CHAPTER 6 EMERgENCY AND TRAuMA SERVICES IN … · The highest ratio of trained nurses in emergency...

73

NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

CHAPTER 6 | EMERgENCY AND TRAuMA SERVICES IN MALAYSIAN HOSPITALSArunah C1*, Teo AH2, Faizah A1*, Mahathar AW3, Tajuddin AMN4, Khairi K5, Idzwan Z6, Ismail MS7, Alzamani MI3, Shukruddeen S8, Kasuadi H9.

1. Clinical Research Centre, Ministry of Health 2. Hospital Pulau Pinang 3. Hospital Kuala Lumpur 4. Hospital Tengku Ampuan Rahimah, Klang 5. Hospital Tengku Ampuan Afzan, Kuantan 6. University Malaya Medical Centre 7. Universiti Kebangsaan Malaysia Medical Centre 8. Hospital Kuala Krai 9. Medical Development Division, Ministry of Health.* Corresponding author.

Summary: The emergency and trauma services in Malaysian hospitals were extensive; being widely available in almost every hospital in Malaysia. However, the services available varied from being a highly specialised dedicated emergency and trauma department in many of the larger public hospitals, to a more multi-purpose 24-hour centre in other smaller district and private hospitals. There were 223 hospitals that provided emergency and trauma services in 2010. This report represents initial efforts to obtain overall basic data on the workload, resources and performance of all emergency and trauma departments in Malaysia to provide the foundation for more comprehensive data collection efforts in the near future.

In 2010, there were 223 hospitals in Malaysia that provided emergency and trauma services, of which 133 were public hospitals and 90 private hospitals. Of these, 198 hospitals responded to this survey (88.8% response rate). The response rate from public hospitals was 100% (133 hospitals) and private hospitals was 72.22% (65 out of 90 private hospitals)

The overall density of emergency service was 0.08 hospitals per 10,000 population.The ratio was the same as results from the 2009 survey. Sarawak and Negeri Sembilan had the highest (0.11 per 10,000 population) and Perlis had the lowest density (0.04 per 10,000 population) (Table 6.1).

facilities

Overall, there were 421 red zone cubicles in the country, which translates into 0.15 per 10,000 population. Negeri Sembilan had the highest, whilst Perlis had the lowest ratio of red zone cubicles (0.26 and 0.09 per 10,000 respectively). Out of the 421 red zone cubicles, 91 cubicles were from the private hospitals. There were 636 yellow zone cubicles, which corresponds to 0.22 per 10,000 population in the country. WPKL had the highest, whilst Perlis had the lowest ratio of yellow zone cubicles (0.38 and 0.13 per 10,000 population respectively). of the 636 yellow zone cubicles, 154 cubicles were from the private hospitals (Table 6.2).

As for asthma cubicles, there were a total of 473 cubicles which was 0.17 per 10,000 population in the country. Out of this, 71 cubicles were from the private hospitals. Pahang had the highest, whilst Johor had the lowest ratio of asthma cubicles (0.23 and 0.12 per 10,000 respectively) (Table 6.2).

A total of 72 paediatric resuscitation cubicles were available in the country, which corresponds to 0.03 per 10,000 population. Perlis had the highest ratio, whereas Pahang had the lowest (0.09 and 0.01 per 10,000 respectively). of the 72 paediatric resuscitation cubicles, 11 cubicles were reported in the private hospitals (Table 6.2).

Overall, there were 692 observation beds, which was equivalent to 0.24 beds per 10,000 population in the country. WPKL had the highest, whilst Terengganu had the lowest ratio of observation beds (0.54 and 0.12 per 10,000 respectively). Out of the 692 observation beds, 140 beds were from the private hospitals (Table 6.3).

As for OSCC rooms, there were 115 in the country (0.04 per 10,000 population). Pahang had the highest ratio per 10,000 population (0.07). Four states (Melaka, Selangor, WP Putrajaya and WPKL) had the lowest ratios of OSCC rooms (0.02 per 10,000 population). None of the private hospitals had OSCC rooms (Table 6.3).

