www.emergencymedicine.in - Editorial
According to the BBC, as on Sep 2005, one person is dying in a road traffic accident every 6 minutes in India, and ten persons are getting injured in the same time. Our Government is always making an effort to prevent the accidents from taking place. Stricter traffic laws, hefty fines for traffic violations, compulsory helmet and seatbelt rule, better roads, street lights, etc. All these have brought down the mortality rate by, I believe, a fraction.
But has anybody done or even looked into what happens to a person after he is involved in an accident. Injured victims most often lie in a pool of blood, police do nothing about it because investigation is their first priority, bystanders avoid helping for the fear of getting involved in legal hassles, and treatment is delayed in most of the existing hospitals due to lack proper emergency rooms, leading to death.
Is there any form of accident and emergency system in India? Two or three cities like Hyderabad have better prehospital care in the form of fleets of ambulances run by private hospitals and organizations. What about other places?
Many studies involving victims of road traffic accidents which were conducted in India have highlighted the fact that majority of the victims of trauma were transported to the first hospital either by autorickshaw or private 4 wheelers with absolutely no first aid. And among those who were transported by ambulances, none of them recieved treatment which would have benefited them in any way. Non existent prehospital care.
When will our health care system start caring for these people. Trauma and accidents are just a fraction of the emergencies which are recieved in a hospital's casualty or emergency room. Who looks after these people on the verge of death? The current situation in these so called emergency rooms in our country is this.
Patients are recieved by ward boys or "compounders" who most of the time do the sorting or 'triaging' them to recieve care from units like surgery, medicine, orthopedics and so on. They are evaluated by the residents or post graduates from these specialties and care is rendered. If a problem relating to different specialty is detected then the patient is referred to that concerned unit. Treatment is given by the specialist who is called in. Then if he finds another problem, he refers the patient to another specialty. And so on. This method is known as sequential or serial referral. No problem at all if the patient is having some stable condition like back ache for two months, fever for 20 days, long term headache or chronic chest pain. Now imagine this method in a patient who is about to die.
Victims die on the trolleys and stretchers waiting for the concerned specialists to arrive and render treatment. The situation in corporate hospitals is the same except that the patients die in ICU beds away from the eyes of his / her relatives. This is what happens in almost all the hospitals where there is no emergency medicine. Worse happens in government hospitals. You won't find the patient recieving proper evaluation and care even after arrival. Imagine all the other emegencies that are being neglected in this fashion.
Accident and Emergency Medicine, or simply Emergency Medicine is a specialty which deals with and addresses this huge gap in health care. Doctors trained in emergency medicine, also known as emergency physicians, are trained to evaluate and treat all life threatening conditions. They know all the life saving procedures of every specialty, their minds are trained to detect acute problems, and they stabilize patients immediately and ensure their continued care by appropriate referrals. Not just critical but all patients who require any emergency care, regardless of their age, previous illness and disease, are managed efficiently by emergency physicians who spend their entire time either in the emergency departments or in the prehospital situations like disasters or mass casualty incidents. They are the only doctors who are routinely trained to manage situations involving multiple victims.
Currently hospitals and other doctors fail to recognise this specialty because its still unknown in India. Most emergency rooms are managed by anesthetists or critical care specialists, who most often have no specific training either in emergency medicine or critical care. Mind you, both are entirely different specialties, although there's a partial overlap. Introduction of emergency medicine in such locations is often resisted. But we are definitely going to change all this.
My wish is that India develops emergency medical services, akin to that in the United States where an ambulance will be able reach any victim involved in any emergency within a short time span.
My wish is that all hospitals have independent emergency departments, manned by emergency physicians, where all patients are completely evaluated and treated, or stabilized before any referral is given; where training is conducted to educate the paramedics and emergency nurses; where first aid training is given to the community in general.
My wish is that emergency medicine is recognised as an independent specialty by the Medical Council of India, and that it is appropriately included into the curriculum of all undergraduate and every post graduate medical training.
We, as emergency physicians, will work towards this.
We will bring the change. Right now is the time.
Remember the words, "The responsibility for change lies with all of us." - Late Rippan Kapur (1954 - 94), Founder of CRY (Child Rights and You) www.cry.org
Dr. Imron Subhan, FEM (CMC, Vellore), Senior Resident in Emergency Medicine, Apollo Hospitals, Hyderabad. 01-May-2006
(The author has graduated from Bangalore Medical College, Bangalore in 2002. He completed his Fellowship In Accident & Emergency Medicine from Christian Medical College, Vellore in 2004 and is currently doing his senior residency in emergency medicine in Apollo Hospitals, Hyderabad under MCEM [Member of College of Emergency Medicine, UK] program).
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