaths occur from preventable emergencies. Sepsis, cardiac, pulmonary events, and trauma are the major causes of emergency deaths. Not all deaths due to these causes are preventable but through extensive research and the development of emergency management, we are now at a stage where if proper effort is given, many of these deaths can be prevented. In the West, the efforts in saving emergency patients are profound due to affordability, R&D, and insurance support. However, in the East such support are either not readily available or are not availed due to a lack of knowledge.
During an emergency that cannot be managed at home, a patient must immediately be taken to the Emergency Room (ER) of the nearest hospital. Some hospitals in Asia are very well equipped to take care of such patients. Unfortunately, in Bangladesh most ER’s do not have adequately trained medical professionals, a proper set up including electronic medical monitoring instruments, and logistics. I would like to talk about what to do in a situation where emergencies are not addressed appropriately.
Recently, Emergency Medicine (EM) has been developed as an independent subject which allows ER doctors to be better equipped to handle most emergency cases. Emergency Medicine consists of two parts. The first is out of hospital, also known as Pre-Hospital Care or Emergency Medical Service (EMS). This handles patients at the site where the emergency took place and transfer them to a health facility. The second part is that during the transfer, patients need to be stabilized in a well-designed EMS ambulance. In Bangladesh and some neighboring countries, these ambulances are merely medical vans with no support service or equipment inside.
I have been working with Praava Health as a Senior Medical Advisor from the planning stage and have helped to create a facility where patients are treated with empathy and respect along with accurate diagnosis. The primary reason behind my interest in joining Praava was the vision and concept of family medicine doctors, which our Founder & CEO Ms. Sylvana Sinha was determined and passionate to introduce to our health sector. Although Praava is an outpatient facility, there are instances where we do need to manage patient related emergencies. I have worked extensively with our doctors, nurses, and allied health professionals, including all of our patient facing staff, to train and guide them on how to properly address and manage emergency cases. One of the vital skills required during an emergency is the ability to perform CPR. It is a challenging training in Bangladesh which we continually conduct for all our staff.
In Bangladesh, Emergency Medicine is still not a recognized specialty and sadly, no FCPS or MD courses have been introduced yet. Doctors and nurses need to be trained for Pre-Hospital Care and ER management and this requires advanced level of education and training. It is a core reason behind why our Emergency Rooms are not supervised by properly trained professionals. In an attempt to overcome this, a few colleagues from different specialties and I, have introduced Bangladesh Society of Emergency Medicine. We are still striving for recognition and development of this specialty. However, FCPS and MD courses are yet to be developed.
In emergency cases, patients who only require first-aid are released after ER management, some may require hospital admission, out of whom a few may need ICU admission – meaning they are either critically ill or could end up in a critical condition.
Critical Care Medicine deals with patients with respiratory failure, heart failure, severe stroke, and sepsis with single or multiple organ failure. In Bangladesh, critical care management is fairly new but available in many hospitals in Dhaka, while being almost absent in most of the peripheral districts. It is often perceived that if one is admitted in the ICU it means they would eventually expire. This is not true. According to the Society of Critical Care Medicine, USA, mortality ranges between 10% to 29% depending on the severity of illness. In my own ICU, we found the mortality rate to be 35%, meaning 65% patients survived and was discharged from the ICU in a stable condition. Also, not all patients in ICU require life support or ventilation. Many require intensive nursing care, some require close monitoring only, while a few need shock management. The rest may require intervention such as intubation, non-invasive, or invasive ventilation. Terminally ill patients also get benefitted from staying in an ICU, especially those with cancer.
Managing emergencies should only be considered under the following conditions:
- No time to save life is justified with positive Risk: Benefit ratio
- No help or assistance from a health facility is expected within an hour
- Some experience in dealing with emergencies
- Emergency apps assisted performance is strictly followed
Praava’s holistic approach to patient care centered around family medicine is a concept that is the first of its kind in Bangladesh. This system which is widespread in the West could unfortunately not even be introduced by our Ministry of Health. Yes, there are numerous challenges that we had overcome to initiate this system and there will be many more ahead of us to establish the importance and need of family medicine.
I utilized my expertise in emergency medicine and care at Praava to ensure that regardless of any situation, a patient is provided with the highest level of care during an emergency. My hope is that by successfully continuing to deliver our promise to patients and also taking proper care of them during emergencies, Praava will help set an example and encourage other healthcare providers to be better trained and equipped to manage emergencies.
All of this effort to empower, educate and train health professionals in emergency medicine, is for the patients to get the right service and care during an emergency and reduce fatality. Afterall, it is all about the people of our country who deserve proper treatment.
Disclaimer: Despite taking all the right measures taken, there might be instances where a patient’s life cannot be saved.
By Dr. Raghib Manzoor, MBBS DA