|Volume 6 | Issue 08 | August 2012 ||
Abysmal Emergency Medical Services
PROF RASHID E MAHBUB finds our emergency medical services essentially crippled at both public and private hospitals.
Medical emergency is an acute health problem which needs immediate attention for comfort and safety of life. It is a pre-hospital arrangement for patient care. It needs immediate transportation to an emergency room of a hospital for definite care. It will not be an exaggeration to say that the overall condition of a country's medical services is best reflected in its emergency service facilities. In Bangladesh, unfortunately though, we have virtually no emergency facilities system, a fact which accounts for thousands of deaths every year.
The common causes of medical emergency in Bangladesh are acute diseases, trauma and accident, violence, drowning, snake bites, suicidal attempts and burn. In delivering medical services, our public hospitals are obligated to provide emergency services to patients, especially to the poor. But facilities required to provide services are so poor that patients often receive delayed and inadequate treatment at public hospitals. Lack of skilled manpower and ill-planning compound the situation, failing to provide services at the time of a patient's need. Some small hospitals provide only first aid.
Condition at the private hospitals is good and bad at the same time. On one hand, they have better equipments and comparatively skilled manpower but affording those services are too expensive for the poor and lower income groups. So when an emergency patient needing immediate treatment is taken to a private hospital, s/he is left unattended until the hefty bills are paid.
Specialised public hospitals have their own emergency services. They receive the patient on arrival, provide the required services. But these hospitals are overcrowded, and lack of beds and other facilities make the services uncomfortable and unsatisfactory. They also lack logistics and manpower. In district hospitals the facilities are a lot poorer and more inadequate than divisional hospitals. They provide emergency medical care of sorts for the district town and its surroundings. But problems arise when there is big accident or disaster. Upazila hospitals also have some provisions for emergency medical service but their conditions are even worse. They in fact give service as a first service provider and transfer the patients in the nearby emergency department of the medical college hospitals or district hospitals. Here the transportation is done by the ambulance if there is any or with the hired vehicle with some logistic supply and medical attendant. Thanks to lack of coordination, there are often incidents of unexpected deaths on the way because in many instances this transferring takes so much time that the patient succumbs to his/her injuries.
Emergency service provider physicians are to keep medical record and inform the police if there is any unusual finding of medico-legal importance. A physician is also legally bound to attend the court of justice as an expert witness. It does not only take away a lot of their time but also put them in embarrassing situations. This is one of the reasons why private hospitals are less interested to attend the call on emergency medical care. This law related aspect of emergency medical facility should be taken seriously and addressed immediately. Many patients are not even admitted in private hospitals for these complicated legal problems. Although everyone is admitted in public hospitals, due to legal impediments it often takes doctors or para-medics more than usual to attend patients. A patient who attempted suicide cannot be attended until certain legal matters are settled but such complications often take a heavy toll on patients. Therefore, these legal matters must be amended immediately.
There are different types of hospitals and clinics both in private and public sectors. Each of them is to be graded according to their emergency medical service capacity. No clinic and hospital can refuse treatment for the patient's inability to pay. If necessary, laws should be formulated to this end.
Bangladesh is a small land with a vast population and poverty. It is making significant strides in social and economic transformation. Per capita income is increasing, poverty is reducing. Literacy rate is also increasing while women are becoming more empowered.
Social sensibility on emergency medical services is rising. Mobility of the people have increased manifold. Life expectancy has improved. This makes a big demand on emergency medical services.
Hence a national planning is the demand of the day for the emergency medical services. It should be economically affordable as well as accessible to all. In south East Asia, Srilanka has a national Emergency Medical Services. In our National Health Policy, 2011 emergency medical services are included as a basic right of the people. A national planning on emergency medical services is inevitable and should incorporate public and private healthcare providers, professionals, economists and other stake holders. The government is to be in the driving seat. The plan should be done prioritising certain matters: accessibility, affordability and last but not least, improvement of technologies and other facilities. In order to come up with an effective and people-friendly emergency service providing system, the following things need attention.
Prof Rashid E Mahbub is UGC Professor and Former President, Bangladesh Medical Association.
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