Emergency medical care in Libyan hospitals is outdated
‘Reception’ / Outpatient Department provide a disjointed service
An alternative model is proposed
As we all know, the emergency medical care in Libyan hospitals is
far from optimum. The service
provided is disjointed and fragmented, and a complete overhaul is
needed to modernise the service.
• Each speciality has its own independent Emergency Department
• SOPD, MOPD , POPD, GOPD
• Difficulty for patients
• Difficulty for Staff
• Poor outcome of care
At present, each Speciality has its own ‘Reception’ and Emergency
Department. This arrangement
leads to significant problems.
For example, patients would not necessarily have the ability to determine
which OPD they should
attend, and valuable time is lost. Patients attending the wrong Department
will be seen by staff who
are not trained to deal with their conditions. All that leads to poor
outcome, unnecessary suffering,
and wasted resources.
• 24-hour access to high-quality emergency care
• Easy access to diagnostic facilities
• Immediate access to Critical Care / Intensive Care
• Immediate access to emergency treatment including resuscitation,
stabilization and surgery
The Emergency Department should provide 24-hour high-quality care to all
those who need it. It should allow easy access to diagnostic facilities, such
as radiology, pathology, haematology, and biochemistry, to help in
diagnosing conditions in a timely manner. It is also essential that such
departments work closely with Intensive Care facilities, to provide the
continuity of care that some critically ill or seriously injured patients might
need. Emergency Departments should be backed up by facilities to enable
the resuscitation, stabilization, and treatment of patients, including
Modern Emergency Departments
• Resuscitation facilities to manage severe conditions
• Facilities to deal with acute illness and severe injuries in children and
• Facilities to deal with high volumes of ‘minor’ injuries
• Capability to deal with mass casualties from
major incidents and disasters
The modern emergency department should be
able to provide resuscitation for severely injured
And seriously ill patients in a specialized
environment, where patients can be closely
monitored, and their care can be optimised early
In the process. The concept of the ‘Golden Hour’
in trauma management emphasizes the need for
prompt effective treatment for that group of patients.
The Emergency Department should also have the ability to treat acute illnesses and serious
as well as large numbers of patients with minimal injuries.
It is essential that emergency departments have the ability to cope with very large numbers
of severely injured patients in the event of major incidents and natural disasters. Emergency
departments must have pre-determined procedures to deal with such unusual circumstances.
It has the following requirements:
• Area to fit t a specialised resuscitation bed.
space to ensure 360° access to all parts of the
patient for uninterrupted procedures
• Circulation space to allow movement of staff
and equipment around the work area.
• Space for equipment, monitors, storage, wash up
and disposal facilities.
• Appropriate lighting, equipment to hang IV fluids etc.
• Maximum possible visual and auditory privacy for t
he occupants of the room and other patients and relatives.
• Minimum size for a single bed resuscitation room is
35m2 or 25m2 for each bed space if in a
multimedia room (not including storage area).
• The following should be immediately accessible:
Intravenous access trolleys
• Peritoneal lavage tray, Thoracotomy tray, Intercostals tray , USSG, Urinary catheterisation tray,
Airway management tray (including surgical airway equipment), Invasive vascular access insertion
tray, Paediatric resuscitation equipment, and Refrigerator.
This room is used for the
resuscitation and treatment of
critically ill or injured patients.
The need for change?..
• To provide high-quality service to patients
• To provide emergency care to a wide spectrum
of emergency conditions
• To provide high-quality training for staff
• To establish and develop Emergency
Medicine as a recognised and respected
Speciality We need to change the current unacceptable situation. Our
patients currently receive disjointed fragmented care from untrained staff in
inadequate facilities. We have to provide our patients with high-quality care
in an appropriate, well-equipped environment. In order to do that, we need
to train staff, medical, nursing and paramedical, in the discipline of
Emergency Medicine. Such trained
staff should be able to assess, diagnose and manage the whole spectrum of
conditions presenting to these departments. This will lead to the creation of
a new breed of specialists in Libya. The Emergency Physician
• All patients present to a single ‘Reception’ area.
• Rapid assessment by trained nurses
• Patients directed to the appropriate area
– ‘Major’ Area
– ‘Minor’ Area
In the model we propose, which is broadly based on the Emergency
Departments in the UK, patients would present to a central reception
area, regardless of their complaint or injury. The patient would
then be assessed by trained nurses, who, using protocols and
guidelines, can determine the broad nature of the complaint, and
direct the patient to the appropriate part of the Department. They
would also be able to determine the seriousness of the problem by the
process of ‘Triage’, therefore determining the priority at which patients
would be seen.
