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Emergency Care Is A Neglected Public Health Challenge

All around the world, acutely ill and injured people seek care every day.

Emergency care is a necessary part of a health system. Imagine being in a car accident, and you break your leg. There are no ambulances, no paramedics. You somehow make your way to the hospital, but when you get there, there’s no doctor. You don’t get any pain medication, splinting or washing of your wound initially. You are placed in a hospital bed, but you don’t actually get seen by a provider for over a day. This is the reality in many parts of the world.

And, of course, it’s not just trauma services that are lacking. It’s basic access to acute care for the entire spectrum of illness, for diarrhea, pneumonia, malaria, dehydration, surgical and obstetric emergencies…and the list goes on. The World Health Organization has identified acute and emergency care services as an essential part of a public health system, and a part that is severely lacking in many parts of the world. (1)

Emergency care is public health. Public health focuses on populations. Public health focuses on prevention. The emphasis is on communities, not just individuals. Emergency care shares these core tenets of public health measures. Everyone suffers from acute illness and injury at some point, young or old, male or female, pregnant or not. Emergency services are not isolated to a single disease process; they are available for those with HIV and those with high blood pressure.

Early intervention is essential. With high quality emergency care, unnecessary disability and death can be avoided. You get wound care so you don’t get an infection that ends up in a leg amputation. You get an antibiotic so you don’t die from your pneumonia. You get hydration to prevent needless death from diarrhea. What’s more, emergency care services can link people to primary care services. For many who are poor, the only point of access to the health care system is when they are in dire straits and come to the ER. Screening for HIV, malnutrition, high blood pressure, and diabetes in the ER can lead to chronic care for these conditions.

 

Emergency care systems are essential for natural and humanitarian disasters as well. Not only for the next earthquake or civil war but also for the next Ebola or Zika outbreak. Emergency systems are indispensable for disease surveillance, to recognize outbreaks early in order to mitigate them.

Emergency care is effective. Our organization, Global Emergency Care, has found that for every 41 children under five treated with emergency care for severe malaria, one life will be saved. This is comparable to other essential public health services such as vaccines. Moreover, emergency care can also be cost-effective. Proper training in emergency care can make the best use of existing resources, including basic medical supplies and essential medications such as antibiotics and intravenous fluids. Task-shifting emergency care from physicians to nurses, particularly in rural settings, can make the best use of health care providers and resources in locations where there is an enormous human resource gap. (2)

Emergency medicine is so much more than depicted in shows like “ER.” Emergency care is a part of a public health system to provide care for all.

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1.  Hsia R, Mbembati N, MacFarlance S. et al.  Access to emergency and surgical care in sub-Saharan Africa:  the infrastructure gap.  Health Policy Plan. 2012;27:234-244.
2.  Terry B, Bisanzo M, McNamara M, et al.  Task shifting:  meeting the human resource needs for acute care in Africa.  African J Emerg Med.  2012;2:182-187.
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