S4E12: Pre-Season Bonus! Prehospital System Design with Prof Junaid Abdul Razzak - Trauma/Pre-Hosp
Season 5 is just around the corner! We'll be kicking off the new season on Monday October 7th. Mark your calendars! In the meantime, Mohammed is off to Pakistan this week to PakTraumaCon 2024.
Being the insufferable nerd that he is, he's not satisfied annoying his colleagues and new acquaintances only at the conference, but has also been after them for chats before even getting on the plane... Someone needs to stop him.
Joining him on this bonus is Prof Junaid Abdul Razzak, also a speaker at PakTraumaCon this year. Prof Abdul Razzak is Vice Chair of Research at Weill Cornell Medicine in New York, and is also the Director of the Centre of Excellence for Trauma and Emergencies at the Aga Khan University in Karachi.
Right! Let's get to it.
Why should we care about system design in pre-hospital care?
Many patients die before reaching the hospital.
In traditional models of healthcare, it’s often seen that care begins when the patient gets to the hospital. While research in this area is sparce, it’s fair to assume that the gap in care may lead to preventable morbidity and mortality. A system design that thinks more from a disease and patient perspective than a provider perspective is key to approaching these issues and reducing morbidity and mortality.
What does good system design look like in pre-hospital care?
Prof Junaid Abdul Razzak emphasises the necessity of recognising how the chain of survival is exactly what it says on the tin - a chain - and every chain has interconnected components. Issues in system design can commonly, at least in part, be attributed to breakdown in the seamless integration between the transition points.
In an EMS to hospital setting, Prof Abdul Razzak reminds us that the chain begins with the bystander, and continues all the way through to each of the specialties and professionals that see the patient on the way to, and through the hospital. Culturally, each of these providers from the EMT, to ED nurses, all the way through to the ICU staff can have different priorities, but in reality they should be the same. A system that isn’t in unison leads to worse outcomes for the patient.
If you were to design an EMS system de-novo today, what would it look like?
Prof Abdul Razzak speaks comprehensively about the core principles to target to improve EMS systems, and touches on three main priorities:
Legal Framework (to ensure the chain of survival functions)
Better communication between EMS and hospital
Focusing on training that addresses the local need
“In many countries, trauma and many medical emergencies are still seen as a medico-legal issue, and people are hesitant to engage… (and) provide on-scene care and to call 911 because of the fear of consequences for themselves.
Legal framework that protects this chain of survival starting from bystander onward is (a key priority)...”
Mo and Prof Abdul Razzak continue to discuss the barriers in communication between EMS and hospital staff, as well as the nuances of how “good training” means a different thing depending on the setting - i.e. rural or socially economically disadvantaged areas vs urban or wealthy areas.
Critical care doctors pre-hospital, Research priorities, and getting legislative buy-in
Many physicians with critical care experience want to be involved in enhanced prehospital care, but are there any pre-requisites in system maturity and the pre-existing service level, before which having pre-hospital advanced care becomes a worthy investment?
In an area with very little research, what are the priorities for research in a pre-hospital setting in the next few years?
How difficult is it to engage and receive the support of stakeholders in developing pre-hospital system design?
Interested in these questions? What are you waiting for? Tune in now!
And that’s a wrap for this special pre-seaon bonus!
We are incredibly excited for season 5 which is dropping on Monday 7th of October!
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And in the meantime - may your coffee be strong, and your rounds grand. TCR, out.
