Emergency Medicine - Introducing New Approaches to Patient Care
The First to Start a Residency Training Programme in Emergency
Medicine in Pakistan

 

L to R: Dr Nadeemullah Khan and Dr Muhammad Shahid, Senior Instructors, Dr Junaid Razzak, Assistant Professor and Acting Head of the Section, and Dr Muhammad Baqir, Assistant Professor, at the Section of Emergency Medicine.

An emergency department is the front door of the hospital, with its prime objective being the provision of timely, accessible and appropriate emergency health services to patients with acute illness or injury. Emergency departments are also primary care centres, providing a variety of additional services to meet community and hospital needs.

This unit at Aga Khan University Hospital (AKUH) is organised as a section within the Department of Medicine. It was previously an Emergency Room. In 2004, it was upgraded to a Section following the international trend of recognising Emergency Medicine as a unique academic discipline with a focus on patient care, education and research.

The Section of Emergency Medicine is staffed 24 hours a day by three Senior Medical Officers and five-to-six residents/interns. Faculty supervision has expanded considerably in the last one year and plans for hiring additional faculty members are under way so as to also provide 24-hour supervision. The mission of the Section is to provide high quality and timely care to patients seeking emergency treatment; to offer outstanding educational opportunities for medical, nursing and allied health personnel; and to further medical knowledge through the pursuit of research.

The section will serve on average 45,000 patients a year in 2005, which is a 50 per cent increase in patient population in just seven years. With this significant increase in service needs, the section is striving to improve efficiency through continuous simplification of the processes of emergency care, benefiting both the patients and their health care providers. The section is equipped with all the facilities necessary for managing all adult and paediatric emergencies.

 

The section has earned the distinction of being the first to start a residency training programme in Emergency Medicine in Pakistan.

The current facility has a total of 26 patient-beds, including three fast-track spaces. There is also a triage area which follows accepted international standards of triaging patients to appropriate level of care. This makes the section perhaps the only emergency centre in Karachi working on modern triage and treatment concept. "We are seeing more and more patients every year within the same facility. Through this system of triage, we attempt to identify critically ill patients who are then given priority over patients who have less severe illnesses, helping us use our resources effectively and efficiently," says Dr Junaid Razzak, Assistant Professor and Acting Head of the Section, who is the only board-certified emergency medicine specialist in Pakistan. Patients with minor injuries are taken through the fast track, and are discharged after medical attention is given.

The Emergency Section, in a disaster situation, is able to manage up to 30 casualties simultaneously. However, the section has successfully handled many more patients in mid 2004 when the deteriorating law and order situation in Karachi inundated the section with an unprecedented number of casualties. The section not only aptly managed the crises, but also set an example of a well-coordinated and multidisciplinary approach to handling emergencies.

One of the goals of the Section of Emergency Medicine is to foster and provide a forum for emergency medicine research. Ongoing research, both analytical and interventional, includes all the major emergency medicine areas, such as trauma and injury prevention, deliberate self harm, pain management, ED Management and toxicology.

 

Qualified nursing staff, including registered nurses and other paramedics, forms the standard nursing model at the section.

At the national level, faculty is actively involved in work on road traffic injury prevention, and has been instrumental in founding the Pakistan Society for Emergency Medicine, which held its first meeting in 2005 at AKUH. One of the faculty members is on the World Health Organization's Steering Committee on Emergency and Trauma Care. The faculty also serves as peer reviewers for different international journals. Like other departments of the University, the section gains much from research collaborations with a number of international universities. The section recently obtained the NIH/Fogarty Centre grant for research training in trauma researchers in Pakistan in collaboration with Johns Hopkins University.

On the education front, the section has earned the distinction of being the first to start a residency training programme in Emergency Medicine in Pakistan in 2000. "The section con- ducts basic life support courses at the time of induction of new interns, residents, and fellows," observes Assistant Professor Dr Muhammad Baqir, who is trained in Family Medicine and commands extensive experience in Emergency Medicine practice, both in Pakistan, at AKUH, and Iran. Other faculty members are Dr Nadeemullah Khan and Dr Muhammad Shahid, both Senior Instructors. Dr Nadeemullah Khan is trained and board certified in Internal Medicine from University of Illinois, Chicago, while Dr Muhammad Shahid is the first resident trainee of Emergency Medicine programme at AKU and in Pakistan. The nursing coverage in the section, counted as one of the best in the city, encompasses critical patient management, handling trauma patients and several other emergencies. Under the leadership of Neemat Ahmed, Senior Assistant Manager, qualified nursing staff, including registered nurses and other paramedics, forms the standard nursing model at the section.

The future looks exciting for the Section. Planning for expanding the current section capacity is in its final phases. The facility is expected to double the current patient care areas: there will be a separate paediatrics area, more resuscitation beds, and a state-of-the-art Clinical Decision Unit. A larger and family friendly waiting area will also help reduce congestion in the corridors and at the entrance. More faculty members are being recruited and special emphasis is being placed on research and teaching, to make this section the first and a model academic emergency medicine programme in Pakistan.