A Center of Excellence in Emergency Medicine of Bangladesh

Emergency Medicine (EM) is a relatively new and dynamic specialty. The idea of Emergency Medicine was first introduced during French revolution by the French military surgeon Dominique Jean Larrey (Father of Emergency Medicine), by his use of “flying carriages”, bringing injured soldiers from war fields to the nearest hospital. But, it was not until 1970 when the first residency training on EM was introduced at the University of Cincinnati. In 1971, the first Emergency Department (ED) was established at the University of Southern California. Finally, in 1979, Emergency Medicine was recognized as a separate specialty in the USA. In the UK, the College of Emergency Medicine (CEM) was formed in 2004.

In Bangladesh, Emergency Medicine was first introduced officially by the BSEM (Bangladesh Society of Emergency Medicine) in 2009. Since then BSEM has been organising international workshops and seminars every year. It is not so far away when Emergency Medicine will be one of the most demanding post graduate specialties in Bangladesh like in the western countries.

The Emergency Department at United Hospital is one of the best in Bangladesh in terms of its infrastructure, diversity in patient base and the availability of expert emergency physicians & nurses. It has now also become one of the most dynamic academic venues for teaching and learning various skills and knowledge on emergency management.

The Emergency Department in United Hospital can be divided into four major sections. The first and the most important section is the “Triage Area” which comprises of a nursing station, a reception / customer service & accounts area and a waiting area. The second section is the “Critical Area” with three beds. The third section is called “Non Critical Area” comprising of eight beds. The fourth section is the “Observation Area” which has three beds. There is a “Minor OT” for minor wound repairs & dressings and a “Full Fledged OT” for major wound repair & procedures. The area also has a “Doctors Room” for OPD consultations & counselling and the recent addition of an “A&E Skill Lab” room for hands on practice and learning of different emergency procedures.

All Emergency doctors and nurses have training opportunity on many emergency procedures and management. The emergency department provides service 24 hours a day and 7 days a week. Ambulance service is also available for both critical and non-critical patient transfers. On January 2 and 3 2015, two emergency physicians from United Hospital participated in EMICON 6 (6th International Conference on Emergency Medicine) as invited speakers and faculty for the ATLS station at Trauma Workshop organized by BSEM. Later that month a daylong “Workshop on Emergency Medicine” was held at United Hospital. On 7 May 2015, the first A&E skill lab of the country was founded in United Hospital.

Being part of this recent academic revolution, all emergency physicians and some indoor doctors have been motivated to pursue their future career in the field of emergency medicine by showing their willingness to sit for the UK based MCEM (Membership of the Royal College of Emergency Medicine) exams. All study materials are from the UK and a first MCEM study group is being formed.

Note: These rates are inclusive of return trip; the distance that the ambulance will cover while going as well coming back to the hospital, needs to be calculated.

Extra charge of TK. 500/= (five hundred) will be added for each waiting period of one hour after the first hour.

The rapid changes in the teaching and learning methods in medical field along with tremendous growth of technology challenged the traditional way of clinical skills development that led to the emergence of clinical skills laboratories (CSLs) or Skill Labs worldwide. This Skill Lab teaches emergency physicians and nurses the critical skills that are needed for critical patient management and allows practicing procedures that are performed on day-to-day basis in the emergency department.

Skill Labs provide a safe and protected environment in which the learner can practice clinical skills before using them in real clinical settings. Worldwide, the first Skill Lab was established in Maastricht, The Netherlands Limburg University in 1976.

Since then many medical schools and educational institutions have integrated Skill Labs into their curricula. Currently, Skill Labs have been established in several innovative medical schools including the University of Leeds, Dundee, Dublin, Southampton, Liverpool, and the Imperial College. In the Arab world, the United Arab Emirates University was the first to establish Skill Labs in 1988.

In Bangladesh, the first A&E Skill Lab was established on 7 May 2015 at United Hospital. It was founded by two dedicated emergency physicians based on their prior work experience in the USA and Trinidad.

Being the first in its category, the work and training in the skill lab at United Hospital has been progressing well with the cooperation from all specialty departments. The department prepares a monthly calendar with training sessions held every fortnight. So far about 25 Skill Lab sessions have been organised in A&E department. As a result there has been a huge impact in the practice of Emergency Medicine.

1. Introduction of “Silent CPR” concept in A&E department.
2. Nursing priority during code blue has been revised and training being given periodically.
3. A nursing “Code Blue Roster” is being maintained per shift.
4. Nurses are being trained on “A&E Triage” following UK based 5 level triage scale.
5. A separate designated area for “A&E Skill Lab” has been established.
6. The idea of “Shift In–Charge” ER doctor has been initiated.