Mumbai: In the realm of healthcare, emergency medicine professionals stand as the last line of defence, tirelessly working to save lives in the face of adversity. Emergency Medicine Day serves as a powerful reminder of the immense challenges faced by these dedicated healthcare workers. From bustling urban emergency rooms to remote rural clinics, they navigate chaotic and high-pressure environments with precision, skill, and unwavering determination.
From heart-stopping cardiac arrests to traumatic accidents and life-threatening illnesses, emergency medicine professionals encounter a wide range of cases that demand their immediate attention. Through their expertise and quick decision-making, they provide critical interventions, resuscitate the critically ill, and provide a sense of calm and reassurance in moments of chaos.
On Emergency Medicine Day, ETHealthworld interacted with emergency department professionals to gain a deeper understanding of the challenges they face and the remarkable impact they have on the lives of countless individuals.
Changes in working environment
During the pandemic, there was a noticeable decrease in Emergency Department (ED) attendance. This presented both opportunities and challenges for healthcare providers. On one hand, the reduced influx of low-severity cases allowed EDs to allocate resources more efficiently. However, the fear and reluctance among people to seek medical attention for non-communicable diseases such as hypertension and coronary artery disease posed a risk of delayed treatment. In some cases, individuals even refrained from seeking emergency care, resulting in potentially life-threatening delays.
Dr Sushant Chhabra, Head, Department of Emergency Medicine, Manipal Hospitals, emphasised the dynamic nature of emergency medicine. It is a speciality that demands doctors to be constantly alert and ready to respond swiftly. While the overall management of patients has remained consistent, the COVID-19 pandemic brought about a significant change in the emergency department’s dynamics.
As the post-pandemic era progresses, Dr Chhabra observes a positive trend with an increase in patients returning to the emergency department. This indicates a growing confidence in seeking timely medical attention. He said, “Recently, there is a rise in patients coming to the emergency department post-pandemic which is a positive sign in terms of better treatment. It has now gone back to pre-pandemic levels. During the COVID period, the range of medical education also went beyond classrooms that gave the new physicians better paramedical training.”
Dr M Shahnawaz Purkait, Medical Superintendent, Techno India Dama Healthcare and Medical Centre, Kolkata, West Bengal, highlighted the critical role of the Emergency Medicine Department. Often referred to as a short-stay unit (SSU), it is as vital as the intensive care unit (ICU) or the intensive therapy unit (ITU) in any hospital. The initial hours of treatment initiated in the ER can significantly impact a patient’s outcome.
Dr Purkait further discussed a concerning issue prevalent in many ERs across India—the subpar working conditions. He added, “ Sadly the environment existing in ERs across India is appalling.
Staffs are underpaid, overworked and are not encouraged to update their knowledge or skill levels. Working in a highly stressful environment requires incentives, perks, additional leaves and counselling which is sadly lacking.”
Improving emergency medicine
On a community level, the awareness about emergency care needs to improve. People need to know that if there is any acute problem with themselves, They should not delay the initial symptoms and visit the emergency department during the golden hour.
Dr Chhabra emphasised, “For the medical fraternity, there is a need to do in-depth research on their own department to find the loopholes. Secondly, optimizing the patient flow is very important because overcrowding will decrease the quality of treatment. Additionally, emergency visits are unexpected, and due to that some patients need to wait. During this time, these patients must be given basic care by the time help arrives. Patient feedback is also important so there is also a need for customer care service in the emergency department. This will help in improving the medical facilities.”
Dr Shahnawaz Purkait echoed, “An Emergency Doctor in charge should also have at least three years experience of working in the ICU of any renowned institute. A dedicated junior doctor should also be available and the primary physician should be available within reasonable time for expert opinion. Skilled technicians, nurses, counsellors and security personnel should be posted round the clock.”
Addressing the common challenge of burnout among emergency medical professionals due to long and stressful working hours. To mitigate this issue, Dr Chhabra expressed the need for adequate staffing to ensure that healthcare providers have a manageable workload and can maintain their well-being. He said, “This can take a toll on their mind and body. Hence, there is a need for adequate staffing.”
Another challenge highlighted by Dr Chhabra was the occurrence of violence or physical/mental harassment directed towards emergency staff members. “Most of the time, such disputes happen when there is a lack of communication with the patient. Therefore, there is a need for soft training sessions for the staff to train them in better communication and at the same time appoint adequate security in the emergency department,” he added.
Dr Purkait raised a concerning issue related to patients brought in by bystanders or the police who promptly disappear, leaving the responsibility of treatment, cost, paperwork, and legal issues on the healthcare providers. Calling for government intervention and support in such cases, he stated, “The Govt needs to wake up to this problem and pitch in and help in this matter. Treatment should be initiated for patients coming to the ER and after stabilisation shifting of patients to a higher set-up /government hospital must be done with help from the Government. This is happening in certain parts of Andhra Pradesh and should be adopted across all states.
Dr Purkait also stressed the importance of protecting the ER staff and equipment, particularly in government hospitals where such measures are often lacking. Additionally, he pointed out that inadequate infrastructure planning and design can lead to delays in shifting patients to operating rooms, diagnostic facilities, or administering life-saving drugs. He urges hospital administrations to address these issues through modifications and improvements where possible.
There is a lack of emergency-trained physicians and nurses. Therefore, it is important to work on capacity building of training emergency physicians. To attract and retain talented professionals, Dr Chhabra suggested, “At the same time, there should be proper compensation offered along with proper administrative support and a cordial environment. This gives reassurance to the physicians to do their best.”
Dr Purkait acknowledged the immense challenges faced in the emergency medicine department and asserted that not everyone can work effectively in this demanding environment. He concluded, “The challenges are huge and not everyone can work in this department. One has to have tremendous skill and all-around competence in every aspect of medicine along with a working knowledge of the law to be heading such a department. The rate of burn-out and attrition among the staff is high.”
The above insights underscore the significance of addressing challenges faced by emergency department personnel. By investing in resources, training programmes, compensation, and administrative support, the emergency medicine field can attract and retain skilled professionals. Furthermore, improving community awareness, enhancing communication skills, and establishing effective patient feedback systems can elevate the quality of emergency care and patient experiences.
Emergency Medicine Day serves as a reminder of the remarkable efforts and dedication demonstrated by emergency medical professionals.