Death on the Roads

Death on the Roads

Save the date:

Why? Because road victims will be remembered that day. Starting from 2005, The World Day of Remembrance for Road Traffic Victims is held on the third Sunday of November each year to remember those who died or were injured from road crashes (1).

Road traffic injuries kill more than 1.35 million people every year and they are the number one cause of death among 15–29-year-olds. There are also over 50 million people who are injured in non-fatal crashes every year. These also cause a real economic burden. Total cost of injuries is as high as 5% of GDP in some low- and middle-income countries and cost 3% of gross domestic product (2). It is also important to note that there has been no reduction in the number of road traffic deaths in any low-income country since 2013.

The proportion of population, road traffic deaths, and registered motor vehicles by country income, 2016 (Source: Global Status Report On Road Safety 2018, WHO)

Emergency care for injury has pivotal importance in improving the post-crash response. “Effective care of the injured requires a series of time-sensitive actions, beginning with the activation of the emergency care system, and continuing with care at the scene, transport, and facility-based emergency care” as outlined in detail in World Health Organization’s (WHO) Post-Crash Response Booklet.

As we know, the majority of deaths after road traffic injuries occur in the first hours following the accident. Interventions performed during these “golden hours” are considered to have the most significant impact on mortality and morbidity. Therefore, having an advanced emergency medical response system in order to make emergency care effective is highly essential for countries.

Various health components are used to assess the development of health systems by country. Where a country is placed in these parameters also shows the level of overall development of that country. WHO states that 93% of the world’s fatalities related to road injuries occur in low-income and middle-income countries, even though these countries have approximately 60% of the world’s vehicles. This statistic shows that road traffic injuries may be considered as one of the “barometer”s to assess the development of a country’s health system. If a country has a high rate of road traffic injuries, that may clearly demonstrate the country has deficiencies of health management as well as infrastructure, education and legal deficiencies.

WHO has a rather depressing page showing numbers of deaths related to road injuries. (Source: Death on the Roads, WHO, https://extranet.who.int/roadsafety/death-on-the-roads/ )

WHO is monitoring progress on road safety through global status reports. Its’ global status report on road safety 2018 presents information on road safety from 175 countries (3).

We have studied the statistics presented in the report and made two maps (All countries and High-income countries) illustrating the road accident death rate by country (per 100,000 population). You can view these works below (click on images to view full size).

References and Further Reading

  1. Official website of The World Day of Remembrance, https://worlddayofremembrance.org
  2. WHO. Road traffic injuries – https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
  3. WHO. Global status report on road safety 2018 – https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/
Cite this article as: Ibrahim Sarbay, "Death on the Roads," in International Emergency Medicine Education Project, November 1, 2019, https://iem-student.org/2019/11/01/death-on-the-roads/, date accessed: November 18, 2019

Just Some Broken Ribs

Just Some Broken Ribs

The phone was ringing incessantly. I barely woke up. In my pitch dark bedroom, the ringing phone was the only light source. I slowly grabbed my phone while involuntarily rubbing my eyes. I looked at the caller I.D. It was my father. And what time was it? 1:30 am! In a typical day, this might be an early hour for me, but I was attending a local Emergency Medicine conference that day; so I went to bed early.

I cradled the phone between my ear and shoulder. My father’s voice was fussy. “Someone lies unconscious on the street,” he said hastily. “Can you come and help us?” I asked him to call for an ambulance by that time. He said that he already called. 

While I was preparing in a hurry, my heart started to beat faster and my mind swelled with CPR guidelines, syncope algorithms and my past experiences.

My home is down the block from my parents. I ran there and saw a crowd gathered around a man who was lying on the street. When I passed through I realized someone was doing CPR. I have spotted my parents standing in the crowd and my eyes met with my father. He pointed my younger brother, a trainee surgeon also lives in the same area and was taking his turn on the CPR and checking his pulse. I rushed near them and he filled me in with all they know about the citizen at that point.

The first responder to the cries of the patient’s wife was an ambulance driver with ten years of experience. He said he pulled the patient out of his vehicle. He laid down the man in his 50s suffered from heartburn for the last couple of hours and was about to go to the hospital but lost his consciousness as soon as he started the engine. Since the man wasn’t responding, the former driver started the CPR. About 3 minutes later, my brother showed up along with my father and he took the turn while they kept checking for any response. He said that the rhythm never lasted longer than 10 seconds. So I asked them to keep it up and I took my turn till the ambulance shows up.

It was clear that the patient endured a heart-related condition, probably a myocardial infarction. And I knew by experience that with a proper CPR and early defibrillation, these patients have a high chance of returning of spontaneous circulation, and survival.

