International Emergency MedicinePediatric Preparedness of Lebanese Emergency Departments
Introduction
The emergent care of children varies across the world, dependent upon such factors as the type of health care system, funding, provider education, and burden of disease. In Malawi, for example, emergency care remains dependent upon visiting physicians, whereas in Kosovo, physicians without specific training in Pediatric Emergency Medicine (PEM) or Emergency Medicine (EM) staff the Emergency Departments (EDs) 1, 2. A European survey of tertiary care centers reported that only 24% of the pediatric ED medical directors have formal PEM training (3).
Whereas local efforts have identified challenges to improving pediatric emergency care (PEC) in particular countries, such as staffing and parental education difficulties in the Congo and lack of equipment in Uganda; other countries have partnered with international providers to improve their outcomes 4, 5, 6, 7. However, few data describe in detail the state of PEC in a region or country. Most such publications describe care in high-income countries in North America and Europe 3, 8, 9, 10, 11, 12, 13, 14.
Lebanon, a small Middle Eastern country, is prone to armed conflict, emphasizing the need for appropriate emergency medical services to care for the ill and wounded. Recently, there has been increased attention to EM in Lebanon, including the establishment of the Lebanese Society of Emergency Medicine (2003), the first Academic Emergency Department (2007), and the first EM residency program (2012). Although these efforts will help develop EM as a whole, complementary efforts to develop the standards for PEC are also necessary. To date, there are no data to determine the preparedness of Lebanese EDs.
Our objective was to describe the status of Lebanese EDs that care for children to inform the further development of PEC. More specifically, we aimed to describe the number, regional location, and characteristics of hospitals in Lebanon with EDs providing emergency care to children and to describe the staffing, equipment, and support services of these EDs.
Section snippets
Study Design and Population
The study was approved by the Institutional Review Board of both home institutions of the investigators.
We conducted a survey, between September 2009 and September 2010, of hospitals in Lebanon caring for children in an ED setting. We defined a hospital as any building termed “Hospital,” “Mostashfa” (Arabic), or “Hôpital” (French). We chose this definition to be inclusive of any institution the Lebanese government or the Lebanese population would typically attend to receive emergent medical
EDs Identified and Surveyed
A total of 206 hospitals were identified; 115 fulfilled our inclusion criteria, and 72 of these (62.6%) answered the survey. Three responses were lost due to unforeseen events, resulting in 69 surveys analyzed (Figure 1). We present the response rate based on the region and population density of Lebanon in Figure 2 (19). All regions are represented.
Hospital Characteristics
The majority of participating hospitals were urban, private (for profit), with fewer than 100 inpatient beds (44/68, 64.8%), and without residents
Discussion
This is the first study to provide a description of Lebanon’s ED preparedness for pediatric patients. We found that there are many EDs that care for children throughout this small country, and that none of the EDs was dedicated solely to pediatric patients. The majority of children in Lebanese EDs are cared for in the same area as adult patients by physicians with no specialized PEM or critical care training. Only a moderate number of EDs stated they had at least one EM-trained physician on
Conclusion
The emergency care of children in Lebanon is provided at numerous hospitals throughout the country with a wide range of staffing patterns and available support services. Although pediatricians are usually involved in their care, children who present to Lebanese EDs seem to be most frequently cared for by physicians with limited or no training in PEC. Further studies that would more specifically assess ED quality measures and clinical outcomes could facilitate the development of pediatric
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