A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Donaldson, Ross I.; Shanovich, Patrick; Shetty, Pranav; Clark, Emma; Aziz, Sharaf; Morton, Mark J.; Hasoon, Tariq; Evans, Gerald E.

doi:10.1017/s1049023x12000519

Cited by 20 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Many countries have reported high incidence of BMJ Global Health physical and verbal violence especially in the emergency departments. [5][6][7][8][9][10] HCWs are mostly susceptible to reactive violence from patients and their attendants, affecting their mental and physical well-being. 11 If the workers are stressed about security, it can lead to post-traumatic stress disorder and can decrease job performance and increase burn-out.…”

Section: Introductionmentioning

confidence: 99%

The magnitude and determinants of violence against healthcare workers in Pakistan

et al. 2020

View full text Add to dashboard Cite

► Main reasons among hospital HCW's included reaction of attendants to adverse outcomes, impatient behavior of patients and attendants, delay in care and lack of facilities ► Among ambulance workers, main reasons included delay in arrival and shifting of the patient and lack of facilities to provide good quality pre-hospital emergency care ► Among field healthcare workers, misconception of vaccines was the main reason. ► This study proposes interventions according to main reasons of violence.What do the findings imply?► The findings of the study provide directions for different healthcare settings on how to protect HCW's. ► The essential interventions required are increasing resources to provide good quality of care, introducing policies to improve responsiveness to patient's needs, training HCW's in communication and deescalation skills and introducing educational and regulatory measures to improve patient and attendant behavio AbsTrACTObjectives To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them.Methodology A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. results More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68

show abstract

Section: Introductionmentioning

confidence: 99%

The magnitude and determinants of violence against healthcare workers in Pakistan

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Human resource shortages also create a lack of local trainers for professional development courses aimed at the healthcare workforce in LMICs [ 3 ]. This results in emergency rooms staffed with rotating, off-service physicians or residents who often have minimal training and experience in emergency medicine [ 4 ]. A poor primary care system compounds this issue by increasing the acuity of patients presenting to the emergency room [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The readiness of emergency and trauma care in low- and middle-income countries: a cross-sectional descriptive study of 42 public hospitals in Albania

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundTraumatic injuries have become a substantial but neglected epidemic in low- and middle-income countries (LMICs), but emergency rooms (ERs) in these countries are often staffed with healthcare providers who have minimal emergency training and experience. The aim of this paper was to describe the specialized training, available interventions, and the patient management strategies in the ERs in Albanian public hospitals.MethodsA cross-sectional descriptive study of 42 ERs in the Republic of Albania between September 5, 2014, and December 29, 2014 was performed. Assessment subcategories included the following: (1) specialized training and/or certifications possessed by healthcare providers, (2) interventions performed in the ER, and (3) patient management strategies.ResultsAcross the 42 ERs surveyed, less than half (37.1–42.5 %) of physicians and one third of nurses (7.1–26.0 %) working in the ERs received specialized trauma training. About half (47.9–57.1 %) of the ER physicians and one fifth of the nurses (18.3–22.9 %) possessed basic life support certification. This survey demonstrated some significant differences in the emergency medical care provided between primary, secondary, and tertiary hospitals across Albania (the significance level was set at 0.05). Specifically, these differences involved spinal immobilization (p = 0.01), FAST scan (p = 0.04), splinting (p = 0.01), closed reduction of displaced fractures (p = 0.02), and nurses performing cardiopulmonary resuscitation (CPR) (p = 0.01). Between 50.0 and 71.4 % of the facilities cited a combined lack of training and supplies as the reason for not offering interventions such as rapid sequence induction, needle thoracotomy, chest tube insertion, and thrombolysis. Mass casualty triage was utilized among 39.1 % primary hospitals, 41.7 % of secondary, and 28.6 % of tertiary.ConclusionsThe emergency services in Albania are currently staffed with inadequately trained personnel, who lack the equipment and protocols to meet the needs of the population.

show abstract

“…Once they arrive, they become part of a very busy system. Emergency physicians see more than seven patients per hour, with RTIs among the most common conditions 29. Despite the volume of trauma, only 19% of Iraq's emergency departments have a standard triage system, fewer than a quarter of physicians in emergency departments have undergone advanced trauma life support training, and only 3% of physicians have specialised emergency training 29.…”

Section: Discussionmentioning

confidence: 99%

“…Emergency physicians see more than seven patients per hour, with RTIs among the most common conditions 29. Despite the volume of trauma, only 19% of Iraq's emergency departments have a standard triage system, fewer than a quarter of physicians in emergency departments have undergone advanced trauma life support training, and only 3% of physicians have specialised emergency training 29. Increasing the coverage and skill of prehospital services and training clinicians who care for the injured have all been shown to reduce trauma-related morbidity and mortality 30–32…”

Section: Discussionmentioning

confidence: 99%

Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey

et al. 2016

View full text Add to dashboard Cite

IntroductionAround 50 million people are killed or left disabled on the world's roads each year; most are in middle-income cities. In addition to this background risk, Baghdad has been plagued by decades of insecurity that undermine injury prevention strategies. This study aimed to determine death and disability and household consequences of road traffic injuries (RTIs) in postinvasion Baghdad.MethodsA two-stage, cluster-randomised, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding crash specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.ResultsNine hundred households, totalling 5148 individuals, were interviewed. There were 86 RTIs (16% of all reported injuries) that resulted in 8 deaths (9% of RTIs). Serious RTIs increased in the decade postinvasion and were estimated to be 26 341 in 2013 (350 per 100 000 persons). 53% of RTIs involved pedestrians, motorcyclists or bicyclists. 51% of families directly affected by a RTI reported a significant decline in household income or suffered food insecurity.ConclusionsRTIs were extremely common and have increased in Baghdad. Young adults, pedestrians, motorcyclists and bicyclists were the most frequently injured or killed by RTCs. There is a large burden of road injury, and the families of road injury victims suffered considerably from lost wages, often resulting in household food insecurity. Ongoing conflict may worsen RTI risk and undermine efforts to reduce road traffic death and disability.

show abstract

A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Cited by 20 publications

References 27 publications

The magnitude and determinants of violence against healthcare workers in Pakistan

The magnitude and determinants of violence against healthcare workers in Pakistan

The readiness of emergency and trauma care in low- and middle-income countries: a cross-sectional descriptive study of 42 public hospitals in Albania

Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey

Contact Info

Product

Resources

About