Fighting Death, Impacting lives: Emergency Medicine

May 26, 2019 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine

At any point of the day, there is a sick, dying patient that the emergency room staff is fighting to keep alive. Over the years, acute medical care was slowly improving but then came the specialty of emergency medicine, and the practice of emergent medical care has drastically improved since.
Life-threatening illnesses and injuries are now detected much earlier and managed more efficiently and effectively. The emergency medicine doctors see the very sick and injured patients, impact their lives, and rarely ever get to see them when they regain their senses.
The nurses and doctors in this field work under intense pressure against the unpredictable and always attempt to come out on top. The sad reality of life is that they cannot always come out on top, but they will try to: lives often depend on the efforts of these professionals. This, along with the opportunity to be the first to get a chance to impact patient’s lives, is what drives the emergency medicine specialists, often against the odds.
As we prepare to celebrate World Emergency Medicine Day tomorrow, I thought it would be fitting to let you know a little more about this vital specialty of medicine.

WHAT IS EMERGENCY MEDICINE?

According to the International Federation for Emergency Medicine, Emergency Medicine is a medical specialty based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.
This still new specialty has tremendously impacted healthcare and to the benefit of the population. Establishment of this specialty began in the late 1960s to early 1970s and its growth is now easily recognized worldwide. Emergency specialists staff most emergency departments in hospitals and studies have proven the benefit of their presence to the sick and injured patient population. The last census in the US showed that the rate of emergency department visits per 100 people rose from 34.2 to 40.5 from years 1996 to 2006. This emphasizes the need for emergency medicine specialists but also the impact of their presence on patient visits.

WHAT IS IT THAT EMERGENCY DOCTORS DO?

The reality is a sick or injured individual on average has the best chance of survival if they encounter an emergency physician first. These specialists are required to keep a strong knowledge of all the aspects of medicine because of the differing and unknown nature of the patient that may present to them. Emergency physicians must have the skills of many specialists. They must have the ability to resuscitate a patient (critical care medicine), manage a difficult airway (anesthesia), suture a complex laceration (plastic surgery), reduce (set) a fractured bone or dislocated joint (orthopedic surgery), treat a heart attack (cardiology), work-up a pregnant patient with vaginal bleeding (Obstetrics and Gynecology), stop a bad nosebleed (Ear Nose and Throat), place a chest tube(cardiothoracic surgery), and to conduct and interpret x-rays and ultrasounds (radiology).
They must be able to deliver these and many other skills at any point in time to any patient according to the setting they are provided. What makes it even more remarkable is the fact that they multi-task and prioritize so that they can be managing multiple patients at any given time. These doctors are required to function in emergency departments and sometimes wards, events (any large gathering who are at risk of being injured or getting sick), disasters/mass casualties, ambulances, air medevacs, and are also often required to assist in medical administration of these settings.

WHAT’S HAPPENING IN GUYANA?

In 2010 this specialty migrated to Guyana and it has blossomed strongly under the leadership of faculties from Vanderbilt Medical Center and Georgetown Public Hospital Corporation. Emergency specialists are present at the Georgetown Public Hospital Corporation Accident & Emergency Department (GPHC A&E) year round, training budding doctors to become emergency medicine specialists.
The critically ill and injured Guyanese patient in need of emergent medical care now have the opportunity to access specialized emergent medical care at this emergency room. Medical conditions ranging from a heart attack to stroke, pneumonia, complications from a motor vehicle accident, an abscess or even a sick patient who doesn’t know what’s the cause, can be seen and effectively managed by these emergency physicians.
Administering advanced cardiopulmonary resuscitation (CPR) to a dying patient is often regarded as the hallmark of practice for emergency physicians. There are at least two of these specialists on every shift at the GPHC A&E.
As we progress, you will have more access to these specialists and benefit from more advanced emergency care earlier. More importantly, as we train more of these specialists, you will be able to access their service at other regional hospitals in the near future. But we are not done, we have also embarked on training specialist emergency nurses and Emergency Medical Technicians (EMTs).
We are building a strong team of emergency professionals who will initiate care at the site of your illness (home or an accident scene) and efficiently transport you to the specialist nurses and doctors in the emergency departments who will make your emergency their emergency.
Emergency care in Guyana is improving rapidly. Once there are critically sick or injured patients in need, then there will always be reason for the enhancement of the emergency medicine specialty. So the next time you come across an emergency medical provider tending to the sick, know that they have a packed plate, but if you have a real emergency, they will find space on that plate for you.

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