The ambulance arrived in a couple of minutes. Paramedics jumped out of the vehicle and rushed to the scene and recognized that I am an Emergency Medicine resident at the State Research and Education Hospital. They let me control the situation. The first rhythm was read on the screen as ventricular fibrillation (VF) and we delivered a shock and started chest compressions again. With the equipment they’ve brought, I intubated the patient while they monitored him with the defibrillator from the ambulance. The nearest hospital was 10 minutes away, and we have shocked-compressed for at least 4 or 5 times in an ambulance moving fast. IT-WAS-HARD!

We have arrived at the hospital. After 10 minutes of additional CPR and proper mediations, spontaneous circulation of the patient returned spontaneous circulation. And a control ECG was consistent with Inferior MI. In a couple of minutes, we were in a different ambulance, headed to the nearest hospital with a coronary angiography unit and ICU.

I took a deep breath after we have delivered the patient to the ICU safe and sound. It was over, for now. One week later, he returned to his home with full recovery, without any neurological sequelae. They were very thankful.

Later on, I’ve heard many funny words people were chattering about this incident. One has particularly given me the giggle. It was coming from an ENT specialist. He said, “So that was no big deal, they probably overreacted and caused him a couple of broken ribs.”

Yeah, there were just some broken ribs… and a life saved.

Further Reading

Cite this article as: Ibrahim Sarbay, "Just Some Broken Ribs," in International Emergency Medicine Education Project, August 16, 2019, https://iem-student.org/2019/08/16/just-some-broken-ribs/, date accessed: November 18, 2019

How to Subscribe to iEM Student Podcast

“A podcast, is an episodic series of digital audio or video files which a user can download in order to listen to.” by Wikipedia’s definition. Listening to podcasts is a useful way of consuming FOAMed materials.

iEM Student audio podcast is one of the components of the project to increase accessibility to the content provided by international contributors. If you like to subscribe and listen to this podcast through your favourite podcast player, here is how: 

1. Just click to your favourite podcast player (We use Overcast app as an example).

2.Click to the plus sign located on the top right.

3. Click to Add URL link.

4. Add below link

http://feeds.soundcloud.com/users/soundcloud:users:443815290/sounds.rss

to the box located below "Podcast URL" text.

5. iEM Student Podcast is now available on the app's main page.

6. Click to the podcast to see the list of available recordings.

That's all! Enjoy!

Cite this article as: Ibrahim Sarbay, "How to Subscribe to iEM Student Podcast," in International Emergency Medicine Education Project, June 26, 2019, https://iem-student.org/2019/06/26/how-to-subscribe-to-iem-student-podcast/, date accessed: November 18, 2019

Countries Recognize Emergency Medicine as a Specialty

As health care professionals working on Emergency medicine, our history is still being written. Let’s say you would like to learn which countries officially recognize Emergency Medicine (EM) as a specialty, and want to make a beautiful interactive infographic depicting these countries with their official EM recognition years (Because, why not?). It should be an easy task, right? WRONG.

What is your guess?

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How many countries recognize Emergency Medicine as a specialty?

Even though it seems like a simple question which should have a clear answer, the answer is somewhat of a conundrum. There are a few difficulties for the answer. First of all, what is the definition of “recognition”? Could it be possible to consider having an EM residency program or the presence of EM specialists in a country as recognition? Probably not. Secondly, some of the countries recognize EM as a specialty but the exact year of recognition is unclear. Also, the answer may vary between articles and makes it hard to choose one. To make things clear, we have accepted the definition of “recognition” as a country’s official approvement of Emergency Medicine as a primary specialty. Countries recognizing EM as a supra-specialty (such as Switzerland) were also considered as a recognizing country in our list.

Anyway, we have rolled our sleeves up and dug deep. Many articles and tweets later, we had all the data available on this topic. To the best of our knowledge, this is the first time an article or blog post lists EM’s official dates of recognition for the entire world. We have also taken one step further and showed them on a neat interactive map.

So here we go: As of 05/2019, there are 82 countries in the world which recognize EM as a specialty. 13 countries from Africa, 27 countries from Asia, 13 countries from the America, 27 countries from Europe, and two countries from Oceania recognize EM.

As a well-known fact, the first two countries to recognize EM as a specialty are the United States and the U.K. Which are the latest? Germany and Denmark are the most recent of these countries, as both of them recognized EM in 2018. Perhaps, one year later, there will be new countries which welcome EM specialty. Who knows?

Shall we take a look at the current situation in an eye-pleasing way? Of course! You can view our interactive map right here. You can view maps with colors corresponding to the years of EM recognition for each country in the world (darker the color, earlier the date) in Figure 1. You can also view continental maps for Africa, Asia, Americas, Europe and Oceania in Figures 2, 3, 4, 5, 6, respectively.

