Friday, September 6, 2013

Emergency medical service - As simple as ABC

I'm currently doing a stint in the Emergency department in a country in the Pacific working alongside great doctors and nurses. They all do a great job saving lives and providing good service to the local community. It made me think of what options exist in my beloved homeland Nigeria for people in need of emergency medical attention.

A Google search of 'emergency medicine nigeria' doesn't yield much evidence of a structured approach to the delivery of emergency care. Several websites allude to the non-existence of a working state ambulance service or a national emergency telephone number such as a '111', '911' or '999' (depending on where in the world  you are).

Thankfully some private groups have attempted to fill the gap but their attempts sadly fall short of what is needed. Their services while laudable are either not skilled enough or not well publicized. What's more deterring is the phone numbers they encourage people dial in case of an emergency. The numbers are often longer than the numbers on a lottery ticket! tough enough to remember on a good day, much worse when in the panic stricken state of an emergency. Reminds me of an episode of 'IT crowd' where '999' is changed to '011 899 988 199...' (See video here)  Perhaps they should try a similarly catchy song!

The poor state of  the existing situation is seen here in a Nigerian paper on Pubmed (read here). The authors tracked over four years how victims of rood traffic accidents presented to an emergency department in Ilorin. A whooping 52% of victims were brought in by relatives and 40% by police or FRSC. In the majority of these instances no intervention was given during transport, furthermore none of the transporters were trained in any type of life support, not even the police or FRSC officers! This paper makes dire reading!

So now one has somehow made their way - against many odds- to the emergency room, what service do they expect to receive? Stories abound on how patients are required to deposit large amounts of money before they are attended to (follow my friends blog who writes from the front line on some of the problems plaguing our hospitals)

When money is finally deposited, one obstacle after another surfaces. an instance of a fatal obstacle i read recently is that of a vibrant young girl (read here) who was having an acute asthma attack. She arrived at a hospital that had no supply of oxygen thus had to seek attention elsewhere but sadly passed away before she could be treated. Tell me please how can an emergency room not have oxygen! It's simple ABC - Airway, breathing, circulation. If an emergency room can't manage ABC it has no business taking emergencies or calling itself an emergency room.

A similarly sad story was told  to me during my medical elective in Nigeria. It goes as follows: a patient had come in severely distressed and was in danger of losing his airway. A call was made to secure the airway  through the placement of a tube that goes directly into the windpipe, to do this one needs a laryngoscope. Okay so people run around frantically searching for the scope and finally find it! yay, a life will be saved, not quite. The scope has no batteries to power it. Another frantic search for batteries ensues, yay! a drawer full of batteries found, a life will be saved. Not quite. The drawer is locked and the key holder is nowhere to be found. A life slips away.

The system (used here in the most liberal sense of the word) is broken from top to bottom, nothing works. Nil to few people really care. More must be done, life cannot be as trivial as it currently is. Other than the obvious setting up of an emergency number and a good ambulance service the following suggestions in my opinion can improve emergency care as it currently is:
 - All secondary school students should be taught the rudiments of life support,
 - Police and road safety officers should be required to learn basic life support and
 - Emergency departments need to be tightly regulated to ensure they possess a bare minimum of materials and services or be shut down.

I believe if the above are implemented a big difference will be observed in our emergency care in Nigeria. They are not too difficult to do and is not to much to ask, all that's needed is the will. It's really as simple as ABC