2nd Mediterranean EM Congress - Barcelona. 17 September Emergency Medicine. Kuwait. Sawi,, MD. Nadeem Al-Duaij, MD 1

Transcription

1 Emergency Medicine Kuwait Nadeem Al-Duaij, MD Akmal El-Sawi Sawi,, MD Nadeem Al-Duaij, MD 1

2 SCOPE Background Healthcare EM Challenges Strategies Summary Nadeem Al-Duaij, MD 2 Nadeem Al-Duaij, MD 2

3 BACKGROUND (1) Constitutional monarchy Sabah 1756 Independence 19 June 1961 Size km2 (NJ) Population % non-kuwaitis vs. 38% Kuwaitis 69% yrs; 28% yrs Ethnic groups Kuwaiti 45% Other Arabs 35% South Asian 9% Iranian 4% Nadeem Al-Duaij, MD 3 Nadeem Al-Duaij, MD 3

4 BACKGROUND (2) GCC member 92% Kuwaitis government employees GDP per capita $ % crude oil reserves 90% export revenues 75% govt income ½ GDP Welfare system Nadeem Al-Duaij, MD 4 Nadeem Al-Duaij, MD 4

5 HEALTHCARE (1) Public system 8% govt expenditure (1998); 4% GDP Primary care local clinics (~70) 5 regions w/ 1 major med ctr (2539 beds) 9 specialized centers (2157 beds) Medical care free for all Token fee for expats since mid-90s Health insurance planned Private system 8 hospitals Kuwaitis & NK charged equally Charges low compared to West Small facilities (total 565 beds) Nadeem Al-Duaij, MD 5 Nadeem Al-Duaij, MD 5

6 HEALTHCARE (2) Burden of Disease* Life expectancy 76 yrs Mortality Cardiovascular diseases (44.3/ ) 000) Cancer (23.7/ ) 000) Traffic accidents (16.2/ ) 000) Contemporary diseases Diabetes (KDA 20% of population; highest rate of T1DM in region) HTN Obesity * Health & Vital Statistics Division, Dept. of Statistics & Medical Records, Ministry of Health Kuwait Health Kuwait th Edition. Nadeem Al-Duaij, MD 6 Nadeem Al-Duaij, MD 6

7 HEALTHCARE (3) Medical Education Faculty of Medicine 1973 Health Sciences Center year program (premed, preclinical, clinical) Mandatory internship in IM, surgery, OB/GYN & peds KIMS established 1984 GME Kuwait Board Certification Scholarships CME Nadeem Al-Duaij, MD 7 Nadeem Al-Duaij, MD 7

8 EM STATUS GENERAL Specialty recognized 1992 (MOH) Kuwait Society of Emergency Physicians (est. June 2003) organized EM system/gme/journal Local MDs trained abroad ED staff Expats w/ EM/IM/surgery experience 2 nd /3 rd yr EM residents 3 established EDs trauma centers EMTALA/Good Samaritan-like laws enforced Nadeem Al-Duaij, MD 8 Largest census Jahra Hospital visits 2001 ED visits in Kuwait in Nadeem Al-Duaij, MD 8

9 EM STATUS PREHOSPITAL Department of EMS National emergency no. 777 BLS/EMT ambulances Training EMT, paramedic, ambulance driver UK standards/curricula Disaster planning QA ISO 9002 (since 1997) Coast Guards Nadeem Al-Duaij, MD 9 Funding: Variable budget according to need Budget mainly goes into education & equipment Air medical transport: Kuwait Air Force helicopter Dept. of EMS has one major dispatch center + one backup center Calls to 777 Ministry of Interior dispatch center operated by police force trained in BLS if health-related dispatched to main EMS center dispatched to local community EMS Nadeem Al-Duaij, MD 9

10 EM STATUS HOSPITAL Mubarak Al-Kabeer Hospital ED 400 bed general hospital 1 st integrated medical/surgical dept (1992) Pediatric ED (2001) Radiology suite ( ( CT or U/S) On site ortho surgeon ( ( ortho dept) Coverage Census adult visits 2001!! ¾ visits non-emergent, non-urgent Adult ED: 20 physicians/50 nurses ED pharmacy Nadeem Al-Duaij, MD observation beds (22 female / 25 male) 1 resuscitation bay with 4 beds 2 operating rooms for minor procedures Shifts: Morning 8 am 2:30 pm Afternoon 2:30 pm 10 pm Night 10 pm 8 am 4 physicians (including 1 senior) & 10 nurses per shift Nadeem Al-Duaij, MD 10

11 CHALLENGES IN EM EDs Overcrowding Training Triage Protocols Logistics Prevention Communication EMS Education Motivation Maintenance Equipment Schedule Nadeem Al-Duaij, MD 11 Nadeem Al-Duaij, MD 11

12 CHALLENGES IN EMS CHALLENGES STRATEGIES EDUCATION clear cut responsibilities EMS collaborating w/ College of Health Sciences to establish BA in EMS MOTIVATION Low salaries Overcrowding/demanding patients Stipend increase MAINTENANCE Poorly qualified mechanics Unused vehicles/devices Unresolved EQUIPMENT defibrillators Unresolved Nadeem Al-Duaij, MD 12 Major concerns 1. Limited to BLS 2. Lack of public confidence 3. Lack of laws & regulations protecting EMS personnel Nadeem Al-Duaij, MD 12

13 CHALLENGES IN THE ED CHALLENGES OVERCROWDING (1) Underused clinics Ease of access Social behavior standards communication between PCP & ED TRAINING ACLS/PALS/ATLS standards in GME requirements time factor administrative skills TRIAGE Virtually inexistent EP serves as triage nurse Uncontrolled patient flow PROTOCOL guidelines/protocols/sops Clinic opening hours Educate patients during ED visits Public relations Invited ACLS instructors GME in Canada & USA Kuwaiti Board Kuwait Society of Emergency Physicians Unresolved Unresolved STRATEGIES 1. Shah NM, Shah MA, Behbehani J. Predictors of non-urgent utilization of hospital emergency services in Kuwait. Soc Sci Med 1996; 42(9): Nadeem Al-Duaij, MD 13 Limiting factors in overcoming challenges 1. Slow, inefficient administration 2. Poor communication 3. Threatening medico-legal environment 4. Lack of motivation due to job security 5. Disregard for cost-effective measures due to country s wealth & free healthcare 6. Absent quality assurance measures 7. Lack of research/collaboration with mature systems Nadeem Al-Duaij, MD 13

14 SUMMARY Underdeveloped/developing system EM recognized/1 st dept GME or journal KSEP 2003 Anglo-American American EMS model Major challenges organized EM structure protocols/training Overcrowding Public education Nadeem Al-Duaij, MD 14 Nadeem Al-Duaij, MD 14