Seven public hospitals had a dedicated psychiatric evaluation room for assessment and management of suspected non-organic causes of altered behaviour or severe symptoms of mental illness (Table 6.4).

There were 75 decontamination facilities in Malaysian healthcare (0.03 per 10,000 population). Sixty-three decontamination facilities were located in the public hospitals and 12 in private hospitals. Kedah had the highest ratio, at 0.05 per 10,000 population with a total of 10 facilities, while Johor had the highest number of this facility (12). Only Perlis did not have this facility (Table 6.4).

There were 793 functioning ambulances in Malaysia which equals to 0.28 per 10,000 population in reference to developed countries which was 1 per 10,000 population3. Selangor and WP Putrajaya had the least ambulances to population ratio of 0.14 per 10,000 population. In terms of ambulance runs for emergency response, there were a total of 169,129 runs which translates to 59.69 runs per 10,000 population. Out of this, six states surpassed the national average of ambulance runs, with Pulau Pinang being the highest (130.16), followed by Perak (112.79), Melaka (111.47), Negeri Sembilan (95.23), Kedah & Perlis (63.24) and Pahang (61.83). In comparison, only Melaka had a small number of ambulances per 10,000 population (0.24) with an above average ambulance runs. Only 6 states had interfacility transfers above the national average (57.58 per 10,000 population), and these were Negeri Sembilan (109.43), Kelantan (108.32), Pulau Pinang (98.69), Perak (80.84), Pahang (69.52) and WPKL (63.32) (Table 6.5).

Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

74


A total of 8,105,520 visits were made to emergency and trauma departments in Malaysia. This corresponds to 2,860.69 visits per 10,000 population. This ratio showed an increment from 2009 data, with 2,524 visits per 10,000 population. In comparison, this visit ratio was relatively high as Singapore’s was 1,691 per 10,000 population1. The data in both 2009 and 2010 reflects the high usage of emergency and trauma services in Malaysia (Table 6.6).

The visit ratios were highest in the more densely populated areas. The highest density visits were reported in Wilayah Persekutuan Kuala Lumpur (WPKL) at 4,290.53 per 10,000 population, followed by Pulau Pinang (3,560.24 per 10,000 population). The states that had the lowest ratios were Sabah and WP Labuan at 2,181.31 per 10,000 population. Based on this data, especially for the urban areas, Malaysia will require more emergency and trauma departments to cater for the needs of its growing urban population as the existing departments are already burdened by overutilisation of their services (Table 6.6).

Overall, there were 836,327 trauma cases which equates to 295.17 cases per 10,000 population in the country. Perlis, with only one emergency department, had the highest, whilst Sabah and WP Labuan collectively had the lowest ratios of trauma cases (577.71 and 124.63 per 10,000 population, respectively). Of the overall total trauma cases, 70,371 (8.4%) were seen in private hospitals (Table 6.7).

A total of 226,253 critically ill or injured patients were treated in red zones throughout the country, at the ratio of 79.85 per 10,000 population. Negeri Sembilan had the highest, while Sabah & WP Labuan collectively had the lowest ratios of red zone cases (148.0 and 39.36 per 10,000 population, respectively). Out of 226,253 red zone cases, only 25,416 were seen in private hospitals (Table 6.7).

A total of 13,984 One Stop Crisis Centre (OSCC) cases were managed in 2010, corresponding to 4.94 per 10,000 population in the country. Negeri Sembilan had the highest, whilst Terengganu had the lowest ratio of OSCC cases (10.80 and 2.94 per 10,000 population respectively). Private hospitals did not report any OSCC cases (Table 6.7).

Overall, 14,127 poisoning cases were seen nationwide, at a density of 4.99 per 10,000 population in the country. WPKL had the highest, whilst Terengganu had the lowest ratios of poisoning cases (9.94 and 0.74 per 10,000 population, respectively). Out of 14,127 cases, only 1,041 (7.4%) cases were seen in private hospitals (Table 6.7).

