Emerge or Emergency Medicine Education and Research Global Exchange is a new initiative from Aga Khan University Hospital and our emergency medicine colleagues at the AKU emergency department. The EMERGE 2024 was themed “A Global Call to Action: Rethinking Emergency Care Science”.
It was a two-day program with 15 workshops 12 conference sessions over two days three panel discussions and 35+ modified abstract presentations. It was carried out in Aga Khan University Hospital campus in Karachi.
The program had multiple themes, and I was one of the guests in the last program, which was about the leadership and its challenges. The session was chaired by Dr. Huba Atiq and Dr. Fazal Hamid, and the panelists included Dr. Benjamin Wachira, Dr. Khalid Siddiqui, Dr. Sherin Kassamali, Dr. Abdus Salam Khan, Dr Nosheen Razi, Brig. Tarique Quadir Lakhiar, Mr. Ahson Rabbani, and Mr. Steve Nierman. They all represented different areas of either emergency medicine or hospital medicine with an emphasis on emergency care as well as prehospital care including 1122 in Pakistan.
The talk was extremely important and it gave the audience a perspective on how important Emergency and Pre-hospital Care is as well as the difficulties felt by the leadership while trying to establish Emergency Medicine in Pakistan. The emphasis to the audience was on changing the understanding of all the stakeholders as well as working as a team to accomplish the task at hand, which is improving the quality and patient care of people coming to the emergency department.
I explained the philosophy of leadership that I have used during my work as a Director of the Emergency Department at Shifa International Hospital. I told the audience that I have used three different styles of leadership for three different circumstances. I used the transactional style of leadership or the transactional philosophy for my Hospital colleagues other than the emergency department. I told the audience that initially when we started working as emergency consultants people had doubts about our handling of emergency patients as well as doubts about how we will manage their patients in the Emergency Department. So when we worked on the patients, we had to make sure that we did a good job and then ask our colleagues who were admitting the patients to put their trust in us. So in the transaction style we gave them the service and ask for their trust in us. It took a long time, but finally, they realized that, having a good Emergency Physician in the emergency department gets the patient better service for them. This helps us grow as Emergency Medicine and we were able to run the Emergency Department based upon the modern philosophy of Emergency Medicine.
The second style of leadership that I have utilized is Transformational leadership. This philosophy or style makes sure that the people working under me as Emergency Physicians are transformed into better physicians, who can work under pressure and as a team and would become the advocates of the patients and the extended team of all the inpatient consultants.
The third style is the Autocratic style or autocratic philosophy of leadership. I told the audience that it is necessary at some point in time to take the charge of the situation and get the things done quickly with some forceful actions and leadership to save the life of the patient. After all the physician working in the emergency department has the utmost responsibility to take care of the patient regardless of others are agreeing with his decision-making or not. At times you have to be a forceful advocate of your patient who is struggling to hang on to life and you struggling to get him the services as quickly as you can, whether it be a CT scan on an MRI or getting the patient to the OR for the definitive care and surgery.
The AKU Tanzania campus Emergency Department has very inspirational stories to tell as they are five physician emergency team for the whole country. They had put up an exceptional effort to make sure that Emergency Care is provided in the best possible way to all the people coming to the emergency departments. They have utilized the services of non-trained physicians and nurses and other providers and have equipped them with knowledge, and have provided them with ample training and with resources so that when they provide care to the patients, they are adequately equipped to give good service.
The prehospital in Pakistan is a sore spot but slowly, and gradually it is increasingly getting transformed into where it can provide better service to the patients needing a quick transfer to the emergency department or some sort of intervention while at home or at the road. The efforts of 1122 in this regard are extremely important and needed to be enhanced further. Our colleagues at 1122 explained how quickly they are increasing the services to the citizens of the area. They showed us that the availability of fund was an issue at some point in time, but with the efforts of the leadership and the citizens of the area, they have acquired enough funds to run the business and increase in the number of ambulances which are now around 400.
The value of research and academics was also explained by some of the parts expense of the talk and also the value of working together in collaboration in all fronts. It was also discussed that the needed number of physicians force for Pakistan is far more than the number of emergency physicians available at this point in time. The stakeholders at the government level at the College of Physicians and Surgeons Pakistan, and all the university levels should make some effort to increase the number of trained emergency physicians by possibly creating different cadres like, MCPS for the CPSP, Masters in Emergency Medicine and similar diploma and other courses which can equip the already working physicians in the Emergency Department across Pakistan. Newly budding physicians should also be encouraged to come to the Emergency Department with least resistance and increasingly equip them to work to save the lives of the patients coming to the Emergency Department.
Overall, EMERGE was a very good program and a good initiative for the leadership to come at single stage and talk about problems faced by each one of them while working in the Emergency Department across Pakistan. We are hopeful that similar programs will continue to happen in Pakistan as these pave the way for our young Emergency Physicians to become future leaders.