State of emergency

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The UAE's emergency medicine departments are facing an unusual problem - their patients are not sick enough. Abu Dhabi's Sheikh Khalifa Medical City (SKMC) estimates 90,000 patients will pass through its doors seeking emergency treatment this year. Almost 50% of these cases, says Dr Murray Van Dyke, chairman of the department of emergency medicine, are wasting valuable physician time.

"Half of the cases are low acuity," he shrugs. "[Patients] want prescription refills, they want sick leave, they want routine blood tests and X-rays that could be obtained elsewhere; they essentially want to obtain primary care."

Rashid Hospital Trauma Center is one of the largest and best equipped emergency departments in the Middle East, but Dubai's residents are tying up services with minor aches and pains. "We see here about 300 to 350 patients a day, but about 200 of them are minor problems," complains Dr Dilip Da Cruz, a consultant in emergency medicine at Rashid Hospital. "We must make our hospitals acute facilities with a rapid turnover."

But achieving this is easier said than done. One of the golden rules of emergency medicine is that everyone who presents for treatment is seen as promptly as possible. The flaw in the system is that the concept of a medical emergency is relative. "For anyone who thinks they have a medical issue, for them it will be an emergency," explains Dr Abdelhamid Reda, chief of emergency department at the American Hospital.

As a discipline, emergency medicine is a broad science that exists at the business end of healthcare. Clogging departments with cases of low acuity is not only a nuisance for physicians, but can also fatally divert resources from genuine trauma. The UAE's emergency departments may see many minor complaints, but it does not mean they avoid the major. The reality is quite the opposite. Due to its unparalleled activity in construction, and a cavalier approach to road safety, the UAE witnesses a staggering amount of trauma. For the country's embattled emergency departments, getting rid of primary care patients is only the first step.

Are you experienced?

Emergency medicine is still in its infancy in the UAE, but, as with most aspects of society, concerted efforts are being made to accelerate the development process. In April of this year, Dubai played host to McMaster University's Best Evidence in Emergency Medicine (BEEM) course. Delegates highlighted a national system battling with extremes, says Dr Andrew Worster, associate professor of the Division of Emergency Medicine at McMaster and chair of the course, reporting glossy equipment unmatched by staff skills.

"The UAE has fantastic facilities, in fact it is far superior than what we will ever have here at McMaster," he explains. "The ability to use the equipment, however, is still limited."

And while the UAE has been proactive in attracting western-qualified, specialist emergency physicians to its hospitals, translating this expertise into an effective, sustainable trauma programme will take years. Characteristically, patients in the Gulf do not regard patience as much of a virtue."What we see in the UAE is just an explosion of population and an explosion in the demand and the expectation of high quality healthcare - in the same way there is an explosion in the demand for housing, high quality hotels and entertainment," explains Van Dyke.The global popularity of television shows such as ER and Grey's anatomy has given patients an unrealistic view of the capabilities of emergency medicine, he adds. "I have never had anybody come right up to me and say you are not quite as good as George Clooney, but managing people's expectations can be a difficult thing. You just have to do the best you can, deal with it and improve any areas that you can."

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