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Trauma centre under stress.

A window-cleaner is rushed to the resuscitation room at Dubai's Rashid Hospital Emergency and Trauma Centre. Barely conscious, he is trembling in pain after falling from the fifth floor of a building.

But, he is not the first critical patient of the day. A number of emergency cases have already arrived at the hospital. In fact, by noon, patients are brought in by the minute - each worse than the other. And this happens almost every day.

According to Dr Mo'en Fikri, Chairman of the Central Disaster Committee and Clinical Director of Rashid Hospital Emergency and Trauma Centre, the medical staff at the centre are being pushed way beyond their limits due to the rising number of emergency cases, especially those arising from road accidents.

"Every day, we perform 30 operations," and at least half of these cases are due to road accidents. "These are excluding heart attacks and breathing problems. In fact, Dubai falls in the 'red zone' for the highest number of road accident mortalities," Dr Fikri added.

The centre, which opened one-and-a-half years ago, has already exceeded its capacity by 40 per cent, having treated more than 140,000 patients in 2007 alone - much more than any emergency hospital in the UK, Australia or Canada. With such a high patient inflow, the atmosphere at the centre is always tense. It acts as a pulse-point for all emergencies in the city.

"When death rates are high, the rate of disability is also five to six times higher. This means moderate and minor injuries are also high. That's why we have so many patients every day," Dr Fikri said.

And because of that, he said, "non-critical" patients have to wait longer to be treated.

The recent 200-car pile-up near Ghantoot was an example of a high-level disaster and Dr Fikri said the centre had to fly in two doctors and two nurses to the accident scene.

"When we saw the burnt cars from the helicopter, we expected it to be a huge disaster. It's a miracle that there were relatively few casualties and mortalities, given the scale of the accident," said Dr Taleb Salem, Senior Registrar at the centre. "Road accidents are a major problem in the UAE and the centre gets far too many accident cases."

Overworked

While there are plans to build another centre at Jebel Ali and set up smaller clinics, the Rashid Hospital Emergency and Trauma Centre remains hard-pressed.

The centre usually receives around 400 to 500 patients per day. "Over-capacity in itself is a disaster for us," said Walid Jamal Al Sawalhi, Director of Finance and Administration, Rashid Hospital.

"We get many minor cases that can be catered to by primary health clinics. Such patients put our whole emergency centre under severe pressure.

"They end up waiting for long periods until the priority cases are attended to."

Among critical cases, heart attack patients rank second on the list. "During my 20 years of practice in the US, I have never seen such young people having heart attacks. I am alarmed to find 26- to 32-year-olds in the UAE having heart attacks," said Dr Fikri.

The centre also gets many cases of industrial accidents, especially potentially fatal fall victims. "We get cases from Hatta, the northern emirates and Jebel Ali, so we cater to a vast population," said Dr Fikri.

"At present, when there is a disaster, the first thing we do is transfer patients with moderate injuries to other hospitals, while other patients, who are unnecessarily occupying bed spaces, are discharged," he said.

And though the trauma centre has equipment to attend to double the capacity of critical patients, the main problem, he said, is the high number of walk-in patients.

Expansion plans

"Once the Jebel Ali Trauma Centre is built, it will give us some relief," he added.

But since that will take two to three years, immediate plans to reduce pressure on the 140-bed centre are under way, said Al Sawalhi. "We plan to introduce smaller clinics that will help alleviate the load on the trauma centre. We will open up a minor injuries centre, an infusion centre and a wound-care centre to deal with this load."

Dealing with disaster

Every Department of Health and Medical Services (Dohms) hospital and 17 Dohms primary health clinics have a disaster management committee to report to the central disaster committee.

In case a disaster strikes, the police are the first responders, said Dr Fikri. "In Dubai, the police go to the scene and assess the level of disaster. They then activate different units such as the Civil Defence and the healthcare system, including the ambulance service."

The central disaster committee then communicates with the healthcare system. "During disasters, all hospitals, irrespective of whether they are government or private, work together," said Dr Fikri.

"We have a disaster management code and, accordingly, hospitals are put on standby or on alert. We have a central communication room that can direct transfer of disaster victims to different hospitals. This disaster communication chamber operates only in case of a major disaster."

He added that Dubai is well-equipped to deal with any disaster and has done so in the past.

Disaster codes and action plan

1111: This is the basic level. The emergency department at the trauma centre is notified.

2222: The emergency department is activated. First line hospitals such as Dubai Hospital, Iranian Hospital and Al Baraha Hospital are put on stand-by.

3333: This is a major disaster. Both the trauma centre and Rashid Hospital are activated. The first line hospitals are also activated. And all hospitals in Dubai are put on standby. The recent Ghantoot accident is a case in point.

4444: This is a huge disaster. All hospitals are activated and are ready to accept disaster victims.

0000: Activation ends.

2222 onwards: Three teams leave to reach disaster areas. One leaves immediately, the second team departs within 10 minutes of activation, and the third team within 30 minutes.

Case priorities

First priority (code red): Serious car accidents and falls, heart attacks

Second priority (code orange): Chest pain and breathing problems

Third priority (code yellow): Bad injuries and broken bones

Fourth priority (code green): High fevers, bad diarrhoea

Last priority (code blue): Other minor injuries

TRAUMA IN FIGURES

140,000 patients were brought to the Rashid Hospital Emergency and Trauma Centre last year. This was 40 per cent over the capacity

400-500 patients are brought to the centre every day.

30 operations are performed at the centre every day

The average number of road accident casualties per day is 25

The centre can handle four ambulances simultaneously and has two helipads for emergency cases

It has six major operation rooms and four minor operation rooms

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Publication:XPRESS (United Arab Emirates)
Date:Apr 2, 2008
Words:1136
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