(With Dr Zulfikar Bux, Head of GPHC’s A&E; Asst. Prof. 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 now being managed in a more efficient manner. 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 can’t always come out on top, but the will to try lives on in these professionals. This will to fight, and 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.
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 behavioural 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.
Studies have proven that the presence of emergency specialist staff in most emergency departments in hospitals is of great benefit to the sick and injured patient population. The last census in the United States 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.
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 nose bleed (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 medivacs, and are also often required to assist in medical administration of these settings.
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 and Emergency Department (GPHC A&E) year round, training budding emergency specialists. The critically ill and injured Guyanese patient in need of emergent medical care now for the first time, has the opportunity to access specialized emergent medical care at this emergency room. Medical conditions ranging from a heart attack, stroke, pneumonia, complications from a motor vehicle accident, complicated chikungunya, an abscess or even a sick patient who doesn’t know what the cause is, can be seen and effectively managed by an emergency physician. Administering advanced cardiopulmonary resuscitation (CPR) to a dying patient is often regarded as the hallmark of practice for emergency physicians. It is only a matter of time until there are emergency medicine specialists on every shift to take care of the incoming sick patient at GPHC A&E. More importantly, these specialists will then be able to staff other emergency departments in the country and ultimately modernize emergency medical care for all Guyanese to benefit.
Emergency care in Guyana is improving rapidly and once there is a critically sick or injured patient that is 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 physician tending to the sick, know that he has a packed plate but if required, he will always find room in that plate for another sick individual that is in need of care.
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