Challenges and Possibilities of Emergency Medicine from Public and Global Health

Perspectives

TEODORO JAVIER HERBOSA MD FPCS FPCEM!PROFESSOR!

Department of Emergency Medicine!University of the Philippines, Manila!

Undersecretary of Health (2010-2015) Philippines!

–Johnny Appleseed

Manila Skyline

Philippine General Hospital University of the Philippines, Manila

First Certified FACEP in the Philippines 1986

Dr. Joel Gernsheimer FACEP, fulltime Emergency Physician at PGH ERC

1986-1987 - introduced Emergency Medicine

After, PGH created an Emergency Room Management Committee which took responsibility and administration of the ERC

UP PGH - Emergency Room Management Team

ERMAT - headed by an orthopedic surgeon Dr. Antonio Montalban

a multidisciplinary team, composed of ER nursing supervisor from Surgery, Orthopedics, Internal Medicine, Pediatrics & Family Medicine.

Dr. Montalban published the first Aid Manual written in Filipino and founded the Philippine Society of Emergency Care Physicians (PSECP).

Philippine Society of Emergency Care Physicians PSECP

!

Formed on August 26, 1989 Group of different specialty doctors Led by Dr Antonio Montalban and Dr Victorio Pidlaoan Organized a meeting of various doctors from major hospitals Improve Emergency Care throughout the country Annual scientific meetings and postgraduate courses Journal of Philippine Emergency Care

Philippine Society of Emergency Care PSECP 1989

!

National organisation of over 200 members of different specialties interested in improving emergency care throughout the Philippines

Regular twice yearly conferences in Manila and the other islands to improve the emergency care

Scientific meetings eventually led to the publication of the Official journal of the Society—Philippine Journal of Emergency Care

The forum for further development of the practice of Emergency Medicine in the Philippines

Department of Emergency Medical ServicesUP-PGH 1990

Dr. Richard Tiongco, travelled to Chicago, USA to observe the management of hospital ER’s.

1991 Department of Emergency Medical Services (DEMS) The University of the Philippines, Board of Regents created the first

Department of Emergency Medicine in February 1991, with the department composed of specialists and consultants representing different disciplines.

Returning from Trauma Fellowship at Cook County, USA, Dr. Teodoro Herbosa, in April, 1994 was appointed Chair of DEMS.

1995, additional specialists in the DEMS were recruited by Dr. Herbosa. One more trauma surgeon,

three orthopedic surgeons, one internal medicine /pulmonologist and one family medicine toxicologist joined the department.

Dr. Lynn Palacol Ropollo FACEP !

Undergraduate medical Student 1992

Clinical and research elective in the DEMS UP-PGH

Preceptor: Prof. Dr. Peter Rosen of UCSD

Dr. Peter RosenIn 1996, Dr. Herbosa met with Dr. Peter

Rosen at the University of Southern California San Diego (UCSD) after he sent a medical student on elective rotation there at the PGH - DEMS.

Dr. Rosen is one of the pioneers who encouraged us at UP-PGH to pursue the development of Emergency Medicine residency program in the University.

UP PGH Emergency Medicine Faculty

Dr. Wilma Geck FACEP Dr. Maria Acosta Soriano FACEP

First Emergency Medicine Graduates UPPGH 1999

Department of Emergency MedicineUniversiti Kebangsaan Malaysia Medical

Center 2007-2009

Manila Doctors' Hospital

East Avenue Medical Center

–Johnny Appleseed

“VSMMC pic.”

–Johnny Appleseed

Vicente Sotto

Health Reforms, Global Health, Universal Health Coverage and

Emergency Medicine

• UHC Reforms!

• Financing!

• Systems!

• Health Inequity

Continuum of Care

SUBSTANTIAL INCREASE IN THE DEPARTMENT OF HEALTH BUDGET

Budget (in billion pesos)

Billi

on P

esos

0

22.5

45

67.5

90

Year2008 2009 2010 2011 2012 2013 2014

Budget (in billion pesos)

18.91 23.67 24.65 31.83 42.08 50.44 89.7

IMPROVED ACCESS TO QUALITY HOSPITALS AND FACILITIES

3,576:Total health facilities upgraded and rehabilitated as of Feb 2013

1,049 hospitals

Another 2,487 health facilities will be upgraded this 2013.2,751 (91%) came from the 609 priority municipalities listed by the National Anti-Poverty Commission

Result: Increase in deliveries of mothers in hospitals. 719,552 mothers (38.8%) (2009) vs 1,014,613 mothers (57.1%) (2011)

Pre-hospital Care/Emergency Medical Services EMS

Standards in EMS Education

Emergency Medicine in UHC

• Intermediate Key Performance Indicators

• Efficiency!

• Quality!

• Access!

• Continuum of care, prehospital, acute care, chronic care

Surveillance Post Extreme Emergencies and Disasters

short messaging system or sms reporting of

symptoms seen in evacuation centers

Priorities of Action Sendai Framework

• Priority 1: Understanding disaster risk.

• Priority 2: Strengthening disaster risk governance to manage disaster risk.

• Priority 3: Investing in disaster risk reduction for resilience.

• Priority 4: Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction.

Continuum of Care

Take-home Messages• Emergency Medicine operates in a National Health System.

Always look at the BIG picture.

• In, Asia we have very diverse Health Systems

• To improve efficiency, quality and access to world class standards emergency care, one must understand the health reforms in your own country

• Financing, payment schemes need to be re-thought and remodelled

• Use health system organization & regulation to improve health outcomes

Take home Messages

• Behaviour change of the Physicians, the Patients and the Population

• The journey to health systems strengthening is a journey of the Emergency Medical Services System, Prehospital Care, Acure Care and even Disaster Medicine

Challenges and Possibilities of Emergency Medicine from Public and Global Health Perspectives!

ted.herbosa@gmail.com!Facebook: Ted Herbosa!

Twitter:Teddybird!