21 November 2019 01:37 am Views - 2028
Sri Lanka’s first batch of qualified emergency physicians is now working at different hospitals across the island, trying to save the lives of patients who require immediate medical care. Trained at the Postgraduate Institute of Medicine, they are then sent to Western countries such as Australia and UK to gain experience in the field. The primary task of an emergency physician is to manage the first four hours of a critically ill patient’s life.
Speaking to the DAILYMIRROR, Acting Emergency Physician at the National Hospital of Sri Lanka Dr. Nilanka Wickramaratne (MBBS, DCCM, MD – Emergency Medicine) shed light on the tasks vested upon an emergency physician and progress made in ETUs thus far.
“Triaging is where we sort the patients according to the severity of illness,” he explained. “After checking them we put them to Categories one through four. One is deemed as urgent. Urgent cases require immediate attention and are therefore sent to a resuscitation area in the emergency department. The first four hours of a patient’s life is quite critical. Therefore you need to decide what to do with the patient. They can either be admitted to a ward or discharged. For example, if a patient is having chest pain we need to get an ECG and treat him in the first 60-90 minutes. If there’s a clot in the heart then it needs to be dissolved. If there is any delay, the patient’s life would be at risk.”
The policy further states that the ‘platinum 10 minutes within the golden hour’ should be preserved in order to minimise untimely deaths, complications and long term disabilities
He further said that the accident and emergency department deals with patients undergoing trauma or have experienced medical or surgical emergencies. “The Karapitiya Hospital has one Accident and Emergency centre where as the Colombo National Hospital has no common triage centre. The Accident service and ETU at NHSL serves as separate units. According to the data that has been received 25-30% of cases are related to some sort of trauma while 65-70% of them are medical emergencies. These include heart attacks, breathing difficulties, strokes, pneumonia, infections etc. Fevers could also be critical from time to time,” he said.
According to the policy, pre hospital care service could also be a retrieval service which includes a fully trained team including medical experts attending to a patient on site or scoop and run with minimal intervention to the nearest hospital. The policy further states that the ‘platinum 10 minutes within the golden hour’ should be preserved in order to minimise untimely deaths, complications and long term disabilities. Therefore retrieval teams and paramedical teams would be established, based on the selected suitable pre hospital medical care model for Sri Lanka.
If it’s not a life threatening case and the patient does not have the capacity we will take steps to talk with patient’s next of kin and to manage patient in the best interest of the patient
Dr. Wickramaratne opined that during an emergency one doesn’t need to get consent from the family members to admit a patient because everything is being done in the best interest of the patient. “Here we check the capacity and competency of the patient which is where we check if the patient is able to take a decision. If it’s not a life threatening case and the patient does not have the capacity we will take steps to talk with patient’s next of kin and to manage patient in the best interest of the patient.”
According to statistics at least 15 in 100,000 people die every year in Sri Lanka as a result of road accidents. Therefore, accident and emergency care is a much needed specialty of medicine given the rising number of such incidents being reported in the country. With paramedics being deployed, many lives could be saved during a patient’s journey to the hospital. But for this service to be efficient, an efficient ambulance service is required. On the other hand, by educating the communities, they would take initiative to save a person’s life till he reaches the hospital for further medical assistance.