Emergency Medicine in Jordan Rashed Hijazi MD, FRCSEd (A&E) Consultant EM

Pre-hospital care ( Public ) Covered by the civil defense directorate Multiple locations with 2 ambulances for each 2 crew members in each ambulance Supplied with basic equipment Dispatch by central communication center Transportation time: average 10 minutes Level of training: 6 months, started in 1988, 3 months theoretical, 3m. practical BLS and first aid, no invasive procedures

New regulations in progress for advanced medical protocols for IV access, drugs, defibrillators, etc. Dispatch to the nearest public hospital, unless life threatening situation, then nearest private or public Communication with hospitals Funded by ministry of health Free for the public The Royal medical services (Military Sect.) Air medical evacuation by the Jordanian air force for eligible patients

Civil Defense (public)

Type of Call

Pre hospital Care ( Private ) Each private hospital runs its own ambulances Medical services on special request only High standard, well equipped High standard, well equipped Recently started mobile intensive care units Ambulance crew including a physician Dispatch by the private hospital if called upon Retrieval to the same hospital only No communication with other private hospitals Funded privately or by private health insurance

The Jordanian Board In Emergency Medicine  Independent specialty since July 99  Five approved training centers  Registration in the medical association  Four year program  Part I during the 2 nd year  Only successful candidates are promoted to the 3 rd year  Board exam after 4 th year

Training Program - Established after reviewing Australian, American, Canadian and European programs - Independent specialty - Started 1 st at Jordan University candidates at start of program - 5 candidates obtained Jord. board

1 st Year 3m General Medicine 3mER 2m General Pediatrics 2m General Surgery 2mOrthopedic

2 nd Year m OB & Gyn. 3mER 2m ER Ped. 2mCCU 2mICU 2mPsych.

3 rd Year Plast.SurgAnesth. ER Adm. ER ped. ER 1m1m1m1m2m ElectiveResearchForensicPed.SurgNeur.Surg2m1m1m1m1m

4 th Year ER 12 months ER 12 months Senior : Clinical & administrative Senior : Clinical & administrative Medical, Surgical, Pediatric and OB/Gyne. Medical, Surgical, Pediatric and OB/Gyne.

Program Activities Emergency medicine topics Emergency Surgery topics Pediatric Emergency topics Obstetrics & Gynecology topics Mortality & Morbidity Journal Club Radiology Case presentation Principles and basic science

Program Progress Periodical evaluation End of year examination Written, Oral and Clinical Pass mark 60% Publication Program director Committee ( From other specialties ) Successful : Jordanian Board Certificate Exemption of part1 Arab Board Unsuccessful : 3 trials with conditions

EM Training Centers Jordan University Hospital ( 1 st center ) - Started in July Started in July Jordan University has 550 beds with 60,000 visits to the ER per year - Jordan University has 550 beds with 60,000 visits to the ER per year - Requirement, selection criteria - Requirement, selection criteria

EM Training Centers KA University hospital 1 st Yr #3 candidates 2 nd Yr #4 candidates Commenced June 02 Ministry of Health hospital 1 st Yr #5 candidates Commenced June 03 Military hospital 1 st Yr Private hospital 1 st Yr #1 candidate 2 nd Yr #1 candidate

Challenges New specialty Shortage of ER physicians Limited understanding Under-estimation Lack of support Financial Financial Staff Staff Facilities Facilities Regulations and guidelines Future and security

Optimistic outlook Population and need High incidence of trauma Increasing No. of Private hospitals Competitive other specialty Establishment of the Arab Board in EM International applicants Other specialties applicants Strong link with Family medicine

Improvement More ER physicians Supervisors and trainers Introduction of academic courses, eg: ACLS, ATLS, U/S etc. Advertising Legal and ethical issues Conferences Establishment of an EM association and Collaboration with others Communication and reciprocal recognition

Summary New developing specialty among well developed and high standard medical services The future is bright High spirit present International support needed

Thank you