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Egypt Focuses on Improving Emergency Care

In recent years, a string of terrorist attacks in Egypt have killed and wounded hundreds of people, focusing attention on the country's emergency medical system. But the death toll from everyday traffic accidents is much higher, claiming 6,000 lives per year on Egyptian roads. The health ministry is in the midst of a campaign to improve emergency response not only to high-profile incidents, but also to more routine emergencies.

Just a few hundred meters from Cairo's main public hospital, Qasr El-Aini, an ambulance is stuck in the city's notorious traffic. Its wailing siren has no effect on the cars and buses in front of it, clogging the narrow bridge over the river Nile. Nobody moves. Nobody pulls aside to let the ambulance through.

It takes a full six minutes for the emergency vehicle to travel three blocks.

For a person who is critically injured, those minutes could make the difference between life and death. Trauma specialists call it "the golden hour," the first 60 minutes after a serious injury. Chances of survival are greatest if the patient gets medical treatment in that hour.

When Khaled El-Sayid's daughter Asraa, 4, cut her eye open, he did not bother to call an ambulance. He jumped in his own car and drove her to the hospital himself. He says, "Taking your own car is faster than calling an ambulance and waiting around for it to show up."

The little girl grips his hand as he speaks. Her vision is safe, and her father is full of praise for the hospital and its staff. He says if the same thing had happened to him when he was a boy, he surely would have lost his eye.

Egyptian trauma specialists say the standard of emergency care has risen in the last five years, as the ministry of health has upgraded the equipment in ambulances and hospital emergency rooms. But Dr. Reda Aissa says there is still a long way to go.

"Oh, it needs a lot, of course," said Dr. Aissa. "We are far, far behind. There are a lot of difficulties. Since a long time we are trying to improve, but we have many obstacles, many, many."

Dr. Aissa heads the emergency department at Ain Shams University Hospitals, one of the country's best.

"We are still deficient in the training part," added Dr. Aissa. "We need training, but we have equipment, as you said. We have many ambulances, we have airplanes…we have everything. We have field hospitals. We have equipment, but the people are not yet up to the standard to take care of the critically injured, in disasters or these things. Still we need much on the training part."

The Egyptian transportation ministry says 6,000 people die in traffic accidents alone every year. Add that to heart attacks, industrial and domestic accidents, and terrorist attacks like the one in the resort of Dahab last month. It becomes clear that emergency care is a major issue.

The minister of health has recently brought in a new team to manage emergency care in Egypt. Dr. Amin Elsadek Osman is the new undersecretary for emergency medical services.

"I was asked to concentrate on some items, that is training of the EMTs or the paramedics, to upgrade their level and to upgrade the response to cases," said Dr. Osman. "Also, training of the doctors working with the ambulance service."

Egypt is working on not just the response to individual accident victims, but to improve handling of major multiple casualty incidents, like the terrorist bombings in Dahab last month that killed at least 18 people.

Over the last week, Dr. Aissa and a diverse group of other Egyptian doctors attended training clinics run by trauma and disaster-management specialists from the University of Maryland in the United States.

"And the idea behind both these programs is not only to teach the skills, but over time to train the trainers," explained Dr. Jon Mark Hirshon, one of the training team leaders. "I view this, I think we view this, as a long-term process. You don't make societal changes overnight. And so this is just the first step in what we hope will be a long road that will allow us to work collaboratively so the Egyptians can do what they need to do to improve their response to injuries, and decrease the morbidity and mortality. "

The training program is funded by a grant from the Fogarty International Center at the U.S. National Institutes of Health.

Touring one of the state of the art instruction labs at the ministry of health training center, Dr. Maureen McCunn of the University of Maryland says the issue is global.

"Right now, in the entire world, the primary cause of death is infectious diseases, but the World Health Organization predicts that by 2020, injuries will be the third leading cause of death and disability in the world," noted Dr. McCunn. "So it's something that most countries are recognizing that they need to address."

Dr. Richard Alcorta is the director of emergency medical services for the state of Maryland.

"Physicians are not trained to go into the field and how to immobilize and transport patients," explained Dr. Alcorta. "They are trained how to do the airway techniques and how to ventilate somebody, but they are not taught how to package someone from a crash scene or crash event and get them safely to a hospital setting. So this program is designed to make sure that the physician teams here are familiar with that, seeing as they may be projecting these physicians into the field."

The program will eventually train Egyptian nurses and paramedics as well. Dr. Aissa of Ain Shams University says training the medical staff is only the beginning, because they are rarely the first people on the scene.

"We need better quality because still, until today the first responders, they don't know exactly what things should do and what things they don't do," said Dr. Aissa. "So we need better training for these first responders because it differs. The first thing you do to the injured patient makes the difference for his future, for his life. You have to respond properly at the beginning. The first responder is very important."

In Egypt, those first responders more often than not will be policemen. Egyptian cities such as Cairo are among the most heavily policed in the world. It is hard to walk three blocks in the capital without seeing some kind of police presence.

Some police have gotten basic first-aid training, but it is far from universal. The health minister's advisor on emergency care, Dr. Atef Nasr, hopes that will change.

"Just last night we received a call from the first Undersecretary of the Ministry of Health just asking to put into consideration that the police ask for courses to train the police, just to deal with the cases and give the first aid. So I think this will help a lot in our emergency service," said Dr. Nasr.

To deal with the notorious Cairo traffic, the health ministry has placed ambulances in the public squares of every neighborhood in town, to reduce the time it takes them to respond to emergency calls.

The ministry is also trying to educate drivers to move out of the way when an ambulance is behind them. That could be the toughest job of all.