title: A survey of national physicians working in an active conflict zone: the challenges of emergency medical care in Iraq.
abstract: BACKGROUND
  There has been limited research on the perspectives and needs of national caregivers when confronted with large-scale societal violence. In Iraq, although the security situation has improved from its nadir in 2006-2007, intermittent bombings, and other hostilities continue. National workers remain the primary health resource for the affected populace.
  
  
  OBJECTIVE
  To assess the status and challenges of national physicians working in the Emergency Departments of an active conflict area.
  
  
  METHODS
  This study was a survey of civilian Iraqi doctors working in Emergency Departments (EDs) across Iraq, via a convenience sample of physicians taking the International Medical Corps (IMC) Doctor Course in Emergency Medicine, given in Baghdad from December 2008 through August 2009.
  
  
  RESULTS
  The 148 physician respondents came from 11 provinces and over 50 hospitals in Iraq. They described cardiovascular disease, road traffic injuries, and blast and bullet injuries as the main causes of death and reasons for ED utilization. Eighty percent reported having been assaulted by a patient or their family member at least once within the last year; 38% reported they were threatened with a gun. Doctors reported seeing a median of 7.5 patients per hour, with only 19% indicating that their EDs had adequate physician staffing. Only 19% of respondents were aware of an established triage system for their hospital, and only a minority had taken courses covering ACLS- (16%) or ATLS-related (24%) material. Respondents reported a wide diversity of prior training, with only 3% having some type of specialized emergency medicine degree.
  
  
  CONCLUSIONS
  The results of this study describe some of the challenges faced by national health workers providing emergency care to a violence-stricken populace. Study findings demonstrate high levels of violent behavior directed toward doctors in Iraqi Emergency Departments, as well as staffing shortages and a lack of formal training in emergency medical care.
authors.affiliation: Department of Emergency Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. ross@rossdonaldson.com
authors.forename: Ross I
authors.initials: RI
authors.lastname: Donaldson
authors.forename: Patrick
authors.initials: P
authors.lastname: Shanovich
authors.forename: Pranav
authors.initials: P
authors.lastname: Shetty
authors.forename: Emma
authors.initials: E
authors.lastname: Clark
authors.forename: Sharaf
authors.initials: S
authors.lastname: Aziz
authors.forename: Melinda
authors.initials: M
authors.lastname: Morton
authors.forename: Tariq
authors.initials: T
authors.lastname: Hasoon
authors.forename: Gerald
authors.initials: G
authors.lastname: Evans
mesh_terms: D002423:Cause of Death; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D010820:Physicians; D011795:Surveys and Questionnaires