off record
Shaukat Ali Jawaid

Emergency services
healthcare facilities


Emergency Medicine is an important sub-specialty which has not yet taken routes in Pakistan. The result is that emergency services provided by public as well as private healthcare facilities are highly unsatisfactory. This at times leads to violent behavior by the patients attendants and does create law and order situation. Most of the casualty departments are manned by untrained, inexperienced young doctors who at times have to work without any supervision by senior consultants or the number of doctors posted in the emergency is too small to handle the workload.

The image of any healthcare facility in the public is dependent on how efficient its emergency services are. Accidents and Emergency Department of Jinnah Postgraduate Medical Center at Karachi which is supported to a great extent through donations has been doing a commendable job but even then, sometimes it had to face the violent behaviour of the patient’s attendants. National Institute of Child Health at Karachi also has an excellent emergency service and similar may be the case with many other healthcare facilities both in public and private sector but the overall impression about emergency services is not good.
If you visit any casualty department of a public hospital, it is not uncommon to see the young untrained, inexperienced doctors sitting relaxed while the patients brought in emergency are waiting to be examined. When the doctors fail to attend to emergency immediately, it annoys the patients’ attendants. However, if the patient is examined immediately and the patient as well as the attendants are informed as to what has happened, what is the patient’s condition and how they are going to manage it, it goes a long way in satisfying not only the patient but their attendants as well. Many a times ,the patient come to the emergency when it is too late and not much could be done but even then the sympathetic attitude of the doctors and proper counseling could make all the difference. The doctors posted in emergency in particular should be trained in communication skills so that they can communicate with the patients better and any untoward incident is avoided. If the number of doctors posted in emergency is too few, or they are overworked, one cannot expect them to be so efficient and work with devotion as burnout among physicians working in emergency is quite high.
The authorities need to pay special attention to provision of emergency services. It is extremely important that well trained and experienced doctors are posted in the emergency, casualty departments. Their working hours should be short and they must be provided comfortable, secure working environment. Not only that a senior consultant should also be posted in the emergency and if there is a need for consultation from other departments, the emergency calls from the Casualty should be attended immediately by the respective units, departments. At times what happens is that if the patient has to be taken to the X-ray department, there is nobody to carry the patient and lot of time is thus wasted though in emergency every minute counts and the management during the first hour could make a lot of difference to the final outcome.
College of Physicians and Surgeons Pakistan has started Fellowship programme in emergency medicine and hopefully specialists in this important discipline of medicine will be available in the coming years. But it is important that posts for these emergency physicians are created so that they can be absorbed and they can play their role in improving the emergency services. A hospital may be very well equipped with highly sophisticated equipment and instruments and also very well staffed with competent healthcare professionals but if its emergency service is not satisfactory, it won’t help improve its image in public. Referring to the provision of emergency services at one of the Five Star healthcare facility in the private sector, one of the eminent ophthalmologist who took his wife there in emergency had written in his book that “Khuda Kissi Dushman KO Bhee Iss Hospital Kee Emergency Maain Naa Laay”. These are the feelings and observations of an eminent ophthalmologist and not an ordinary patient. This reflects how badly the patients are managed in emergency and if this could be the situation in this Five Star healthcare facility in private sector, the situation in other hospitals can be very well imagined. In fact sometimes emergency care in public hospitals which remain the last hope for millions of poor patients is much better than private hospitals and it all depends on the hospital administration.
Doctors working in Casualty departments, Emergency Services should be offered refresher courses from time to time and they should also be educated how to communicate with the patients. Instead of waiting for the paper work to be completed first, let them start managing the patient while the patient’s attendants are advised to complete the necessary formalities. Government of Punjab has ensured that patients coming to emergency should get free drugs and medicines for which appropriate financial allocations have also been made. Similar arrangements for free drugs in emergency have been made by some hospitals in the country but the whole system needs to be streamlined. A lot depends on the hospital administration as well as to how it ensures the judicious use of financial as well as human resources. An efficient Ambulance Service with good emergency care can save many precious lives avoiding preventable deaths.{jcomments on}

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