Madam, we read the editorial of June 2012 entitled "Overcrowded emergency departments: A problem looking for solution" wherein the authors presented a well-balanced paper highlighting the causes and solutions of overcrowding in our ERs (Emergency Rooms).1 With the ever increasing population of Karachi and the limited number of hospitals with well-equipped emergency rooms-both in public and private sector, overcrowding is an obvious problem. When we look toward the ERs of public sector hospitals the situation is much bleaker and requires immediate attention (Table).
Overcrowding tops the list and the contributory factors are more or less the same as discussed by the authors in the editorial. Some additional factors contributing to overcrowding are lack of available space in the wards causing an obvious backload on the ER, the large number of walk-in patients many of whom could have been dealt with at lower level health care facilities,2 and the large number of attendants accompanying the patients. With proper functioning ERs, patient admissions are reduced which reduces load from the hospital itself and would be beneficial for those who truly require hospital care.3
Another problem on the list is the aggressive, rude, humiliating and sometimes even life threatening behaviour of the patients and attendants. It cannot be controlled by the limited security staff available and many incidents of violence have been reported time and again. This can lead to adverse psychological problems in the staff effecting their productivity and efficiency.4
Lack of funds and resources both in terms of treatment modalities and work force is also identified as a problem. This is a problem globally.5 It requires urgent attention.
Language barrier is also an issue as these hospitals receive patients from all over Pakistan. People belonging to different ethnicities and speaking their local language causes an obvious communication gap and carries a risk of misinterpretation. Chan et al proposed the idea of interpreter services.6 Interpreters are present in many private sector hospitals but lacking from the public sector hospitals where they are mostly self-arranged by the attendants or the staff.
Hospitals also need to improve their emergency response plans to manage the extra patient load in times of emergencies like bomb blasts/suicide attacks, plane/train crashes and natural calamities. Better communication and patient mobilization protocols need to be established between the various hospitals of the city.
Emergency medicine is an emerging prospect in Pakistan, proper planning and management is required at all stages. Better infrastructure and sufficient fund allocation are the demands of the time and population boost.
Muhammad Danish Saleem, Mohammad Osama Anwer, Mustafa Abbas
4th Year Students, Dow Medical College, Dow University of Health Sciences, Karachi.
Corresponding Author: Muhammad Danish Saleem.
1. Chmiel C , Huber CA, Rosemann T, Zoller M, Eichler, Sidler P et al. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison. BMC Health Serv Res 2011; 11: 94.
2. Kellermann AL. Crisis in the emergency department: N Engl J Med 2006; 355: 1300-3.
3. Belayachi J, Berrechid K, Amlaiky F, Zekraoui A, Abouqal R. Violence toward physicians in emergency departments of Morocco: prevalence, predictive factors, and psychological impact. J Occup Med Toxicol 2010; 5: 27.
4. Ezaki T, Hashizume M. Emergency medicine in Japan. A look at a current university hospital and the problems faced. Emerg Med Australas 2007; 19: 296-9.
5. Chan YF, Alagappan K, Rella J, Bentley S, Soto-Greene M, Martin M. Interpreter services in emergency medicine. J Emerg Med 2010; 38: 133-9.