Let’s improve our emergency care system

Monday October 21 2019



Dr Bonaventure Ahaisibwe

Dr Bonaventure Ahaisibwe 

By Dr Bonaventure Ahaisibwe

Emergencies can happen anytime and anywhere; in our homes, workplaces, schools, and the roads in between. Being prepared to handle emergencies by instituting prevention measures and ensuring quick access to high-quality care for those affected, is critical to saving lives and averting permanent disability.

It has been established that more than half of the deaths in low and middle income countries are caused by conditions that would be addressed by effective emergency care. Many of the leading causes of morbidity and mortality in Uganda present as emergencies. What then can we do to improve our emergency care system?

Consider road traffic accidents, for example. Typically, when they happen, people rush to steal wallets, handbags, and loot all kinds of resalable items. In fact, these actions have become synonymous with most accident scenes in our country.

The impact is two-fold: it makes it harder for first responders to access casualties and takes away key information, typically found in wallets and phones that could be used to aid in care and/or notify the individual’s loved ones.

The public needs to be sensitised on the proper course of action to take during such situations, including which authorities to notify, how to safely check on the condition of the victims, and what they can do to help. However, there are limitations to what the public can do during medical emergencies.

First responders play a key role in stabilising people who end up requiring emergency care, be it from injuries, sudden illness, exacerbation of existing illness, or even pregnancy-related complications and transporting them to a health facility. The health workers in these facilities are in turn critical to providing much-needed life-saving care. Providing emergency care is not the same as the day-to-day treatment of patients. It requires quick thinking to make an accurate diagnosis and appropriately intervene to prevent fatalities.

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The reality today, however, is that less than 25 per cent of our level IV health centres (the first level of health facilities designated to provide emergency care) offer 24-hour emergency care. Health workforce shortages remain a key bottleneck to provision of appropriate emergency services.

Lack of proper and sufficient structures to handle emergencies in our local hospitals usually calls for resource reallocation in cases of a mass casualty influx from an accident, for example. This disrupts routine operations and affects service delivery in general.

Putting in place proper structures specifically for handling emergencies at all times minimises disruption of routine health service delivery. The government has acknowledged the need to have these structures, as well as a specialised health workforce, to improve the state of emergency care across the country. Highly skilled health workers and availability of context appropriate protocols are essential to ensuring that emergency units are prepared to provide effective and timely emergency care.

Regular refresher trainings and professional development opportunities enable health workers to sharpen their skills and constantly create relevant emergency response plans. Unlike other illnesses, medical emergencies may not utilise traditional referral systems because of the need for immediate attention. As such, it is important to build the basic emergency care capacity of health workers across all cadres and levels.

The government can also leverage the support and partnership of different stakeholders to prioritize emergency care. At Seed Global Health, for example, we work with medical schools around the country in the pre-service training of doctors, nurses, and midwives to help strengthen access to high-quality emergency care. This is all done in collaboration with the ministries of Health and that of Education and Sports.

Health professionals are the backbone of strong health systems and the key drivers to linking communities to care. By investing in their training, we ensure that they are prepared to address the wide range of common medical, surgical, and obstetric emergencies that burden communities across the country.

It takes collective effort from across sectors for an emergency care system to function effectively. As a society, we need to continuously advocate for funding to raise public awareness, equip first responders, train health workers, adequately staff health facilities, and ensure that each is sufficiently resourced. By so doing, we can make emergency care accessible to all and prevent the resulting deaths and disability.

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