Crisis in Emergency Medicine

You have to be blind, deaf and from a different planet if you have not come across this statement from a variety of individuals and organisations in UK.

                       ' EMERGENCY MEDICINE IS IN CRISIS IN UK'

I thought I will reflect on this based on my own experience and exposure to emergency medicine in UK over the last 12 years. I did my medical education and surgical training in India. I came to work in NHS in 2000 to pursue further training in surgery. In about 2 years I realized that pursuing a surgical career in UK with a young family would be rather difficult. I choose to train and work in emergency medicine.

I come from a country where emergency medicine is in its infancy. I have seen the terrible loss of life and limb because of lack of basic emergency services. I understand the value of high quality emergency services.

Now let us look at why emergency medicine is in crisis is in UK. I will try  to steer clear of rhetoric and try and stick to objective facts as I see them. I apologize in advance for a certain degree of bias based on my experience.

There are many factors which have lead to the crisis in emergency medicine. Some of these factors are common to other acute care specialities.

1-Most doctors want to work 9-5 and want to do as little out of hours work as possible. This culture among the vast majority of doctors particularly the younger generation has lead to a staffing crisis in emergency medicine.

2-Governmental decision to abolish permit free training in 2006 because of short term target of ensuring the success of MTAS.

3-Inadequate remuneration for out of hours work which is forced upon non-consultant career doctors(SAS doctors and Clinical Fellows) and trainees.

4-Work intensity which is unsustainable for prolonged periods of time.

5-Emergency department overcrowding leading to a unhealthy work atmosphere.

Each of the above factors have multiple contributing factors. Until all stakeholders are willing to sit down and have a transparent constructive discussions this crisis will not be resolved. At the moment that is not happening and yet another short term fix is being planned by the people in charge of making these decisions. This is an ineffective way of dealing with the issues facing emergency medicine.

Sudden Death

On 17th March 2012 something happened on British television. On this fateful day a premiership footballer and a fine gentleman called Fabrice Muamba collapsed on the football field.



https://www.youtube.com/watch?v=_0XN1d6s2oU

https://www.youtube.com/watch?NR=1&v=Xw9Wh9aY8kA&feature=endscreen



 He was successfully resuscitated and has since walked out of hospital with an implantable defibrillator. This was a moment of great achievement for the entire medical/paramedical/scientific community. We did not reach here easily. So lets go back and look at how we reached here. Now let us look at the various factors which have contributed to the successful resuscitation of Muamba.

1-Emergency Medical Services



They are truly the unsung heroes of innumerable lives saved in UK and worldwide. These are the angels that provide immediate assistance on the field, in your home and on the street. If you would like to know more about EMS please have a look at the following links.

http://www.nhscareers.nhs.uk/explore-by-career/ambulance-service-team/careers-in-the-ambulance-service-team/paramedic/

http://en.wikipedia.org/wiki/Emergency_medical_services

http://careers.bmj.com/careers/advice/view-article.html?id=819

http://www.basics.org.uk/

2-Advanced life support

Guidelines on how to administer resuscitation were first brought out by the American Heart Association in 1974 and have subsequently been revised many times. What is probably more important for successful resuscitation is Basic Life Support. Successful vaccination against a particular virus is dependent on crowd immunity- that magical critical percentage of the population who have been vaccinated. Similarly successful resuscitation will be directly proportional to crowd BLSability(once again an unknown magical percentage of members of public who can provide BLS).



http://en.wikipedia.org/wiki/Advanced_life_support

http://www.resus.org.uk/siteindx.htm

http://www.resus.org.uk/pages/bls.pdf

http://www.youtube.com/watch?v=kpQqqZJIptM

3-Definitive treatment

Obviously this will depend on the diagnosis. There has been a lot of interest in sudden death among young adults. Fabrice Muamba has been a great catalyst in speeding up the minds of various people to tackle this largely preventable problem.



http://www.c-r-y.org.uk/index.htm?gclid=CLvo9PSwxrMCFbMbtAodUBYAkw

http://en.wikipedia.org/wiki/Sudden_unexpected_death_syndrome

http://www.sads.org.uk/

http://www.bhf.org.uk/research/research-milestones/sads.aspx

This blog post is not meant to be an encyclopaedia of knowledge nor is it meant as a replacement of traditional sources of information and advice like your textbooks, journals and healthcare professionals. This is just a little stimulant for further reading for everyone including me. I would like to thank all my colleagues who have helped me gather information and have been a source of inspiration to write this article. I dedicate this article to the innumerable young adults who die worldwide just because of lack of simple basic life support, absence of an organised EMS and apathy among the people who run health services.

Welcome to this blog

Hi everyone

I have started this blog to put together all the things I have learnt over the last 10years in emergency medicine     and would like to welcome anybody else who wants to add some content onto this blog. I thought I shall start off with the mother of all emergencies we face in the emergency department-a sudden death in an young adult. I am not talking about the standby call for an 86yr old from a nursing home. I am talking about a relatively healthy adult who suddenly drops down dead! Most of you would agree that this is a nightmarish situation for all involved. I wanted to look into the issue from as many angles as possible but start of with a few important questions in mind.

1-what do we already know about sudden death in young adults ?

2-how common a problem is this ?

3-What can we do-as a bystander; as a paramedic; as an emergency physician ?

4-what is the future ?

5-what are perspectives and issues in resource poor countries ?

Let us take one small bite at this topic a day over the next few days.

Please feel free to share your views/experiences.