Emergency medicine

One of the longest-running primetime TV series in the US was “ER”, with some 300 episodes between 1994 and 2009. The show, which revolved around an emergency room in an American hospital, was written by Michael Crichton of “Jurassic Park” fame, but who was a physician as well.

I’ve heard, many times over, from people who say they were partly inspired to enter medicine and other health professions because of their exposure to “ER” and the attraction of “heroic medicine,” with its adrenaline-driven staff running around and barking out instructions to save lives.

Beyond ERs though, there’s a whole field of emergency medicine or EM. I wasn’t even aware that EM had developed into a medical specialty, with its own association, the Philippine College of Emergency Medicine, and an Asian Association for Emergency Medical Services, the two organizations teaming up for a regional conference just this week in Davao City.

I only stayed a day, but was fascinated by the presentations as well as the exhibits. Unlike other medical conventions, the exhibits were mainly medical and life-saving equipment. The exhibit hall looked like a scene from the TV series “The Walking Dead,” with human mannequins lying on the ground all over, some just heads, others just the head and torso like the aswang! These were actually robotic pieces used to simulate emergency cases, and that can be used to practice procedures like the use of AED or an automated external defibrillator, which checks heart rhythm and uses shock waves to revive a patient with cardiac arrest.

Cardiopulmonary resuscitation, which Boy Scouts learn to administer manually, can now be done with a machine. One exhibitor showed it being administered to a “patient” wearing a Spider Man mask, a cute way of reminding people that anyone can get into a medical emergency situation.

The convention lectures were, of course, more important, highlighting how the gains around emergency medicine are low-key and slow-paced, the product of intense training of EM practitioners, research looking into the outcomes from specific procedures, and lobbying for laws to support quick responses to medical emergencies.

We take some of these advances for granted, like 911 and other emergency phone lines to call. The lectures also dealt with how emergency services remain inaccessible or inadequate for many, maybe even most, people.

There was a moving film in the lecture of Dr. Sarji Muldong of the International Committee of the Red Cross showing a man driving frantically through the streets of a war-torn area, with a very sick daughter at the back of the car. He gets to the hospital site, gets out of the traffic carrying his daughter… and finds that the hospital has been bombed out. Sarji spoke, too, about the need to respect medical neutrality: allowing health personnel to render vital emergency services in areas of conflict.

We have many more dramatic situations played out daily in our ERs, mainly caused by the lack of financial resources (for the hospitals, and for patients), as well as the lack of public awareness of medical emergency situations.

This is where legislation can be useful. Taiwan has a law requiring AEDs in such places as large malls, schools and public transport vehicles. Dr. Pauline Convocar, who headed the conference’s scientific committee, told me one of the “best” places in the Philippines to get a heart attack is a gym or fitness center, because these places do have AEDs.

Dr. Michael Chia, a Singaporean physician who spoke before me, had video clips showing what cellphone apps could do in times of emergencies, including trained personnel giving instructions, by phone, to a relative or friend on what can be done while waiting for the emergency technicians.

The more developed countries have advanced rapidly, all the way up to having cellphone apps connected to emergency lines, and drones being dispatched to deliver an AED, which would be so useful when you’re caught in one of Metro Manila’s traffic gridlocks.

Emergency medicine isn’t just about ERs. On my way to the airport to leave for Davao, I visited an elderly Catholic sister in her congregation house and found, tacked on the wall near their phone, a list of signs that might indicate that a person may be having a stroke. That kind of knowledge should be imparted in our schools, together with medical first aid skills.

Like disaster response programs, emergency medicine should become part of our schools and communities.

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