gency medicine by way of a certification process involving a written and an oral examination. Continuing medical education is one of several requirements for ...
I N T E R N A T I O N A L REPORT
Emergency Medicine in the Philippines From the Philippine College of Emergency Medicine and Acute Care, Incorporated, Manila, Philippines.
Perry G Peralta, MD, FPCEMAC Johnny B Sinon, MD, FPCEMAC
Receivedfor publication May 10, I995. Acceptedfor publication October 4, 1995. Copyright © by the American College of Emergency Medicine.
[Peralta PG, Sinon JB: Emergencymedicine in the Philippines. Ann EmergMed December 1995;26:743-745.]
BACKGROUND Emergency medicine was recognized as a new specialty in the Philippines in 1991. The Philippine Board of Emergency Medicine (PBEM) was created as the certifying body of the college; it has certified 23 dipIomates in emergency medicine by way of a certification process involving a written and an oral examination. Continuing medical education is one of several requirements for the maintenance of this academic status. The core content of training programs is comprehensive and based on the core content of the American College of Emergency Physicians. Unfortunately, fellowships and dual board certifications are not available at this time. However, the Philippine Pediatric Society has shown interest in dual board certification and fellowships in pediatric emergency medicine. The Philippine Society of Critical Care Medicine has likewise shown interest in initiating a fellowship program for critical care medicine involving emergency physicians. The board is also required to set guidelines and standards for emergency practice. Examples include membership classification and chapter development, disaster planning and management, trauma centers, emergency medical services systems, accreditation of emergency departments and emergency medicine residency training programs, air and land ambulance configuration protocols, and triage protocols.
TRAINING PROGRAMS The PBEM accredits emergency medicine training programs, which take 3 years to complete, excluding an extra year for chief residency, which is mainly considered a year of advanced training in the administrative aspects of the specialty.
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So far the board has accredited three residency training programs. These programs are based at two private medical institutions (Makati Medical Center and St Luke's Medical Center) and one government hospital (Ospital ng Makati). St Luke's Medical Center has a medical school to provide academic support for its in-hospital training programs. So far, there are 32 residents. Accreditation for the training program at Ospital ng San Juan, another government institution, will be sought next year. Residents in emergency medicine are given the opportunity for academic and hands-on exposure in disaster medicine and EMS systems. EMERGENCY DEPARTMENTS
All hospitals in the Philippines have emergency facilities, but only five have United States-style EDs. They are Makati Medical Center, Ospital ng Makati, San Juan de Dios Hospital, Manila Central University Hospital, and St Luke's Medical Center. These five EDs had an average of 31,326 ED visits in 1994, with Makati Medical Center handling the largest volume. In the recognized EDs, at least, emergency physicians are actively involved in trauma management. They are automatically responsible for the resuscitative phase but involve other specialists early in the course of in-hospital management. Teamwork is the rule. EMS SYSTEMS
The most common EMS system setup is the local or community-based prehospital care system. A nationwide system is not yet available. Although the country has all the resources necessary for such a system, coordination is lacking; there are no mutual aid agreements between Table.
Philippine research studies. Disaster preparedness plan: Conquering Nature's tantrum Out-of-hospital emergency care: Does it really exist? Spacing and staffing requirements based on demographic studies of the ED Success rates of the basic and advanced life support systems of the Makati Medical Center ED Short-stay observation unit as an alternative to hospitalization at the Makati Medical Center ED Survival rates among patients revived from cardiac arrest ED information sheet: Its effect on patient satisfaction Conscious sedation using rectal midazolam before suturing of uncomplicated lacerations in children Rapid sequence intubation in the ED Use of aminophyl[ine in asystole
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communities, and the individual systems do not fulfill the requirements of an ideal EMS system. Philippine emergency physicians provide off-line and on-line medical control for community-based EMS systems and actively participate in the training of prehospital emergency care providers under these programs. Only one private emergency-response company deals with air medical transport. Strict medical control through designated lines of communications or on-scene supervision is provided by emergency physicians for this aeromedical program. The limiting factor of this service is the cost. Properly channeled, the armed forces of the Philippines may provide free air transport service. However, standardization and coordination have not been established. EMERGENCY PHYS CLANS
Of 23 certified emergency physicians in the Philippines, 17 are full-time emergency practitioners. Aside from inhospital practice, most of these full-time emergency physicians work in ambulatory centers or free-standing emergency facilities. Two of the certified emergency physicians are clinic based, with little or no ED exposure, and four did not pursue the active practice of the specialty. Several trends have unfortunately evolved in new EDs. First, members of other specialties have frequently resisted the advent of emergency medicine as a specialty. Second, the professional fees allowed by the hospital for practicing emergency physicians are usually lower than those charged by other consultants. Emergency physicians are recognized as specialists for the purposes of thirdparty reimbursement. Medical practice in the Philippines is basically fee for service. However, the hospital administration has much control over how much an emergency physician charges. In some institutions, emergency physicians are compensated by the hour or under a contractual arrangement. This is especially true for government institutions. Emergency physicians are responsible for the formal disposition of ED patients, and they initiate hospital admission if it is clinically indicated. RESEARCH
Research in emergency medicine is funded by the principal investigators, by the hospital, and, sometimes, by pharmaceutical companies. Ongoing and locally published studies have involved the administrative and clinical aspects of ED practice, as well as disaster manage-
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ment and prehospital care. The Table gives examples of recent studies. The Philippine College of Emergency Medicine and Acute Care, Incorporated (PCEMAC), was organized in May 1988 by a group of doctors from Makati Medical Center who initiated the modern concept of emergency practice in the country. The objectives of the college are to assure the quality delivery of emergency care, to protect the welfare and professional interests of emergency physicians, and to coordinate education in the specialt)~ At this writing the college has 282 members nationwide and affiliations with various international and local emergency-oriented organizations. It has given recognition to paramedical personnel in the ED, prehospital emergency care providers, and international experts. The college sanctioned the organization of Help In Emergencies and Life Preservation Society, the national paramedic organization. In addition to providing continuing medical education and training programs for medical and paramedical personnel and laypeople, the college has participated in the planning and management of community disasterpreparedness programs and EMS systems. The college was the lead agency for the Mass Casualty Incident Task Force of the 1995 World Youth Day and papal visit to Manila in January 1995. In addition to conducting various outreach and publicrelations programs, the college has been consulted by hospitals seeking to professionalize their emergency facilities and by communities attempting to organize prehospital emergency delivery systems. The PCEMAC has also sponsored two bills (which are at this writing pending in both chambers of the Philippine congress) in the national legislature, one for the professionalization of EDs (Emergency Care Act) and another for the organization of the Philippine EMS system (Philippine Emergency Medical Services System Act). The college's official journal is Lifeline. It serves as a medium of communication for all members and also publishes peer-reviewed articles on all aspects of the specialty. The PCEMAC also celebrates an annual Emergency Medicine Week. This special event was declared through an executive order of former Philippine President Corazon Aquino. The objective of Emergency Medicine Week is to emphasize the importance of the specialty and the extensive responsibility it has over EMS systems and disaster preparedness. Various activities are planned each year to promote this awareness among the private and government sectors of Philippine society.
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Reprint no. 47/1/69553 Address for reprints: Perry G Peralta, MD, FPCEMAC PhilippineCollege of EmergencyMedicine and Acute Care, Incorporated PO Box 3049 Manila, Philippines Fax011-632-819-5423
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