Razzak, Junaid

Siddiqui, Emaduddin

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eCommons@AKU

eCommons@AKUDepartment of Emergency Medicine Medical College, PakistanJanuary 2008Pediatric emergency medicine--an evolving sub-speciality in PakistanEmaduddin SiddiquiAga Khan University, emaduddin.siddiqui@aku.eduJunaid RazzakAga Khan University, junaid.razzak@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_medPart of the Emergency Medicine Commons, and the Pediatrics CommonsRecommended CitationSiddiqui, E., Razzak, J. (2008). Pediatric emergency medicine--an evolving sub-speciality in Pakistan. Journal of the College of Physiciansand Surgeons Pakistan, 18(3), 135-136.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_med/178Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (3): 135-136 135Before 1945, there was little evidence for existence ofpediatric emergency medicine as practiced today.1During the French revolution, witnessing the speed withwhich the carriages of the French Flying Artillerymanoeuvred across the battlefields, French militarysurgeon Dominique Jean Larrey applied the idea ofFlying Ambulances for rapid transport of woundedsoldiers to a central place where medical care was moreaccessible and effective. Emergency medicine is a medical speciality - a field ofpractice, based on the knowledge and skills required forthe diagnosis, management and prevention of acute andurgent aspects of illness and injury affecting patients ofall age groups with a full spectrum of undifferentiatedphysical and behavioural disorders. It furtherencompasses an understanding of the development ofpre-hospital and in-hospital emergency medical systemsand the skills necessary for this development."(International Federation for Emergency Medicine1991).2Emergency Medicine (EM) as a medical speciality isrelatively young. Prior to the 1960's and 70's, hospital"emergency rooms" were generally run by physicians onstaff at the hospital on a rotating basis.2 PediatricEmergency Medicine (PEM) is an even newer conceptthan Emergency Medicine and ties the specialities ofpediatric and emergency medicine.  This is based on thefact that the disease patterns, their manifestation,management and complications as well as thephysiology, anatomy, etc. differs between children andadults. While training in both the emergency medicineand pediatrics covers some aspect of pediatricemergency medicine, they do not do a comprehensiveenough job. Thus, in some developed countries,pediatric emergency medicines has evolved as a sub-speciality of EM and pediatrics.  Since its formal recognition as medical sub-speciality,PEM has made substantial advancement with respect toits scope and sophistication in both the clinical and inresearch. Pediatric emergency medicine spans care provided inthe pre-hospital and in-hospital arena and includes alltypes of medical and surgical emergencies of children.Over the last 20 years, significant advances andimprovements have occurred in the delivery ofemergency care to children, including emergencymedicine residency training in pediatric emergencies,pediatric trauma care, pain management for children,pediatric drug dosages, pediatric equipment/supplies inemergency departments and on ambulances, and anational poison control system. With these great strides,the practice of pediatric emergency medicine continuesto evolve.3The care provided is dependent upon physicians andnurses qualified and trained to provide care, but also onthe facility setup, availability of resources and back-up ofappropriate specialists at the hospital.  Pediatricians and emergency physicians had long-recognized the special needs of children who requireemergency care. In most general EmergencyDepartments (EDs), 20-30% of visits involve patientsunder 16 years of age. Most children's hospitals haveEDs that see only children.4 Visit acuity analysisindicates that urgent and life-threatening conditions areless severe and common in pediatric than adultpopulations,5 these can be managed accurately andimmediately with less chance of adverse consequences.This needs the trained, experience and skilled pediatricemergency physicians.Since there is extreme paucity of pediatric EMspecialists, most pediatric emergency care will continueto be provided by general emergency physicians.6Reflecting this reality, there have been recentimprovements in pediatric EM training for all EMresidents. Sub-specialists in pediatric EM have a uniquerole in advocacy, education and research for thepediatric population.7Advancing injury and disease prevention remains thegreatest challenge in improving the care of children.8Maintenance of pediatric resuscitation skills is a newdilemma caused by the national decrease in pediatricDepartment of Medicine,  The Aga Khan University Hospital,Karachi.Correspondence: Dr. Emad Uddin Siddiqui, Sr. Instructor,Section of Emergency Medicine, Department of Medicine,The