There were 6,484 patients (2.29 per 10,000 population) who received parenteral thrombolytic therapy for myocardial infarction in emergency departments across the country in 2010. The states that had an above average figure per 10,000 population were Pahang (4.25), Kedah & Perlis (3.34), Kelantan (3.13), Perak (2.89) and Negeri Sembilan (2.53) (Table 6.8).

Human Workforce

A total of 93 emergency physicians were in practice in Malaysia in 2010, the numbers having increased from 82 in 2008-2009. These specialists practiced mainly in the public and university hospitals. Based on the ratio of emergency physicians to population, the figure was lowest in the states of Sabah, Sarawak and Johor at a ratio of 0.01 per 10,000 population (Table 6.9).

In 2010, the number of trainees in emergency medicine that were documented was 179. This number reflects the effort to increase the number of emergency physicians in Malaysia to be in line with the growing demands for their services from the community (Table 6.9).

Similarly, the number of allied health personnel in emergency and trauma departments with training in emergency medicine was captured. The data indicates that there were 729 assistant medical officers (AMOs) who had formal training in emergency and trauma services (post basic training). This accounts for 30% of all AMOs at a ratio of 0.26 per 10,000 population. More than 50% of the AMOs was without post basic training (0.58 per 10,000 population). The highest ratio of trained AMOs was in Sarawak and Perlis (0.43) (Table 6.10).

Amongst the nurses working in emergency and trauma departments, only 20% had formal post basic training (0.18 per 10,000 population). The highest ratio of trained nurses in emergency and trauma services was in WPKL, followed by Terengganu (Table 6.10).

Medical Devices

A total of 200 ultrasound machines were available in emergency departments nationwide, 55% (110 units) in public and 45% (90 units) in private hospitals. This was equivalent to 7.06 ultrasound machines per million population nationwide. WPKL had the highest density of ultrasound machines (13.73 per million population), while Perak showed the least with 3.4 machines per million population. A total of 61 full blood count (FBC) machines (2.15 per million population) and 64 arterial blood gas (ABG) machines (2.26 per million population) were available in 223 emergency departments. Johor had the highest density of FBC machines with 3.29 per million population, whilst Perlis had none in their emergency departments. Negeri Sembilan reported the highest density of ABG machines per million population (5.88) and, again, Perlis reported zero (Table 6.11).

75


Limitations

1. Data on emergency services were affected by differences in administrative and reporting arrangements. For example, some public and private hospitals captured outpatient department (OPD) cases in the total number of emergency visits as they provided outpatient and emergency services under one facility. Some hospitals included follow up cases in emergency departments while others did not.

2. Some definitions provided in the data dictionary were also too restrictive e.g. red zone/asthma cubicles, resulting in various different data being reported. Failure to provide certain definitions, such as in the case of decontamination facilities, also proved to be a limitation.

3. Misinterpretation of variables was another major setback in producing this report, especially in reporting parenteral thrombolytic therapy given to myocardial infarct (MI), as input errors required more effort in data cleaning.

References

1. Department of Statistics. Census of population 2010 – advance census release. [Accessed on 2 December 2011]. Available from: www.singstat.gov.sg/pubn/popn/c2010acr.pdf

2. Department of Statistics, Ministry of Trade & Industry. Yearbook of statistics Singapore 2011. 2011 June. [Accessed on 2 December 2011]. Available from: http://www.singstat.gov.sg/pubn/reference/yos11/yos2011.pdf

3. Cadigan RT and Bugarin CE. Predicting demand for emergency ambulance service. Annals of Emergency Medicine. 1989 June; 18(6): 618 – 21

Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

76


Table 6.1 Number and Density of Hospitals Providing Emergency & Trauma Services in Malaysia by State & Sector, 2008-2009 and 2010

STATE SECTORYEAR 2008-2009 YEAR 2010

NO.PER 10,000

POPuLATIONNO.