Figure 1. Countries Recognize Emergency Medicine as a Specialty

WORLD

Figure 2. Countries Recognize Emergency Medicine as a Specialty

AFRICA

Figure 3. Countries Recognize Emergency Medicine as a Specialty

ASIA

Figure 4. Countries Recognize Emergency Medicine as a Specialty

AMERICA

Figure 5. Countries Recognize Emergency Medicine as a Specialty

EUROPE

Figure 6. Countries Recognize Emergency Medicine as a Specialty

OCEANIA

For the ones who believe nothing is better than a list, all countries are listed in alphabetical order in Table 1. Table 1. List of counties which recognize EM as a specialty (alphabetical order).

Table 1. List of counties which recognise EM as a specialty (alphabetical order).
Country Name Year of Recognition
Albania 2011
Argentina 2010
Australia 1993
Bahrain 2001 *
Belgium 2005
Bulgaria 1996
Botswana 2011
Brazil 2016
Canada 1979
Chile 2013
Colombia 2005
Costa Rica 1994
Croatia 2009
Cuba 2000 §
Czech Republic 2013
Denmark 2018
Dominican Republic 2000
Egypt 2003
Estonia 2015
Ethiopia 2010
Finland 2012
France 2015
Georgia 2015
Germany 2018 #
Ghana 2015
Greece 2017 #
Haiti 2014
Hong Kong 1997
Hungary 2003
Iceland 1992
India 2009
Iran 2002
Iraq 2013
Ireland 2003
Israel 2009
Italy 2008
Japan 2003
Jordan 2003
Kenya 2017
Laos 2017
Lebanon 2012
Libya 2013
Lithuania 2013
Malaysia 2002
Malawi 2010
Malta 2004
Mexico 1986
Morocco 2002
Myanmar 2012
Netherlands 1998
New Zealand 1995
Nicaragua 1993
Norway 2017
Oman 1999
Pakistan 2010
Peru 1999
Philippines 1988
Poland 1999
Qatar 2000
Romania 1999
Rwanda 2013
Saudi Arabia 2001
Serbia 1992
Singapore 1984
Slovakia 2003
Slovenia 2006
South Africa 2004
South Korea 1996
Sri Lanka 2011
Sudan 2011
Sweden 2015
Switzerland 2009 #
Taiwan 1998
Tanzania 2011
Thailand 2003
Tunisia 2005
Turkey 1993
United Arab Emirates 2004
United Kingdom 1993
United States 1972
Vietnam 2010
Yemen 2000

* Exact year of EM recognition in Bahrain is unknown and establishing of The Bahrain Emergentologist Association (BEMASSO) in 2004 accepted as the recognition year for this infographic.
§ Cuba has an EM/intensive care unit (ICU) training program which was begun in 2000.
# EM is considered as a supra-specialty in Germany, Greece, and Switzerland.

That is all for now! Please feel free to share it and comment on this list. Also, please tell us if we had any countries left behind or if there were any mistakes. EM family grows every day!

Together we are stronger!

References and Further Reading

  • Swanson RC, Soto NR, Villafuerte AG, Emergency medicine in Peru, J Emerg Med. 2005 Oct;29(3):353-6, DOI:10.1016/j.jemermed.2005.02.013
  • Garcia-Rosas C, Iserson KV, Emergency medicine in México, J Emerg Med. 2006 Nov;31(4):441-5, DOI:10.1016/j.jemermed.2006.05.024
  • Al-Azri NH, Emergency medicine in Oman: current status and future challenges,Int J Emerg Med. 2009 Dec 11;2(4):199-203. doi: 10.1007/s12245-009-0143-6.
  • Sakr M, Wardrope J, Casualty, accident and emergency, or emergency medicine, the evolution, J Accid Emerg Med. 2000 Sep;17(5):314-9.
  • Pek J.H., Lim S.H., Ho H.F., Emergency medicine as a specialty in Asia, Acute Med Surg. 2016 Apr; 3(2): 65–73, doi: 10.1002/ams2.154
  • Fleischmann T, Fulde G.,Emergency medicine in modern Europe, Emerg Med Australas. 2007 Aug;19(4):300-2.
  • Partridge R., Emergency medicine in Cuba: an update, Am J Emerg Med. 2005 Sep;23(5):705-6, DOI: 10.1016/j.ajem.2005.03.006.
  • MacFarlane C, van Loggerenberg C, Kloeck W.,International EMS systems in South Africa–past, present, and future,Resuscitation. 2005 Feb;64(2):145-8,DOI:10.1016/j.resuscitation.2004.11.003
Cite this article as: Ibrahim Sarbay, "Countries Recognize Emergency Medicine as a Specialty," in International Emergency Medicine Education Project, May 13, 2019, https://iem-student.org/2019/05/13/countries-recognize-emergency-medicine/, date accessed: November 18, 2019