Emergency Medicine Fraternity in Malaysia

Emergency Medicine is seen as the provider of critical services at the frontline of each hospital. It is a specialty domain that offers clinical care to a wide range of acute medical infirmities, illnesses or injuries. This involves the provision of emergency critical medical care that includes diagnostic, resuscitation and stabilization of life-saving interventions. It deals with undifferentiated patients presenting with acute medical and even social emergencies from newly born to the oldest and all in between, coming at unscheduled times. The general scope of the medicine includes pre-hospital and hospital-based emergency medical care. Before it was established as a specialty in Malaysia, emergency medicine started as a neglected service and had no champions in progressing the care.

In Early Days

Emergency Medicine in Malaysia started out as a small unit of hospitals where patients having medical emergencies were examined and managed.The set up used to be rather small limited spaces and in most situations not given much attention in terms of importance. It was run by Medical Officers and in some hospitals, by only Assistant Medical Officers. It was not a discipline that was recognized as a specialty on its own. There were no dedicated specialists managing the department. The equipments available were limited and in terms of hospital budget, it received rudimentary allocation. Medical Officers working there did not have a career pathway and they usually went there for a temporary stint. It had no triaging system and no separate areas for resuscitation. The staff were often looked down and bullied by others in bigger and well established departments.

Era of the 90s

In 1993, Dr Abu Hassan Asaari Abdullah, then an orthopaedic surgeon who was also trained in trauma surgery and emergency care in United Kingdom took the challenge of reorganizing emergency medicine in Malaysia. He also established Malaysian Society for Traumatology and Emergency Medicine (MASTEM) to run trainings, organize conferences and scientific meetings. Dr Sabariah Faizah Jamaluddin, a trained anaesthesiologist joined the group and started an organized and more modern Emergency and Trauma Department at Hospital Kuala Lumpur. Dr Azhar Abdul Aziz who was trained as Emergency Physician in United Kingdom also came back around that time and headed the Emergency Department in University Malaya Medical Centre. He later headed the Emergency Department in Universiti Kebangsaan Malaysia Medical Centre.

In 1998, Associate Professor Kamaruddin Ja’alam from Universiti Sains Malaysia (USM) established the Master of Emergency Medicine programme at the university. Dr Wan Aasim Wan Adenan, an anaesthesiologist, Head of the Emergency Department at USM Hospital in Kubang Kerian, Kelantan joined hands to run the programme. The Ministry of Health (MOH) by this time, with strong push by Dr Abu Hassan Asaari agreed to endorse the programme. By this time, emergency departments in Malaysia ‘adopted’ specialists from other departments to be the head. Malaysian Society for Trauma and Emergency Medicine (MASTEM) was established and the society organized multiple courses, meetings and conferences.

Professor Dato’ Sri Dr Abu Hassan Asaari Abdullah was the first national head of Malaysia’s Emergency Medicine and Trauma Services (EMTS). Dr Sabariah Faizah Jamaluddin took over the helm before passing it over to Datuk Dr Mahathar Abdul Wahab.

Early 21st Centuries

In 2002, the first batch of Emergency Physicians graduated from USM. Out of five who graduated, two of them stayed in USM as lecturers and ran the postgraduate programme while the other three went back to the MOH and subsequently sent to head a few Emergency and Trauma Departments in MOH hospitals. In view of demands for more Emergency Physicians, Master of Emergency Medicine Programmes were then started in UKM Medical School and University of Malaya (UM) Medical School in 2005 to increase the number of specialists.

From the successful establishment of the postgraduate programmes in these three universities, a conjoint board was established in 2005. All candidates went through similar examinations and examiners in order to graduate. By 2006, all major MOH hospitals had Emergency Physicians.

2010-2020

Malaysian College of Emergency Physicians was established on 10th September 2011. At this time, there were 31 members. By 2015, 208 Emergency Physicians graduated from local postgraduate programme. Emergency Physicians sent to emergency departments had transformed each department with proper triaging and treatment zones. At that time, a total of 54 Malaysian hospitals had Emergency Physicians. A few Emergency Physicians started to join private practice as there were also demands for consultants in this field.

During this period of time, Emergency Physicians were entrusted with many important initiatives throughout the country. They were heavily involved in reorganization of emergency departments, the development of prehospital care services, medical emergency call centres, running resuscitation courses, planning for disaster response as well as the enhancement of training of emergency medicine specialties and subspecialties. The medicine expanded heavily and the specialists championed the use of bedside ultrasound and even ventured into the use of bronchoscopy and transesophageal echocardiography in resuscitation in some centres.

The quality of the service was recoqnized that some of the specialists were even appointed as Royal Physicians to the Sultans and Agongs. Many also became professors and assistant professors at universities. Many scientific papers were produced and published in high impact international journals. Multiple international conferences on emergency medicine had been held with great success such as International Clinical Case Conference of Emergency Medicine, I-MIREX, National Emergency Critical Care Symposium (NECCS) and Emergency Medicine Annual Symposium (EMAS).

Interests among young doctors to become Emergency Physicians flourished. Emergency Medicine postgraduate programme had become one the top choices for specialization in Malaysia and the demand to join the programme was more than the capacity of intake. For this, a parallel pathway for specialisation was introduced via collaboration with the Royal College of Emergency Medicine in the United Kingdom.

In 2020s

In 2021’s ACEM, Malaysian particpants contributed the highest number of free paper presentation among all participating countries in Asian region.

The start of the decade put all Emergency Physicians in Malaysia to extreme test with the advent of the Covid-19 pandemic that hit the whole nation. As frontliners. Emergency Physicians played vital roles in handling Covid-19 cases and they handled pandemic reasonably well. By 2022, the number of emergency physicians had grown to 535.

The number of Special Interest Groups (SIGs) in the College of Emergency Physicians had increased to eleven, reflecting the widening or various aspects of interests amongst emergency physicians. These includes Emergency Critical Care, Paediatrics Emergency Medicine, Emergency Medical Trauma, Disaster Medicine, Prehospital Care, Toxicology, Wilderness Medicine, Neuroemergency, Clinical Toxinology, Simulation and Geriatric Medicine.

The Future

Through the College of Emergency Physicians, the specialty is expected to grow even stronger and bigger. The college aims to establish a strong culture of research, collaboration, networking and engagement of technology to make this medicine relevant, fresh, dynamic and moving in tandem with time and needs of time. A lot of work is required to ensure the science and art of its practice evolve and kept abreast with the best practices of international standard. The college is determined play its role to this end and ensure that both the fraternity and the community benefit from the evolution of emergency care in Malaysia.

“Humanistic Care When It Matters Most”