Aga Khan University Hospital, Stadium Road,P. O. Box. 3500, Karachi-74800.E-mail: emaduddin.siddiqui@aku.eduReceived  March 4, 2008; accepted  March 8, 2008.Pediatric Emergency Medicine - An Evolving Sub-Speciality in Pakistan Emad Uddin Siddiqui and Junaid A. Razzak EDITORIALmorbidity and mortality. Future controversial issues toaddress include the national debate of disease pattern,type of physicians who take care of pediatric emergencypatients and whether there is a need for pediatric facilitystandards.9,10United States and Europe has formulated and designeda rationale, well-developed and advanced trainingprogram in pediatric emergency medicine for residencyand post-fellow trainings.Still more have to be done on several aspects ofpediatric emergency medicine, such as out of hospitalemergency medicine services, trauma care, emergencycare team development and quality of data recordingsetc.Adequately designed and structured residency trainingprograms is the standard model for the PEM speciality. Atthe same time, the post-fellowship training programs ofone to two years are similarly effective. Thus, providingthe PEM fellow an additional skills and knowledge withhand on experience in an entirely vacant field with plentyof opportunity for research and growth. In developing countries like Pakistan, because of limitedresources, lack of commitments, social and politicalissues, we are still far behind the initial target. There arenumbers of emergency section in both public andprivate sector hospitals. The public sector pediatrictertiary hospitals have their separate status as pediatricER, with their pediatric residents (year two or three) whoruns the ER 24 hours a day on rotation basis, usuallywithout the trained/qualified faculty coverage, who cantrained and teach them in the ER. The situation is evenworse in general private hospitals having a single room,where both the pediatric and adult patients are managedmost of the time by the same physicians. Thesephysicians with little experience or not at all  in pediatriccare, treat children, who require specialized care. Training in pediatric emergency medicine should beformulated, structured, programmed and implementedwith a rationale motivation. Undergraduate, graduateand post-fellow training program should be designedand developed according to our scenario. The westerntraining program can also be followed. The problem ofinitial skilled physicians is standing in front of us. Thiscan be overruled by awarding the scholarships to thedevoted and motivated physicians, who are interested toattain the desired training. They are more helpfull increating the system and becoming role model for others.What required is the commitment from the desiring anddeserving candidates and support from system,department, university, ministry and the government.Nowhere in Pakistan, the emergency medicine trainingis functional. We have to trace down the path.REFERENCES1. McGillivray D, Jarvis A. History of paediatric emergencymedicine in Canada. Paediatr Child Health 2006; 12: 453-6.2. Wikipedia: the free encyclopedia [internet]. San Francisco (CA):Wikipedia Foundation Inc. Emergency Medicine; [updated2007 Aug 18; cited 2007 Oct 31]. Available from: http://en.wikipedia.org/wiki/Emergency medicine. 3. American College of Emergency Physicians. A decade ofadvancements in   paediatric emergency care. [internet]. [cited2006 Jan 31]. Available from : http://www.acep.org/webportal/PatientsConsumers/HealthSubjectsByTopic/Pediatrics/FactShe-tADecadeofAdvancementsinPediatricEmergencyCare.htm. 4. Sinclair D. Sub specialization in emergency medicine: where dowe go from here? CJEM 2005; 7: 344-6. 5. Pena ME, Snyder BL. Pediatric emergency medicine. Thehistory of a growing discipline. Emerg Med Clin North Am 1995; 13:235-53.6. Baker MD. Physician coverage in the pediatric emergency room:a national survey. Am J Dis Child 1986; 140:755-7. 7. Chande VT, Krug SE. Practitioners of pediatric emergencymedicine: a 5-year longitudinal study. Pediatr Emerg Care 2001; 17:237-9. 8. Rivara FP, Grossman DC. Prevention of traumatic deaths tochildren in the United   States: how far have we come and wheredo we need to go? Pediatrics 1996; 97(6 Pt 1):791-7. 9. Guidelines for pediatric emergency care facilities. AmericanAcademy of Pediatrics Committee on pediatric emergencymedicine. Pediatrics 1995; 96 (3 Pt 1):526-37. 10. Eitzen E Jr, Schafermeyer RW, Strange GR. The role of theemergency physician in providing pediatric emergency care: amembership survey. Ann Emerg Med 1990; 19: 532-5. 136 Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (3): 135-136Emad Uddin Siddiqui and Junaid A. Razzak● ● ● ● ●✯● ● ● ● ●

Pediatric emergency medicine--an evolving sub-speciality in Pakistan

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Pediatric emergency medicine--an evolving sub-speciality in Pakistan

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