Emergency Medicine in Jordan Rashed Hijazi MD, FRCSEd (A&E) Consultant EM.

Emergency Medicine in JordanEmergency Medicine in Jordan

Rashed Hijazi MD, FRCSEd (A&E)Rashed Hijazi MD, FRCSEd (A&E)Consultant EMConsultant EM

Pre-hospital care ( Public )Pre-hospital care ( Public )

Covered by the civil defense directorate

Multiple locations with 2 ambulances for each

2 crew members in each ambulance

Supplied with basic equipment

Dispatch by central communication center

Transportation time: average 10 minutes

Level of training: 6 months, started in 1988, 3 months theoretical, 3m. practical

BLS and first aid , no invasive procedures

New regulations in progress for advanced New regulations in progress for advanced medical protocols for IV access, drugs, medical protocols for IV access, drugs, defibrillators, etc.defibrillators, etc.

Dispatch to the nearest public hospital, Dispatch to the nearest public hospital, unless life threatening situation, then unless life threatening situation, then nearest private or publicnearest private or public

Communication with hospitals

Funded by ministry of healthFunded by ministry of health

Free for the publicFree for the public

The Royal medical services (Military Sect.)

Air medical evacuation by the Jordanian air force for eligible patients

Civil DefenseCivil Defense(public)(public)

2001

2002

940950960970980990

1000101010201030

Death Rate

2001

2002

52000

52500

53000

53500

54000

54500

55000

55500

56000

56500

Ambulance Calls

Type of CallType of Call

38769

54542960 2562 2450

0

5000

10000

15000

20000

25000

30000

35000

40000

Medical Fallingdown

Delivery MVA Trauma

Pre hospital Care ( Private )Pre hospital Care ( Private )Each private hospital runs its own ambulancesEach private hospital runs its own ambulances

Medical services on special request only Medical services on special request only

High standard , well equippedHigh standard , well equipped

Recently started mobile intensive care unitsRecently started mobile intensive care units

Ambulance crew including a physicianAmbulance crew including a physician

Dispatch by the private hospital if called upon Dispatch by the private hospital if called upon

Retrieval to the same hospital onlyRetrieval to the same hospital only

No communication with other private hospitalsNo communication with other private hospitals

Funded privately or by private health insurance Funded privately or by private health insurance

The Jordanian Board In The Jordanian Board In Emergency MedicineEmergency Medicine

Independent specialty since July 99Independent specialty since July 99Five approved training centersFive approved training centersRegistration in the medical associationRegistration in the medical association Four year programFour year program Part I during the 2Part I during the 2ndnd year year Only successful candidates are Only successful candidates are promoted to the 3promoted to the 3rdrd year year Board exam after 4Board exam after 4thth year year

Training ProgramTraining Program

- Established after reviewing Established after reviewing Australian, American, Canadian and Australian, American, Canadian and European programsEuropean programs

- Independent specialty Independent specialty - Started 1Started 1stst at Jordan University 1998 at Jordan University 1998- 7 candidates at start of program7 candidates at start of program- 5 candidates obtained Jord. board5 candidates obtained Jord. board

11stst Year Year

General MedicineGeneral Medicine3m3m

ERER3m3m

General PediatricsGeneral Pediatrics2m2m

General SurgeryGeneral Surgery2m2m

OrthopedicOrthopedic2m2m

22ndnd Year Year

OB & Gyn.OB & Gyn.1m1m

ERER3m3m

ER PedER Ped..2m2m

CCUCCU2m2m

ICUICU2m2m

PsychPsych..2m2m

33rdrd Year Year

ERERER ped.ER ped.ER Adm.ER Adm.Anesth.Anesth.Plast.SurgPlast.Surg

2m2m1m1m1m1m1m1m1m1m

Neur.SurgNeur.SurgPed.SurgPed.SurgForensicForensicResearchResearchElective Elective

1m1m1m1m1m1m1m1m2m2m

44thth Year Year

ER 12 monthsER 12 months

Senior : Clinical & administrativeSenior : Clinical & administrative

Medical, Surgical, Pediatric and Medical, Surgical, Pediatric and OB/Gyne.OB/Gyne.

Program ActivitiesProgram Activities

Emergency medicine topicsEmergency medicine topics

Emergency Surgery topicsEmergency Surgery topics

Pediatric Emergency topicsPediatric Emergency topics

Obstetrics & Gynecology topicsObstetrics & Gynecology topics

Mortality & MorbidityMortality & Morbidity

Journal ClubJournal Club

RadiologyRadiology

Case presentationCase presentation

Principles and basic science Principles and basic science

Program ProgressProgram Progress

Periodical evaluationEnd of year examination Written, Oral and Clinical Pass mark 60% Publication Program director Committee ( From other specialties ) Successful : Jordanian Board Certificate

Exemption of part1 Arab Board Unsuccessful : 3 trials with conditions

EM Training CentersEM Training Centers

Jordan University Hospital ( 1Jordan University Hospital ( 1stst center ) center )

- Started in July 1998 - Started in July 1998

- Jordan University has 550 beds with - Jordan University has 550 beds with 60,000 visits to the ER per year60,000 visits to the ER per year

- Requirement, selection criteria- Requirement, selection criteria

EM Training CentersEM Training Centers KA University hospital KA University hospital

11stst Yr #3 candidates Yr #3 candidates22ndnd Yr #4 candidates Yr #4 candidates Commenced June 02Commenced June 02

Ministry of Health hospital Ministry of Health hospital 11stst Yr #5 candidates Yr #5 candidatesCommenced June 03Commenced June 03

Military hospital Military hospital 11stst Yr Yr

Private hospitalPrivate hospital11stst Yr #1 candidate Yr #1 candidate22ndnd Yr #1 candidate Yr #1 candidate

ChallengesChallengesNew specialty New specialty

Shortage of ER physiciansShortage of ER physicians

Limited understandingLimited understanding

Under-estimationUnder-estimation

Lack of supportLack of support

Financial Financial

StaffStaff

FacilitiesFacilities

Regulations and guidelinesRegulations and guidelines

Future and securityFuture and security

Optimistic outlookOptimistic outlook Population and need Population and need High incidence of trauma High incidence of trauma Increasing No. of Private hospitalsIncreasing No. of Private hospitalsCompetitive other specialtyCompetitive other specialtyEstablishment of the Arab Board in Establishment of the Arab Board in EMEMInternational applicantsInternational applicantsOther specialties applicantsOther specialties applicantsStrong link with Family medicineStrong link with Family medicine

ImprovementImprovement

More ER physiciansMore ER physicians

Supervisors and trainersSupervisors and trainers

Introduction of academic courses, eg: Introduction of academic courses, eg: ACLS, ATLS, U/S etc.ACLS, ATLS, U/S etc.

Advertising Advertising

Legal and ethical issuesLegal and ethical issues

ConferencesConferences

Establishment of an EM association and Establishment of an EM association and Collaboration with othersCollaboration with others

Communication and reciprocal recognitionCommunication and reciprocal recognition

SummarySummary

New developing specialty among New developing specialty among well developed and high standard well developed and high standard medical servicesmedical services

The future is brightThe future is bright

High spirit presentHigh spirit present

International support neededInternational support needed

Thank youThank you