PER 10,000 POPuLATION

Malaysia Public 132 - 133 -Malaysia Private 99 - 90 -Malaysia Total 231 0.08 223 0.08Perlis Public 1 - 1 -Perlis Private na na na naPerlis Total 1 0.04 1 0.04Kedah Public 9 - 9 -Kedah Private 5 - 4 -Kedah Total 14 0.07 13 0.07Kedah & Perlis Public 10 - 10 -Kedah & Perlis Private 5 - 4 -Kedah & Perlis Total 15 0.07 14 0.06Pulau Pinang Public 6 - 6 -Pulau Pinang Private 10 - 9 -Pulau Pinang Total 16 0.1 15 0.1Perak Public 14 - 14 -Perak Private 8 - 8 -Perak Total 22 0.09 22 0.09Selangor & WP Putrajaya Public 11 - 11 -Selangor & WP Putrajaya Private 22 - 22 -Selangor & WP Putrajaya Total 33 0.06 33 0.06WP Kuala Lumpur Public 3 - 3 -WP Kuala Lumpur Private 19 - 14 -WP Kuala Lumpur Total 22 0.13 17 0.1Selangor & WP Putrajaya & WPKL Public 14 - 14 -Selangor & WP Putrajaya & WPKL Private 41 - 36 -Selangor & WP Putrajaya & WPKL Total 55 0.08 50 0.07Negeri Sembilan Public 6 - 6 -Negeri Sembilan Private 5 - 5 -Negeri Sembilan Total 11 0.11 11 0.11Melaka Public 3 - 3 -Melaka Private 4 - 3 -Melaka Total 7 0.09 6 0.07Johor Public 11 - 11 -Johor Private 10 - 9 -Johor Total 21 0.06 20 0.06Pahang Public 10 - 10 -Pahang Private 3 - 3 -Pahang Total 13 0.08 13 0.09Terengganu Public 6 - 6 -Terengganu Private 1 - 1 -Terengganu Total 7 0.06 7 0.07Kelantan Public 10 - 10 -Kelantan Private 2 - 2 -Kelantan Total 12 0.07 12 0.08Sabah & WP Labuan Public 22 - 23 -Sabah & WP Labuan Private 3 - 2 -Sabah & WP Labuan Total 25 0.08 25 0.08Sarawak Public 20 - 20 -Sarawak Private 7 - 8 -Sarawak Total 27 0.11 28 0.11

Abbreviation: na – not applicable

77


Table 6.2 Number and Density of Red Zone, Yellow Zone, Asthma and Paediatrics Resuscitation Cubicles in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTORRED ZONE CubICLES

YELLOW ZONE CubICLES

ASTHMA CubICLESPAEDIATRIC

RESuSCITATION CubICLES

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONNO.


