Emergency Medicine (EM) in Singapore has made tremendous progress over the past 20 years, in part due to the focus on research by dedicated clinicians. As the Chair of the newest Academic Clinical Programme (ACP) in the SingHealth Duke-NUS Academic Medical Centre, Clinical Professor Goh Siang Hiong, Senior Consultant and Head of Emergency Medicine at Changi General Hospital shares how research is helping to save lives, sometimes even before patients arrive at hospital, and why he donates to the EM ACP.
The Emergency Department is usually a fast-paced environment, how does research fit in as teams are racing against time to save lives?
Getting the right care at the right time makes the difference between life and death in the Emergency Department (ED). That is why research is so important. Resuscitation is a critical part of our work and our number one research priority. For instance, Associate Professor Marcus Ong and his colleagues at Singapore General Hospital have taken part in local and international trials of drugs that are used to resuscitate heart attack patients and also chest compression devices. They have also conducted research on the effects of cooling the body after a heart attack to improve survival outcomes. EDs also see other life-threatening conditions that are less well known to the public, such as septic shock, and research in this area has been vital in improving outcomes.
In septic shock, infection leads to multiple organ failure. It is a common cause of death in elderly patients who are suffering from pneumonia or urinary tract infections. Through research conducted by the EM ACP and learning from other local and overseas trials, for example, we identified several treatments that increase survival rates when administered to patients together in the shortest time possible, rather than prescribed individually. So Dr Koh Shao Hui and his team at Sengkang General Hospital developed a “septic shock bundle of care” that will soon be given to all septic shock patients on arrival at EDs across SingHealth hospitals. This includes starting antibiotics early, fluid resuscitation to improve blood pressure and increasing the oxygen concentration in their blood stream. Such septic shock bundles have helped to reduce the percentage of mortalities in many trials overseas and we hope to utilise this to further improve our outcomes.
How is their research helping to save lives before patients arrive at the hospital?
The ED is usually the gateway to specialist care for critically ill patients, but the first person to provide care to an individual suffering from a heart attack is usually his or her family member or an SCDF officer. Assoc Prof Marcus Ong has done a lot of work to expand the skills of paramedics, so that those who suffer from heart attacks, trauma and suffering from pain, can start receiving the right care before they arrive at the ED. His research has shown improvements in the usage of prehospital chest compression devices, inhalational pain relief using the Penthrox device, and also pre-hospital defibrillation.
When we analyse data of the patients we treat, we also see trends and patterns that enable us to determine our research focus to further the impact of our work in the ED. For instance, a study on road traffic related injuries led by Drs Angelina Ang, Chong Shu-Lin, Arif Tyebally, emergency physicians at KK Women’s and Children’s Hospital (KKH) ED, found that the majority of children who suffered road traffic injuries used to be unrestrained when travelling in the vehicle. Research also showed that the younger the passenger, the higher the risk of serious injury when an accident occurs. This study prompted KKH to work with government agencies and industry bodies to spread awareness about the risks of childhood injury and measures to prevent them so that more young lives can be saved and spared from severe pain and trauma.
In our research, we also harness technology and innovation to find ways to prevent ill health and advance medical education. At Sengkang General Hospital, Dr Jean Lee is linking up with nursing homes via telemedicine to advise on skin care to prevent pressure ulcers. Drs Lee Shu Woan and June Sim from Changi General Hospital ED have also teamed up with some educational institutions to develop disaster scenarios for healthcare professionals using augmented/virtual reality. During situations involving mass casualties, clinicians have to triage patients and prioritise who gets treated first. The use of this training tool will enable us to simulate real-life scenarios so that our doctors can be continuously trained to be better prepared should disasters strike. The same duo recently obtained successfully external funding for an educational project to revamp triage education for nurses.
You recently made a personal gift to the EM ACP. Why did you decide to make the donation?
What I’ve described are but a few of the many research and innovation initiatives we have. All these can only be successfully germinated and achieved if we wisely develop our talent and continue to support them in time and training. We need funding to fuel these.
The role of the ED is to resuscitate patients and stabilise them so they can be transferred to the operating theatres and intensive care units for management by other specialist teams. But many of our severely ill patients are unaware of the role we play in their recovery journey, because they are often unconscious or too ill to remember the treatment they receive when they arrive at the ED. Therefore, it is very rare for grateful patients to request to make donations to support our medical research and education in ED, unlike other inpatient specialties.
The healthcare professionals who work in the ED see, first-hand, the impact research makes to patients’ lives. I’m encouraging our staff to give towards our ACP to support our work so that we can continue to make a difference. I wanted to lead by example, so I made the donation to start the ball rolling. Every dollar adds up so if we all make a monthly contribution in our own little ways, we can continue to drive further innovations in Emergency Medicine to save even more lives in our institutions.
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