Need for quick thinking: Inadequacies in urban emergency response systems set off alarms
Research paper by JPMC’s faculty puts forward recommendations to tackle problem.
Acute shortage of water for firefighting purposes, shortage of firefighting staff, fire stations and special firefighting units were among the problems identified with regards to fire services in a recent evaluation by Muhammad Masood Alam. PHOTO (TOP): FILE/ PHOTO (BOTTOM) COURTESY SHEHRI-CITIZENS FOR A BETTER ENVIRONMENT
KARACHI:
Karachi is facing a variety of ongoing and potential risks and disaster-related scenarios -- both natural and man-made. From urban flooding, extreme heat, earthquake scares to urban street violence, bomb blasts and more.
In any such case, the first institutional mechanism and apparatus that is called into action is the ‘emergency response system’ — civil defence, fire fighters, paramedics, emergency trauma and related healthcare. In Karachi’s case, particularly at the level of the government, the situation is far from satisfactory.
To a great extent, some gaps in the health-related emergency response have been filled by the private sector but the fact remains that the critical role of the government, both in terms of having the equipment, facilities and trained manpower and a well-oiled coordination system between related agencies, is missing.
There is limited, if any, quality research analysing the status of emergency response systems, such as emergency medicine, healthcare, fire services and others. For example, to assess the emergency healthcare response, faculty members of the Jinnah Post Graduate Medical Centre’s (JPMC) surgery department prepared a research paper in 2009 [Pakistan: The new target of terrorism. Are Karachi’s emergency medical response systems adequately prepared?).
In this research, a cross-sectional survey of postgraduate trainees was conducted at JPMC and Civil Hospital Karachi from July 21, 2007 to July 24, 2007, to evaluate the preparedness and self-identified deficiencies of doctors involved in massive trauma casualty management. Out of the 90 respondents questioned, only three (3.3%) were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures were found available in the ambulances. An overwhelming 96 per cent of the doctors felt that they were deficient in their training and management of such scenarios. Despite availability of communication between ambulances of the same organisation, no communication links are available between the ambulance services and intended hospitals.
With regards to fire services, a recent evaluation by Muhammad Masood Alam, the executive district officer of the municipal services group of offices, City District Government Karachi, in the context of Vulnerabilities and Hazards of Karachi and Preparation of District Disaster Plan 2011, is self-explanatory -- no fire hydrant system throughout the city is available, non-provision of training on international standard and unavailability of fire training institute/school. The evaluation also mentions acute shortage of water for firefighting purpose, shortage of firefighting staff, fire stations and special fire fighting units snorkel, hazmat rescue units and ambulances, as well as an absence of coordination and cooperation of different agencies on scene of incident.
What is needed is not just improvement at the institutional level but a comprehensive system of ‘institutional coordination’ ensuring resilience within the city’s infrastructure system, whereby the knowledge base crosses disciplines and agency jurisdictions. There has to be documentation on shared equipment and resource reserves with improved mapping and communication systems.
The writer is an urban planner and runs a non-profit organisation based in Karachi city focusing on urban sustainability issues. He can be reached at fanwar@sustainableinitiatives.org.pk
Steps for better response to emergencies
Setting up a dedicated disaster control management department, with communication links to paramedic services, security agencies and all major hospitals, for better macro management and appropriate distribution of casualties
Accreditation of trauma centres and critical care units should be done and mandatory training of emergency physicians and surgeons ensured
Efforts to include private hospitals in the disaster management to reduce the overwhelming load on the public sector hospitals
Establishment of pre-hospital care and training of paramedics involved in onsite rescue
Training of hospital staff and establishment of a triage service with a trained doctor in charge for appropriate, comprehensive and timely screening of individuals
Proper assignment of tasks and roles with simulated drills involving the health professionals for better efficiency and coordinated approach in times of chaos
Establishment of a central trauma registry so that reliable data could be obtained on trauma admissions as well as their clinical outcomes. This will help in carrying out more effective research work and consequently aid in development and implementation of an effective public policy on trauma care
Published in The Express Tribune, February 3rd, 2014.
