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Physician brings order to emergency chaos The following article describes one of many poster presentations set for this year’s faculty convocation Aug. 22. The Catalyst will highlight some of the presentations on MUSC’s international clinical, educational and research opportunities and outreach. by Heather Woolwine Public Relations In schools and homes throughout the country, concerned teachers and parents ingrain the numbers 911 into the heads of little ones so they know who to call in an emergency. When a person has to call that number, he or she knows that someone on the other end will send others to the rescue.   What if these options didn’t exist for the American people? What if just transporting someone to the emergency room for necessary, even life-saving, treatment took not minutes, but hours?   Hard for Americans to comprehend, but this is the daily existence for most people living in India. Sarvotham (Sam) Kini, M.D., an Indian native and MUSC Emergency Medicine associate professor, is choosing to do something about it.   Well-known for his easy-going personality and emergency medicine expertise, Kini felt the need to go back to his hometown of Mangalore and Kasturba Medical College Hospital to help establish an emergency enterprise that would serve the people of his roots and hopefully become a national model of emergency care.   “I wanted to do something on a volunteer basis that would help and I was already visiting family and friends. I became involved with the American Academy of Emergency Medicine and suggested that we begin an outreach effort in India,” Kini said.   The Department of Emergency Medicine at Long Island Jewish Medical Center (LIJMC) has promoted emergency medicine in India for almost a decade along with individual physicians of Indian origin living outside India, including Kini. A group of those Indian physicians formed the American Academy of Emergency Medicine India (AAEMI), which works alongside the Society of Emergency Medicine in India (SEMI). Emergency medicine awareness has been a goal for these two societies, along with trying to get recognition for emergency medicine as a specialty so that Indian physicians interested in the field could get the appropriate training in their native country.   However, emergency medicine is not yet recognized in India as a medical specialty. Pre-hospital emergency care is vastly inefficient and scarce due to an increasing population and traffic congestion from all sizes and types of vehicles that do not follow any traffic laws, since there are none to follow.   “The highways are traveled by carts pulled by oxen, horses and people. In some rural areas herds of sheep and cows crowd the streets causing problems for free flow of emergency departments at hospitals that, up until recently, were still called casualty departments. Since our involvement, the name was changed to a more appropriate designation of accident and emergency (A&E) departments,” Kini said. Since Kini and the group’s involvement, the hospital in Mangalore has acquired a few ambulances and established an emergency phone number similar to 911. “The Indian government has noticed our efforts and we’re hoping that within the next five years emergency medicine will be officially recognized as a medical specialty practice,” Kini said.   In an area of the world prone to massive earthquakes, tsunamis, flash flooding and other disasters, emergency medicine training and knowledge is a well-established need. Acting as a resource and by educating the physicians and government officials of India about emergency medicine, Kini also hopes to move beyond pre-hospital emergency care and establish a physician base trained in the art of assessing and treating trauma patients.   “For the most part right now, for the little guy who is sick and ends up at the hospital, he gets brought in and it’s like, ‘who do you call?’” Kini said. “There’s no real triage system, so in most places the first physician in many cases to respond to a patient who presents to the A&E is not a trained emergency physician, but an on-call orthopedic surgeon or an internal medicine physician.”   At Kasturba Medical College Hospital in Mangalore, they now have a triage system and an attending anesthesiologist to help with emergency medicine needs.   When Kini visits, he speaks to different medical groups, physicians, and medical students from throughout India about various emergency medicine topics.   In 2002, the LIJMC answered SEMI’s call to jointly sponsor the first International Emergency Medicine and Disaster Preparedness Conference (INTEM 2002) in Hyderabad, India. Kini, his colleagues and more than 1,000 delegates from India and surrounding countries attended. Since that time, the international conference continues every four years in addition to numerous educational activities that allow emergency medicine physicians to lend their knowledge to local, regional and national levels. Continuing medical education credits (CME) conferences are held annually.   “These physicians volunteer their time and money to visit their homeland and offer the help needed in various ERs and teaching institutions,” Kini said. “This type of activity has certainly generated an enormous interest in emergency medicine among Indian physicians and it is evident that hospitals have better equipped and staffed A&E departments prior to our involvement. Patient visits to these centers are increasing daily, and thus access to health care in an emergency is improving.”   Due to the success of the conferences and overall outreach effort, emergency medicine recently was recognized by the Medical Council of Andhra Pradesh, one of the southern states in India, as the newest medical specialty. In that region, emergency medicine is now a part of the medical undergraduate curriculum of several universities.   “It is our hope that other states in India will soon follow the same steps. The Indian Medical Council (the accreditation agency for specialty training) is noticing this activity and is exploring the pros and cons of making emergency medicine a recognized specialty for postgraduate training,” Kini said.     Friday, July 28, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.