THE quality of emergency care in a country has a direct impact on the number of lives saved, whether in case of critical injuries or life-threatening illness. As a symposium last week at Karachi’s Aga Khan University Hospital revealed, we fall far short of even a remotely reassuring situation. The statistics are downright alarming: for a population of over 200m, we have only nine qualified emergency medicine specialists. Shortage of resources, training in emergency care and accessibility for patients in need constitute major gaps in this branch of medicine, and worsen an already dire situation. In Pakistan, lack of awareness compounded by difficulty in accessing primary care providers can result in illness reaching a critical stage before medical attention is sought. We are also no strangers to mass casualty incidents, such as road accidents and terrorist attacks that can overwhelm ill-equipped facilities in areas outside urban centres. The absence of a triage system, which prioritises patients according to the seriousness of their condition, costs dearly in such situations.

Emergency medicine should be an integral part of a healthcare system. In Pakistan, however, where the government spends a measly 0.9pc of its budget outlay on health expenditure, the system often from the outset fails those who do not have time on their side. First of all, most ambulances are rudimentary, essentially meant to transport patients to hospital rather than initiate life-saving measures en route. Second, most hospitals lack properly equipped emergency departments; CT scan and MRI facilities, ventilators, or even a functioning ICU may not be available. As a result, patients are referred to other, comparatively better-equipped hospitals, thereby losing precious time. Third, these departments — as mentioned during the recent symposium — are not usually run by personnel qualified to undertake this specialised task; instead, they are helmed by doctors belonging to other disciplines. Expense is also a vital consideration: most people cannot afford private hospitals that might, in some cases, have a higher standard of critical care, and they have to settle for government-funded facilities. Unfortunately, it may be some time before we are up to scratch. Emergency medicine is a relatively new field in this country, and the Centre for Physicians and Surgeons Pakistan’s training programme in the discipline is still a work in progress. Healthcare reforms and policies must incorporate the requirements of this vital branch of medicine upon which hinges many a life-and-death situation.

Published in Dawn, November 13th, 2018