Karachi is facing a variety of ongoing and potential risks and disaster-related scenarios -- both natural and man-made. From urban flooding, extreme heat, earthquake scares to urban street violence, bomb blasts and more.
In any such case, the first institutional mechanism and apparatus that is called into action is the ‘emergency response system’ — civil defence, fire fighters, paramedics, emergency trauma and related healthcare. In Karachi’s case, particularly at the level of the government, the situation is far from satisfactory.
Acute shortage of water for firefighting purposes, shortage of firefighting staff, fire stations and special firefighting units were among the problems identified with regards to fire services in a recent evaluation by Muhammad Masood Alam. PHOTO (TOP): FILE/ PHOTO (BOTTOM) COURTESY SHEHRI-CITIZENS FOR A BETTER ENVIRONMENT
To a great extent, some gaps in the health-related emergency response have been filled by the private sector but the fact remains that the critical role of the government, both in terms of having the equipment, facilities and trained manpower and a well-oiled coordination system between related agencies, is missing.
There is limited, if any, quality research analysing the status of emergency response systems, such as emergency medicine, healthcare, fire services and others. For example, to assess the emergency healthcare response, faculty members of the Jinnah Post Graduate Medical Centre’s (JPMC) surgery department prepared a research paper in 2009 [Pakistan: The new target of terrorism. Are Karachi’s emergency medical response systems adequately prepared?).
In this research, a cross-sectional survey of postgraduate trainees was conducted at JPMC and Civil Hospital Karachi from July 21, 2007 to July 24, 2007, to evaluate the preparedness and self-identified deficiencies of doctors involved in massive trauma casualty management. Out of the 90 respondents questioned, only three (3.3%) were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures were found available in the ambulances. An overwhelming 96 per cent of the doctors felt that they were deficient in their training and management of such scenarios. Despite availability of communication between ambulances of the same organisation, no communication links are available between the ambulance services and intended hospitals.
With regards to fire services, a recent evaluation by Muhammad Masood Alam, the executive district officer of the municipal services group of offices, City District Government Karachi, in the context of Vulnerabilities and Hazards of Karachi and Preparation of District Disaster Plan 2011, is self-explanatory -- no fire hydrant system throughout the city is available, non-provision of training on international standard and unavailability of fire training institute/school. The evaluation also mentions acute shortage of water for firefighting purpose, shortage of firefighting staff, fire stations and special fire fighting units snorkel, hazmat rescue units and ambulances, as well as an absence of coordination and cooperation of different agencies on scene of incident.
What is needed is not just improvement at the institutional level but a comprehensive system of ‘institutional coordination’ ensuring resilience within the city’s infrastructure system, whereby the knowledge base crosses disciplines and agency jurisdictions. There has to be documentation on shared equipment and resource reserves with improved mapping and communication systems.
The writer is an urban planner and runs a non-profit organisation based in Karachi city focusing on urban sustainability issues. He can be reached at fanwar@sustainableinitiatives.org.pk
Steps for better response to emergencies
Setting up a dedicated disaster control management department, with communication links to paramedic services, security agencies and all major hospitals, for better macro management and appropriate distribution of casualties
Accreditation of trauma centres and critical care units should be done and mandatory training of emergency physicians and surgeons ensured
Efforts to include private hospitals in the disaster management to reduce the overwhelming load on the public sector hospitals
Establishment of pre-hospital care and training of paramedics involved in onsite rescue
Training of hospital staff and establishment of a triage service with a trained doctor in charge for appropriate, comprehensive and timely screening of individuals
Proper assignment of tasks and roles with simulated drills involving the health professionals for better efficiency and coordinated approach in times of chaos
Establishment of a central trauma registry so that reliable data could be obtained on trauma admissions as well as their clinical outcomes. This will help in carrying out more effective research work and consequently aid in development and implementation of an effective public policy on trauma care
Published in The Express Tribune, February 3rd, 2014.