Abdus Salam Khan, May 2020.
The whole world is facing a pandemic since start of the year. Starting from China, COVID-19 is now affecting the entire population of the world. So far it seems that Pakistan has not seen the worst that people saw in UK or New York, but it is far from reassuring at this time, and things may change.
We will discuss some of the areas where as a nation and as healthcare provider we could improve in order to deal with COVID-19 as well as similar situations in future. The world we live in faces challenges and develops the ways to deal with those challenges. Whether natural or man-made, disasters happen and it requires coordinated efforts as well as preparedness in terms of expertise, competence and proper equipment. Unfortunately with COVID-19, our knowledge is not optimal and this results in response at times seems deficient and it has to adjust frequently, and yet it is considered sub-optimal.
In terms of COVID-19 we saw a lack of preparedness and practically no input of people working on the front line, emergency department specifically. This resulted in guidelines not properly emergency oriented and important issues not addressed in time. For the same reason a comprehensive picture is not emerging from Pakistan for the basic reason that our emergency response system is not well coordinated and all emergency departments create their own strategy and guidelines. The National Disaster Management Authority does not have a medical management wing to this date and it is left unplanned. This results in lack of information regarding the real time issues faced by emergency departments across Pakistan.
This pandemic has brought a lot of attention to the emergency care response. As when people face problems they end up going to the emergency department and get the help that they seek. When such health emergency arises there are two resultant responses are expected:
- Identifying the new disease ( COVID-19 at this time).
- Making sure other patients are safely treated and are not neglected.
This two pronged approach has to be created as soon as the problem is identified, and it has to be hospital wide. It is not easy to implement this change and the whole hospital needs to change its mind set to provide safe and efficient care to all patients. For a coordinated response we need to develop teamwork and develop proper plan and also practice it. This plan should be exercised routinely in times when things are normal. The emergency department has to be ready all the time to change the patient flow from normal operation to the one which befits the situation at hand.
If we imagine facing another such outbreak, a few steps needs to be taken now in order to get better response and help our patients in this regard.
- The prime important aspect is to give emergency medicine its due role in the canvas of healthcare. All emergency departments of tertiary care hospitals should have well trained doctors and nurses in order to provide the appropriate level of care.
- The pre-hospital care needs to be brought in order. We need to improve the governance and competence of our ambulance system in a short time span. Creating a central command to control all movement of ambulances. We also need to categorize the ambulances on the level of the competence of the staff to utilise them efficiently. This will help improve the functioning of emergency department in a very meaningful way.
- Increase the number of training program in emergency medicine, in order fulfill the gap of trained emergency physicians in every emergency department across Pakistan.
- Utilize the expertise of national and international experts of emergency medicine as well as Pakistan Society of Emergency Medicine and working together create workable solutions to be implemented across Pakistan.
- A central database needs to be created which will monitor case load and also monitor any potential threat of disease that emergency department is facing.
Ofcourse this topic only relates to the pre-hospital and emergency department care for any such emergency. The task does not finish there as the appropriate response requires input from other specialties, like infectious disease, critical care, pharmacists and all. Without them, the work of emergency physician will not be complete.
These steps may seem big tasks but are necessary to create a vibrant pre-hospital and emergency care response in all situations and thus work to improve the care of the patients. It is the need of the time and will also smooth the normal day patient care across emergency departments of Pakistan.