Oleh/By : DATO' SERI DR. MAHATHIR BIN MOHAMAD
Tempat/Venue : THE TUN DR ISMAIL HALL, PWTC,
KUALA LUMPUR
Tarikh/Date : 03/04/97
Tajuk/Title : THE FIRST ASIAN INTERNATIONAL
CONGRESS ON EMERGENCY MEDICINE
1. I would like to take this opportunity to thank the
organiser, Malaysian Society for Traumatology and
Emergency Medicine, (MASTEM) for inviting me today to
officiate the opening of the First Asian International
Congress on Emergency Medicine.
2. Emergency medicine I understand is a relatively new
field when compared to other disciplines, not only in
Malaysia but in the world generally. In the United
States it was only fully established in the 1970s. In
developing countries like many in Asia, emergency medical
services is poorly developed and frequently a low
priority with the respective Governments. And yet,
emergency departments form the gateway to definitive
care.
3. As Malaysia moves towards full industrialisation, it
has to make significant shifts towards regionalised and
specialised care and towards this end the Government is
moving quickly and expeditiously especially in the areas
of emergency medical services and trauma care.
4. Dramatic shifts in the incidence and frequency of
illness have taken place over the past two decades.
Malaysia's epidemiological profile now resembles much
more closely that of an industrialised country, with
cardiovascular disease, cancer and injury representing
the major killers. Furthermore, the incidence of injury
due to road traffic and industrial accidents is fast
accelerating. It equals if not exceeds that of Western
countries due to the faster rate of development in
Malaysia. Urgent action is required both in terms of
injury control and prevention as well as in the
development of service systems of emergency medical and
trauma care. Prevention is an urgent priority where
intersectoral and interministerial cooperation becomes a
crucial requirement in the reduction of morbidity.
5. In 1993, 56 percent of all hospitalisations were
from injury sustained through motor vehicle accidents,
while 27 percentage were from falls with 7 percent from
machinery-related events.
6. The high number of death due to accident is expected
to increase to 31.2 per 100,000 population and this trend
is consistent with the increase in the number of
registered vehicles in Malaysia, of which motorcycles
make up 58 percent of the number.
7. The rise in fatalities becomes more marked during
periods of heavy population movement. During the 18-day
holiday season over Chinese New Year and Hari Raya, 614
persons lost their lives, 565 sustained serious injuries
and 892 minor injuries. Reflecting the rapid switch from
agriculture to industry an analysis of occupational
injuries in 1993 indicated that the rate is 5 times
higher than that of Japan, Sweden and United Kingdom.
8. In economic terms, this clearly represents a
significant loss to the country. A large proportion of
casualties are young adults in the 20-40 age group. In
1993 where there were 27.8 deaths/100,000 population,
130,000 years of life were lost.
9. Other major causes of death requiring emergency
services relate especially to Ischaemic heart disease,
diabetes Mellitus & Cerebro-vascular accidents. As a
result of the changing lifestyle, the incidence of these
diseases mirrors similar disease patterns in the
developed countries of the West. Mortality from these
diseases rose 18.6 percent in the 10-year period between
1982 - 1992.
10. Chronic obstructive airways disease (COPD) saw a 25
percent increase over the same period. Residents in
Kuala Lumpur have more than twice the risk of dying from
COPD than the national average. Studies have shown that
there is a causal relationship between the incidence of
COPD and the degree of air pollution.
11. Malaysia has undertaken numerous programmes to
overcome these trends. In most instances such programmes
are interministerial in nature. Preventive strategies in
minimising road traffic accidents include seat-belts,
side impact beams and airbags; infrastructure development
and grade separated crossings to minimise traffic
crossflow, speed control and walkways that separate
pedestrians from motor traffic; public education
campaigns, increased surveillance and stricter
enforcement of rules and laws. We are resolved to make
safety a priority.
