title: Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels.
abstract: BACKGROUND
  The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan.
  
  
  METHODS
  We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO's Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument.
  
  
  RESULTS
  Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses.
  
  
  CONCLUSIONS
  The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care.
authors.affiliation: Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan Aman Healthcare Services, Karachi, Pakistan.
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Razzak
authors.affiliation: Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Baqir
authors.affiliation: Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Uzma Rahim
authors.initials: UR
authors.lastname: Khan
authors.affiliation: International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: David
authors.initials: D
authors.lastname: Heller
authors.affiliation: Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan Douglas Hospital Research Centre, Montreal, Canada Public Health Solutions Pakistan (Pvt) Limited, Lahore, Pakistan.
authors.forename: Junaid
authors.initials: J
authors.lastname: Bhatti
authors.affiliation: Aman Healthcare Services, Karachi, Pakistan.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D004522:Educational Status; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D016304:Hospitals, Private / Q000592:standards; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan
keywords: emergency care systems