This room is used for the resuscitation and
treatment of critically ill or injured patients.
After triage, patient details are recorded by the
clerical staff and a medical record either raised
or a previous medical record retrieved.
treatment will be performed either in sequence
or concurrently, depending on the
severity of the patient’s condition.
The patient triaged as Red (patient must seen
immediately), Orange (patient should be seen
within 15 minutes), Yellow( patient must be seen
within an hour), and Green (patient can wait up
to three hours )
– Middle Grade Doctors
The Emergency Department should be staffed by an adequate number of doctors, with
varying degrees of skills and qualifications. The senior staff, or the Consultants, provide
the supervision, guidance and training. They also oversee the management of patients,
and get closely involved in the assessment and treatment of the more seriously-ill
patients. In addition, Consultants have important management roles, which would
allow the smooth running of this complex operation. The Middle Grade doctors provide
the direct supervision of the junior staff, and offer support and help to trainees. They
can also be involved in certain management issues, such as staff recruitment, education
and manpower management. It would be expected that larger Emergency Departments
would have two types of trainees:- basic trainees, who are junior doctors working in the
Emergency Department to gain experience to help them develop their career in other
disciplines (Orthopaedics, General Surgery, Anaesthetics, Medicine, General Practice,
etc.), and specialist trainees, who are experienced doctors training in the speciality of
Emergency Medicine. These doctors would have broad experiences in General
Medicine, General Surgery, Orthopaedics, Critical Care and Paediatrics. They work
under the supervision of Consultants to compliment their training to become
Emergency Medicine Consultants in the future.
• Broad base of skills
• More senior nurses have important management roles
• Specialist skills and extended roles The Emergency
Department nurses are highly-skilled nurses, with broad
experiences. They must have the flexibility to work under
unpredictable conditions. Senior nurses are heavily involved
in the management of the Department, and support the
senior medical staff in that task. Increasingly, Emergency
Nurses are developing extended roles, and specialist skills,
allowing them to see and manage a number of conditions
• Helicopter Landing Pad
• Rapid Response Team
• Decontamination Facilities
• Major Incident and Disaster Management
• Observation Ward
Patients can be lifted by
A decontamination room should be available for
patients who are contaminated with toxic
substances. In addition to the requirements of an
isolation room, this room must:
• Be directly accessible from the ambulance bay
without entering any other part of the department
• Have a flexible water hose, floor drain and
contaminated water trap
• A new concept
• Staff training
• Modern environment
In order to achieve this change, we must embrace the new model of
delivery of emergency care. Then, it is equally important that staff
training and good physical environments go hand in hand.
• Experience of others
• Develop links with international centres
• Exchange programmes and ‘twinning’ initiatives with recognised
teaching hospitals It would make perfect sense that we benefit t from
the experiences of others who have established emergency care
programmes. It would be advantageous to us to establish links with
recognised training centres and organizations in countries like the UK.
I have already established the feasibility of bringing over to the UK
trainees from Libyan teaching hospitals, for training in Emergency
Medicine in the UK. Early discussions are in place for twinning
initiatives, which would allow Libyan doctors to train in reputable UK
centres providing high-quality training in Emergency Medicine. The
success of such important and exciting initiatives depends
heavily on cooperation from the Libyan authorities.
• Change is badly needed
• Alternative models available
• Methods of achieving change are being explored
• Help and support from authorities is essential
In summery, there is no doubt that the current situation is
suboptimal and needs to be changed. There are a number of
alternative models that can replace the existing system. I have
described one that is well tried and tested in an established health
care system. Ways in which we can achieve the transition smoothly
have been proposed, but such change depends heavily on support
from the Libyan authorities
The emergency department is an integral unit of a hospital
and the experience of patients attending the emergency
department significantly influences the public image of the
hospital. Its function is to receive, stabilise and manage
patients who present with a large variety of urgent and non
urgent conditions whether self or otherwise referred. The
emergency department also provides for the reception and
management of disaster patients as part of its role
within the Disaster plan of each region. In addition to
standard treatment areas, some departments may require
additional specifically designed areas
to fulfil special roles.