EMERGENCY MEDICINE in Public Emergency Departments in Kenya Benjamin W. Wachira Dip PEC(SA), MMed EM, FCEM(SA) Emergency Physician

EMERGENCY MEDICINE is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development. The International Federation for Emergency Medicine

Emergency care is a HORIZONTAL INTERVENTION

Kenya Care…

ED Visits (Wachira et al. 2012) Burden of Disease (WHO 2012)

ED Visits (Wachira et al. 2012) Deaths (WHO 2012)

Common treatments in the ED Wachira et al (2012)

So why Care…

…early quantitative resuscitation within the initial 6-hr period was associated improved survival for ED patients presenting with septic shock with a 15.9% % absolute reduction in 28-day mortality rate

So why Care… …each hour of delay in antimicrobial administration over the ensuing 6 h is associated with an average decrease in survival of 7.6%

So why Care… 30% of in hospital deaths are directly attributed to haemorrhage – TXA in 3 hours = 1 in 67 life saved

So why Care… Thrombolysis in 3hrs ?

So why 1 in 43 were helped (life saved, given within 6 hours) 1 in 63 were helped (life saved, given between 6-12 hours) 1 in 200 were helped (life saved, given between hours) Care…

So why Care… …WHEN YOU have your In-Hospital CARDIAC ARREST… will give you an 11% survival chance to go home neurologically intact wachira et al. (2014)

Take home message…

“Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes.” Kobusingye, Bulletin of the WHO, 2005