The importance of emergency medicine in Bangladesh and the need for a residency programme

Emergency Medicine (EM) has become a cornerstone of healthcare systems in richer countries. Recognized as a distinct specialty in the early 1970s, it emerged from the evident need for rapid medical attention at critical moments of patient care. ¹

Despite its importance, many low- and middle-income countries (LMICs), including Bangladesh, do not yet have fully established EM systems, leaving large populations without access to such specialized emergency care. Bangladesh, particularly because of its high population density and frequent natural disasters, has an undisputed need. However, there is no formal Emergency Medicine training pathway in the country, and the existing healthcare infrastructure obviously struggles to provide adequate care for trauma, cardiovascular emergencies, and other acute conditions.^2,3

The only properly functioning public emergency department is in one corner of the country, at Cox's Bazar. This is insufficient for the city's needs, let alone the whole country! This is worrying, particularly in a country vulnerable to both natural and man-made disasters. Currently, in Dhaka and other major cities, “Emergency Care” is staffed by only one doctor who works to triage patients to different departments for admission. Not surprisingly, with the current state of affairs, emergency healthcare is under impossible strain.

The lack of emergency infrastructure exists, as already stressed, because of the country's lack of formal training for emergency physicians. ⁴

Inevitably, with inadequate triage, patients often experience excessively long transit times till they reach specialized care, where it is available. Thus, higher morbidity and mortality rates (often due to delayed or inappropriate treatment) are the result.

To establish an Emergency Medicine programme in Bangladesh, several critical elements need to be in place:

Infrastructure Development:

It may be asked, “Is Bangladesh Ready for This?” The COVID-19 pandemic has laid bare the deficiencies in emergency care and triage, highlighting the urgent need for formalized Emergency Medicine services. Bangladesh may not be ready, but the need is self-evident.

The introduction of Emergency Medicine residency programmes elsewhere in LMICs reveal a marked decrease in mortality rates from 6.3% to 1.2% and a reduction in overall hospital mortality from 12.2% to 8.2% in Rwanda, ⁵ and from 13.6% to 8.2% in Tanzania. ⁶ Successful Emergency Medicine residency programmes have resulted in better management of trauma, cardiovascular emergencies, and natural disaster responses in South Africa and India.^7,8

We rest our case.