12. On the clinical front, attention is being paid
towards building new infrastructure, restructuring the
service system and providing personnel trained in
emergency medicine. A comprehensive and integrated
emergency and trauma services include pre-hospital care,
resuscitation and stabilisation at the emergency
department, definitive care and rehabilitation. The
decentralisation of Hospital Kuala Lumpur, the National
Referral Centre, is a move towards establishing a modern
and new technology department. Two new hospitals with
state-of-the-art technology are currently being built at
Selayang and Sungai Buloh. The Selayang hospital will be
a first in that it will be `paperless' and will have a
large catchment area involving one third of the
population of Kuala Lumpur and will act as a tertiary
referral centre for disciplines like Hand and
Microsurgery, Urology, Nephrology and Cardiology. The
infrastructure within has been redesigned by local
experts and customised to our needs.
13. The Sungai Buloh Hospital on the other hand has been
designated as the main medical centre of Klang Valley
where the national trauma centre and other major medical
department will be sited. It will be self-sufficient
somewhat like a medical city.
14. The trauma centre will provide an integrated and
comprehensive Emergency Medical and Trauma System and
will act as the main co-ordinating centre for the
clinical service networking among the hospitals in the
Klang Valley.
15. As the Malaysian health care system matures and
regional emergency service networking established, there
will be increased demand for the transport of patients
between facilities. This will have a significant impact
as Hospital Kuala Lumpur is dispersed over four or more
facilities with differing missions and case mixes. As
health facilities become more specialised the need for an
efficient communication and consultation services becomes
crucial. The inter-facility transfers of patients will
have to be coordinated through good communication and
dedicated medical communication system.
16. A comprehensive communication system with universal
access line ala the 911 System which will give the public
access into the health care service to acquire any form
of medical assistance needs to be established in this
country as soon as possible.
17. Malaysia is now planning for the establishment of an
emergency communication network which will include
telemedicine & tele-emergency capability. Advances in
audio-visual technology have made it possible for the
complete assessment of patient condition between
hospitals. This is ideal for our current situation where
we do not have adequate specialist service in every part
of the country and hence, telemedicine will provide
access to expert consultation.
18. Currently in Malaysia, local universities produce
approximately 400-500 doctors per year. With the
establishment of new schools, both government and
private, by the year 2000 we hope to produce between 500
- 600 more doctors per year which will considerably
reduce the present doctor - patient ratio of 1:2400. The
three local universities have also been running Post
Graduate Masters programmes for the various specialities
where students graduate with a Master Degree at par with
those given by foreign and more established institutions.
19. Nurses and medical assistants are currently being
trained at the various training schools nation-wide.
Despite this, demand far outstrips supply. With the
mushrooming of private hospitals, the need for trained
paramedic staff becomes more urgent. In line with this,
we are considering establishing a Paramedic Training
Institute which will not only train paramedics for in-
hospital needs but also provide personnel for an
efficient and skillful pre-hospital service.
20. The concept of the `first responder' has been
introduced in Malaysia where individuals who are not
specifically trained in providing emergency care but who
by nature of their occupation are the first to arrive at
the incident site e.g. police will be trained with life
support skill to focus their service life to save victims
and initiate life support procedure together with the
management of other aspect of the accident. First
responders are recognised internationally as a cost-
efficient and effective part of an overall emergency
medical system. Police and fire and rescue personnel
would therefore be encouraged to assume this role where
they can perform initial assessment and basic life-
support procedures.
21. In an emergency service department in a hospital, at
least 2.5 percent of trauma patients are the result of
sport activities. Many of these patients are injured due
to recreational and other sports activities which if not
treated well will result in chronic and recurrent
problem.
22. As Malaysia prepares for the Commonwealth Games in
1998, the Ministry of Health will establish a Sports
Medicine Unit which will be of international standards.
23. We are fortunate this morning to have with us so
many experts from the Atlanta Olympics to share their
experience and expertise with us. It is my hope that
Malaysian medical personnel will maximise this
opportunity to learn from the experiences of these
experts and prepare for the Commonwealth Games.
24. On this note and with great pleasure, I declare open
this First Asian International Congress on Emergency
Medicine.
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