By Prof. Dr Ilias Ali
Emergency Medicine is one of the novel and upcoming branches of medicine which has emerged in our country in the recent time. The practice of emergency medicine is based on the knowledge and skills required for the prompt and active care of undifferentiated and unscheduled patients of all age groups with serious illnesses or injuries requiring immediate medical treatment. Also, the objective of this faculty is to train physicians in a comprehensive manner and render them capable of delivering quality emergency services to the patient in the most crucial hour of their lives.
The concept of Emergency Medicine dates back to the time of the French Revolution (1789-1799),when French military surgeon, Dominique Jean Larrey strategized the idea of ambulances or ‘flying carriages’ for rapid transport of the wounded soldiers to a central place where medical care was more accessible and effective. For this reason, Dominique Jean Larrey is also called the “Father of Emergency Medicine”. Though the significance of the discipline was realized and conceptualized long time back, it was only in 1979 that the American College of Emergency Medicine first distinguished it as a clinical speciality and even now the materialization of this branch of medicine is still in its very nascent stage in the under developed and developing nations.
Worldwide, most hospital Emergency Departments (ED)/ Casualty are generally manned by junior physicians or doctors on a rotating basis. Though this provides a considerable workforce at the ED/ Casualty, yet the lack of efficiency and knowledge of the concerned individuals in dealing with the critically ill patient either surgical or medical problems stands as a major hurdle in providing quality emergency services to the patients. The morbidity and mortality of a patient having medical or surgical emergency largely depends on the treatment received by the patient in the “Golden Hour”. The “Golden hour” refers to a very critical, brief, window time –literally, sixty minutes following a severe injury or medical emergency (strokes/cardiac catastrophe etc) during which there is the highest likelihood that prompt intervention and medical treatment will prevent death. Emergency Medicine physicians intervene in the critical hour i.e “Golden Hour” to save the life of a patient even before any definitive, disease specific management. They are skilled with the prompt assessment, stabilization and management of the patients at this critical phase.
With the advent of Emergency Medicine, the landscape of the Emergency Department workforce has changed tremendously all over the globe. Till a few decades ago, most of the Emergency Departments in the USA were staffed with physicians with no Emergency Medicine training, but according to a study conducted in 2008, 70% of the Emergency physicians are trained in this field. In India the Medical Council of India has introduced Emergency Medicine as a clinical specialty in 2009. The first Emergency Medicine programme was started in India in the government sector in 2010 in Ahmadabad followed by All India Institute of Medical Sciences, New Delhi in 2012.
In 2013, the Gauhati Medical College and Hospital (GMCH) has introduced the MD course, creating a niche for it among medical institutes in the eastern part of the country which are yet to gain functionality in this aspect. In this regard, it is worth mentioning that this specialty is still not present in states like West Bengal, Orissa, Bihar, other north –eastern states and premiere institutes like PGI, Chandigarh. The Post Graduate trainee programme in GMCH enrolls 2 trainees per year with the first batch of trainees successfully graduating this year. Since its inception, the Department of Emergency Medicine has been rendering emergency services like immediate evaluation, resuscitation and stabilization of critically ill patients. It has also been imparting training to nurses and paramedic staffs in both the pre-hospital care and emergency medical services.
Unfortunately, the concept of Emergency Medicine in this part of the country as a clinical specialty lacks clarity in the minds of the people as it is considered a mere up gradation of the pre-existing Casualty Department by many. This common perception however does not hold true as generally Casualty Department caters to all the patients presented to it irrespective of the spectrum or severity of their illness or injury, whereas the Emergency Medicine department is chiefly concerned with the prompt evaluation, resuscitation and stabilization of the acute and critically ill patients. It is worth mentioning that Casualty Department is a mandatory department for a medical institute and the emergency medicine is a new faculty which assists the casualty department with well trained manpower and life saving gadgets in managing the acute and critically ill patients. Contrary to belief it is not the replacement of casualty department rather an auxiliary unit. In India, the lack of adequate infrastructure and resources stands as a major stumbling block in the blooming of this life saving discipline.
As they say ‘Rome wasn’t built in a day’; Emergency Medicine will also take its time to establish itself and sensitize and create awareness among people regarding its significance. Though the Department of Emergency medicine, GMCH has come a long way from its inception yet there are several constraints including of space, logistics, trained human resources and proper organization which needs to be addressed .As the Department of Emergency Medicine, GMCH was the brain-child of the Honorable Minister of Health and Family Welfare, Dr. Himanta Biswa Sarma , we hope that the newly formed Government in Assam will take measures to make the Department a centre of excellence in the entire eastern region in the days to come. This in turn will not only provide a platform for the training of the medical professionals in courses like Advanced Trauma Life Support (ATLS) and Advanced Cardiovascular Life Support (ACLS), which is an essential training programme for all medical professionals, within the state itself but will also lessen the financial burden incurred upon the state for the training and deputation of the medical personals for the same to the higher institutes of the country.
Emergency Medicine, a new medical speciality, is recognized nationally and internationally for excellence in patient care and innovation in medical education. Hope, this novel speciality of GMCH will revolutionize the medical education of North-Eastern region of India and it will provide most scientific and prompt cares to the care-seekers at the most vulnerable moments of their lives following acute injury or illness.
Professor of Surgery, HOD of Emergency Medicine, Gauhati Medical College, State Nodal Officer cum Master Trainer of NSV, Govt of Assam and Senior Consultant, FP, NHM Assam.
Mobile no. 9864061796