Trauma care in Egypt: how to efficiently meet patients' needs?



Tue, 18 Jul 2017 - 04:11 GMT


Tue, 18 Jul 2017 - 04:11 GMT

A picture shows intensive care unit in Cairo’s Mounira Hospital, Photo taken by Dina Romiya

A picture shows intensive care unit in Cairo’s Mounira Hospital, Photo taken by Dina Romiya

CAIRO – 18 July 2017: A minimum of 3,000 hospital beds are needed in intensive care units nationwide to safely care for accident victims, according to a government official in charge of the nation's 6-year-old Central Administration for Critical and Urgent Care (CACUC).

The government established the Central Administration for Critical and Urgent Care (CACUC) in 2010; prior to that burn units, poison centers, and neonatal wards were operating "inefficiently," and without regulated government oversight, head of the administration Dr. Khaled El-Khateeb said in an interview.

“Egypt should pay utmost attention to trauma care and services,” said El-Khateeb, and cited citizens’ complaints over lack of beds at intensive care (ICU) and burns units.

“That’s why we chose the toughest task, which is bringing all these departments to work under the administration,” continued El-Khateeb.

At least 3,675 people died in Egypt in 2015 from preventable injuries including road accidents, burns, poisoning and other causes.

El-Khateeb noted that the emergency sector has faced many challenges since 2011. He said Sinai is witnessing a war against terrorism, and that deaths due to violence-related injuries are high.

Statistics provided by the CACUC, although not comprehensive, showed that violence incidents including fights, armed assaults, and bomb attacks amount to around 21 percent of the total 7,053 cases cited last year.

According to the World Health Organization (WHO,) injuries and violence are among the most prominent public health problems globally, and a leading cause of mortality; many of the non-fatal injuries result in health consequences and life-long disabilities.

A huge fire erupted May 9, 2016 at a Cairo hotel and extended to four other buildings in El-Roweay district, in Ataba, leaving dozens injured. Photo by Hassan Mohamed

On the top of a list containing 29 types of incidents resulting in injury in Egypt, traffic crashes are responsible for 53.3 percent of the total. Around 3 percent of the road injuries suffer disability, El-Khateeb said.

Cairo, the capital, experienced the highest number of incidents in 2015, recording 850, while the restive area of North Sinai saw 279, according to the administration’s report.

Critical Care administration units - Logo provided by Khaled el-Khateeb

Where does Egypt stand in trauma care?

“Talking about trauma care mainly means swift ambulance service, and good emergency care,” said El-Khateeb, adding that the administration in first focused on assessing the status-quo of emergency departments after former health ministers upgraded the ambulance sector with a new fleet.

ambulance vehicle in cairo
Ambulance vehicle in Cairo - Reuters

Egypt currently has approximately 10,300 intensive care beds in both public and private hospitals; the figure is “very low” compared to other countries, said El-Khateeb.

“Egypt’s rate is one [hospital] bed for every 9,000 citizens; in some neighboring states, it is one bed for 7,000 citizens, while in the U.S., the rate is one bed for evert 5,000,” he added.

El-Khateeb, at least 3,000 additional intensive care beds are needed so that the country can meet the public's need for urgent services, “but both public and private hospitals should share responsibility to provide them.”

The head of the administration added that “around 1,300 incubators are also needed at pre-term birth care units.”

He also noted that the emergency sector suffers lack of staff, citing students’ reluctance to register at medicine faculties, due to low salaries and incentives, he said.

“We do not ignore the fact that there are deficiencies in the emergency care units; however, we have short- and long-term plans to eliminate such deficiencies because maintaining people’s health is our mission,” El-Khateeb added.

Egypt’s to-do-list for injury prevention

As part of the ministry’s short-term development plan for emergency departments, El-Khateeb stated that 300 new intensive care beds, 500 incubators and 28 burns units will be added by the financial year 2016/2017. The total cost of the plan for the same FY is around 150 million EGP ($150,000).

According to a 2014 WHO report on injury prevention, more than 5 million people die each year as a result of injuries, making 9% of the world’s deaths, nearly 1.7 times the number of fatalities that result from HIV/AIDS, tuberculosis and malaria combined.

Illustration shows deaths as a result of injury per year exceeding rate of infection with serious diseases. Photo taken from a 2014 report by World Health Organization on Injury prevention.

El-Khateeb explained that a plan to prevent injuries has been designed by the administration, in cooperation with WHO, based on two axes: therapeutic and preventive measures.

Reporter Nourhan Magdi interviewing Dr. Khaled el-Khateeb, head of Central Administration for Critical and Urgent Care.

First, the therapeutic care includes: raising efficiency of hospitals by classifying them into three categories of A, B and C, and providing them with emergency devices according to their proximity to highways and the number of trauma patients checking in.

The Ministry of Health has cooperated with WHO in conducting training sessions to 300-400 doctors and 200-300 nurses in emergency, burns and intensive care services, El-Khateeb added.

An awareness campaign, funded by WHO, is among preventive measures, with TV ads and printed flyers aiming at raising people’s and students’ awareness against all types of injuries.

Road injuries: pre-hospital care

Cairenes are used to the gridlock of mid-day traffic, when a trip of four miles can take almost an hour as cars snake bumper-to-bumper along the capital's main streets. Among those caught in the standstill, however, are ambulances and other emergency workers, exacerbating the problem of health care in a country which sees more than 10,000 fatal road accidents annually, according to U.N. and WHO figures.

Despite road accidents being on the top of Egypt’s agenda with newly established roads, renewed bridges and drug screening carried out to drivers, annual death toll as a result of traffic injuries is still on the rise.

In 2015, Egypt’s road accidents recorded an increase, reaching 14,548 resulting in 6,203 deaths, 19,325 injured and 19,116 damaged vehicles, according to a latest report by the Central Agency for Public Mobilization and Statistics (CAPMAS.)

bus accident
A tour bus crashed into a truck in Abu Simbel, Aswan in 2010 - Reuters

By 2030, road traffic injuries are predicted to become the 7th leading cause of death, according to WHO report.

“Unfortunately, victims of traffic injuries are mostly youth,” El-Khateeb said, adding that one of the main long-term projects he seeks to adopt is establishing trauma centers on highways.

He explained “instead of waiting until the injured is transferred to an internal hospital inside a governorate, which would cost him his life, trauma centers will be built to provide urgent pre-hospital care to stabilize the patient.”

Egypt is among the 10 states enrolled in the UN Decade of Action program for road safety that aims to halve the rate of traffic deaths by 2020.

This interview was carried out last year and re-published by Egypt Today.



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