WHY emergency medicine is crucial ?
Emergency Medicine is a specialty, which encompasses practice based on knowledge and skills essential for the prevention, diagnosis & management of acute/ urgent illnesses and injuries. It incorporates all age patients presenting with a full spectrum of undifferentiated physical and behavioral disorders.
Hence, Emergency Medicine has a broad spectrum of clinical presentations which includes resuscitation and medical care necessitating immediate medical attention. Furthermore, it also provides episodic primary care to patients whose primary care providers are unavailable during peculiar hours of the day.
A competent Emergency Medicine doctor requires a broad field of knowledge and procedural skills which often include some lifesaving surgical procedures, trauma resuscitation, advanced cardiovascular life support, advanced airway management, and the use of point-of-care ultrasound. A well-trained emergency doctor should have the core skills like the ability to resuscitate efficiently, manage difficult airways, suture complex lacerations, set a fractured bone or dislocated joint, treat a heart attack, manage brain stroke, manage asthma attack, manage a polytrauma victim, work up a pregnant patient with vaginal bleed, control a patient with acute psychosis, stop severe nasal bleeding, removing the foreign bodies from the nose & ears, interpret the X-rays and conduct point of care ultrasound at the bedside.
So, a good Emergency Medicine doctor can be an asset to the organization and a good Emergency Medicine department can be a throbbing heart of the hospital.
what is the status of India regarding emergency medicine in comparison with western countries?
Emergency Medicine is a relatively new specialty in the world; India, as compared to the Western world, is at a nascent stage as we are in the 14th year of the inception of Emergency Medicine. There is an immense need for the adoption of Emergency Medicine, as the core of healthcare setups, throughout the world. There is a huge demand and supply gap, and this gap is going to increase exponentially in India and around the world.
Since Emergency Medicine has rising importance globally, many countries have accelerated their aspiration to increase the number of trained Emergency Medicine doctors in their healthcare setups.
Let us understand where we stand in comparison to the developed countries, by looking at some noteworthy statistics.
- United Kingdom’s National Health Services, there are approximately 6600 Emergency Physician providing medical care to a population of 66.6 million
- The United States of America has 53,000 Emergency Physicians serving a population of 25.7 million
- Singapore has one Emergency Physician for every 10,000 individuals.
In comparison, India has a population of 1.4 billion, where the requirement of practicing Emergency Physicians is approximately 1,40,000. Unfortunately, as of 2023, India has an immense scarcity of Emergency Physicians, only filling in for 5% of the total requirement!
Considering our current Emergency training programs all over India, we do not produce more than 1000 Emergency Physicians per year; at this rate, India cannot meet the desired supply and demand gap in near future.
Furthermore, well trained Indian Emergency Physicians are opting to migrate to developed countries due to superior professional, personal and financial growth opportunities. Considering the migration, it makes this a substantially challenging situation, which needs to be addressed strategically by creating similar professional growth opportunities in India.
90% of ambulances run without any equipment/oxygen. 95% of ambulances have untrained personnel. 30% of mortality is due to delays in emergency care. These shocking statistics were revealed in a recent study conducted by JPNATC, AIIMS with the support of NITI Aayog.
why India has to develop emergency medicine on war foot?
India has become the capital of cardiovascular diseases including deaths due to heart and brain attacks. Data states that there are more incidences of Myocardial Infarction in India, than in any other country in the world. Ischemic Heart Disease is the leading cause of death in India. Also, Trauma has become the second most common cause of death in young adults in India.
The current statistics illustrate that there has been a staggering 36 % increase in road traffic fatalities since 2010 and is escalating.
An Emergency Medicine Physician has a very crucial role to play in the management of cardiovascular emergencies and trauma resuscitation. The golden hour care provided by a proficient Emergency Physician can save lives and prevent morbidity drastically.
Trend of deaths due to non-communicable diseases : heart attack, Stroke, Asthma, COPD, Chronic Lung Disease, and pregnancy-related deaths accounting for 57 per cent of mortality between the ages of 30 to 69 years.
in case of communicable diseases: the crucial role of Emergency Department and Emergency Medicine doctors has been highlighted during the COVID19 Pandemic. The pandemic was successfully tackled by incorporating a well-equipped and capable Emergency Department that handled cases as the front line. During the process of providing life-saving care, a trained Emergency Physician undertakes proper triaging, risk stratification, airway management, resuscitation, recognition of deceptive presentations & disposition of patients. The success of the COVID-19 management program of all hospitals depended heavily upon the preparedness, capabilities and training of Emergency Physicians as well as the structure of the ER.
In 2018, the Indian government made an observation that every year more than six crore Indians were pushed into poverty due to medical expenses. It is the inadequate emergency medical care system in India that is one of the possible reasons behind it. Emergency care is a fundamental right for every citizen. Developing a robust emergency care system will only make Bharat Ayushman.
What India needs the most is a well-developed emergency care system, encompassing public, private, rural, and urban sectors.
Delivering emergency care is a race against time for Emergency Physicians, but in India developing a robust emergency care system is a race against time for the policymakers.
How to increase the emergency physicians in INDIA?
Recently, the National Medical Commission has made it compulsory for all medical colleges to have Emergency Medicine as an independent clinical unit.
To develop a robust and trustworthy Emergency Medicine department, the hospital needs a team of holistically well-trained doctors in emergency medicine around the clock.
The infrastructure for an emergency department can be built, but it is of no importance if there is a scarcity of competent Emergency Physicians to drive clinical excellence.
The developed western countries have two pathways for a physician to be certified in Emergency Medicine -
A)conventional training or
B) certification via exit examinations for those who have adequate working experience in the Emergency Department.
By providing these two pathways, they have augmented the number of trained Emergency Physicians in their countries to close the demand and supply gap.
we can also adapt same mechanism in india.
NMC has to increase PG Degree SEATS in emergency medicine. every medical college hospital has huge work load in casuality (emergency department). so its apt to allot 20 emergency medicine PG seats to all colleges having PG medical education approval .
in 400 medical colleges*20 EM seats = 8000 EM graduates every year
Some path breaking decisions and out of box thinking are needed to overcome this challenge.
what should be done to change the grim conditions of medical emergency care in the country ?
1.Tackling the Unorganized EMS:
The unorganized nature of services leads to a haphazard response from the service providers. The utilization of technology can be a boon to solve this problem. Technologies like GPS can enable service providers to position, dispatch and track ambulances efficiently to save more lives. Similarly, access to a centralized database of patients' medical records can help the emergency department make crucial decisions quickly.
2. Making People Aware:
Awareness among the general public is a crucial differentiator. A swift response can be provided when people know their requirements and how to reach out for help through proper channels. Misuse of ambulances is a big issue leading to inefficiency of response. Often not being aware of what type of ambulance to call can lead to a gap in availing the services essential to save a life.
3. Pumping in Resources:
Today if you try to book an ambulance the response is often delayed and unreliable. A major obstacle in providing reliable and quick EMS is the lack of resources. Well-equipped ambulances, trained medical professionals, technological support etc. are fundamental to any emergency medical response but still, their lack is a harsh reality. To change this, most efforts should focus on consolidating the ground-level infrastructure.
4. An emergency medical care system on the lines of Covid command centre and the existing police emergency system.
The emergency medical care system will have its own integrated trauma and emergency system with a call centre and command centre in place, and the facility for “live emergency monitoring system”. Also, the emergency medical and trauma care would be provided free of cost for the first 48 hours.
“A system of live emergency monitoring will be developed through which anyone in need can call and will be connected to the first responders, who would help the person in need by connecting them with the kind of hospital their condition would require, such as Level-1, Level-2 hospital, or if the patient needs any specialised medical care, then the first responders will connect them with the hospital that has the required facility,”
The benefit will be provided through government & Private medical colleges and institutions in entire 750 districts of the country.
The new system will assist in easy admission in hospitals as patients and their attendants would know where to go in case of emergency. It will avoid instances of patients running from one hospital to another in search of the beds&suitable care.
"A patient who receives basic care from trained professionals and is transported to the nearest healthcare facility within 15-20 minutes of an emergency has a greater chance of survival".
The future of emergency care in India lies in employing well organized, consolidated and technology-oriented solutions.
If such solutions are utilized well, EMS can become far more well-structured and responsive in no time, saving thousands of more lives every year.
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