Malaysia Public 330 - 482 - 402 - 61 -Malaysia Private 91 - 154 - 71 - 11 -Malaysia Total 421 0.15 636 0.22 473 0.17 72 0.03Perlis Public 2 - 3 - 4 - 2 -Perlis Private na na na na na na na naPerlis Total 2 0.09 3 0.13 4 0.17 2 0.09Kedah Public 26 - 23 - 27 - 2 -Kedah Private 5 - 5 - 3 - 1 -Kedah Total 31 0.16 28 0.14 30 0.15 3 0.02Kedah & Perlis Public 28 - 26 - 31 - 4 -Kedah & Perlis Private 5 - 5 - 3 - 1 -Kedah & Perlis Total 33 0.15 31 0.14 34 0.16 5 0.02Pulau Pinang Public 10 - 17 - 21 - 2 -Pulau Pinang Private 11 - 16 - 5 - 6 -Pulau Pinang Total 21 0.13 33 0.21 26 0.17 8 0.05Perak Public 34 - 49 - 35 - 7 -Perak Private 6 - 16 - 10 - 0 -Perak Total 40 0.17 65 0.28 45 0.19 7 0.03Selangor & WP Putrajaya Public 42 - 74 - 48 - 8 -Selangor & WP Putrajaya Private 22 - 47 - 26 - 2 -Selangor & WP Putrajaya Total 64 0.12 121 0.22 74 0.13 10 0.02WP Kuala Lumpur Public 24 - 37 - 24 - 4 -WP Kuala Lumpur Private 13 - 26 - 4 - 0 -WP Kuala Lumpur Total 37 0.22 63 0.38 28 0.17 4 0.02Selangor & WP Putrajaya & WPKL Public 66 - 111 - 72 - 12 -Selangor & WP Putrajaya & WPKL Private 35 - 73 - 30 - 2 -Selangor & WP Putrajaya & WPKL Total 101 0.14 184 0.26 102 0.14 14 0.02Negeri Sembilan Public 19 - 16 - 18 - 2 -Negeri Sembilan Private 8 - 11 - 4 - 1 -Negeri Sembilan Total 27 0.26 27 0.26 22 0.22 3 0.03Melaka Public 9 - 8 - 15 - 2 -Melaka Private 5 - 7 - 3 - 0 -Melaka Total 14 0.17 15 0.18 18 0.22 2 0.02Johor Public 30 - 40 - 36 - 8 -Johor Private 6 - 12 - 4 - 1 -Johor Total 36 0.11 52 0.16 40 0.12 9 0.03Pahang Public 20 - 24 - 33 - 1 -Pahang Private 3 - 0 - 2 - 0 -Pahang Total 23 0.15 24 0.16 35 0.23 1 0.01Terengganu Public 16 - 23 - 16 - 3 -Terengganu Private 2 - 0 - 0 - 0 -Terengganu Total 18 0.17 23 0.22 16 0.15 3 0.03Kelantan Public 26 - 54 - 30 - 8 -Kelantan Private 2 - 2 - 2 - 0 -Kelantan Total 28 0.18 56 0.36 32 0.21 8 0.05Sabah & WP Labuan Public 44 - 72 - 58 - 7 -Sabah & WP Labuan Private 0 - 0 - 1 - 0 -Sabah & WP Labuan Total 44 0.13 72 0.22 59 0.18 7 0.02Sarawak Public 28 - 42 - 37 - 5 -Sarawak Private 8 - 12 - 7 - 0 -Sarawak Total 36 0.15 54 0.22 44 0.18 5 0.02


Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

78


Table 6.3 Number and Density of Observation beds and One Stop Crisis Centre (OSCC) Rooms in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTORObSERVATION bEDS OSCC ROOMS

NO.PER 10,000

POPuLATIONNO.


Malaysia Public 552 - 115 -Malaysia Private 140 - 0 -Malaysia Total 692 0.24 115 0.04Perlis Public 6 - 1 -Perlis Private na na na naPerlis Total 6 0.26 1 0.04Kedah Public 46 - 9 -Kedah Private 10 - 0 -Kedah Total 56 0.29 9 0.05Kedah & Perlis Public 52 - 10 -Kedah & Perlis Private 10 - 0 -Kedah & Perlis Total 62 0.28 10 0.05Pulau Pinang Public 17 - 4 -Pulau Pinang Private 6 - 0 -Pulau Pinang Total 23 0.15 4 0.03Perak Public 39 - 14 -Perak Private 0 - 0 -Perak Total 39 0.17 14 0.06Selangor & WP Putrajaya Public 83 - 10 -Selangor & WP Putrajaya Private 35 - 0 -Selangor & WP Putrajaya Total 118 0.21 10 0.02WP Kuala Lumpur Public 53 - 3 -WP Kuala Lumpur Private 37 - 0 -WP Kuala Lumpur Total 90 0.54 3 0.02Selangor & WP Putrajaya & WPKL Public 136 - 13 -Selangor & WP Putrajaya & WPKL Private 72 - 0 -Selangor & WP Putrajaya & WPKL Total 208 0.29 13 0.02Negeri Sembilan Public 21 - 5 -Negeri Sembilan Private 7 - 0 -Negeri Sembilan Total 28 0.27 5 0.05Melaka Public 20 - 2 -Melaka Private 4 - 0 -Melaka Total 24 0.29 2 0.02Johor Public 47 - 10 -Johor Private 14 - 0 -Johor Total 61 0.18 10 0.03Pahang Public 41 - 10 -Pahang Private 0 - 0 -Pahang Total 41 0.27 10 0.07Terengganu Public 9 - 6 -Terengganu Private 3 - 0 -Terengganu Total 12 0.12 6 0.06Kelantan Public 27 - 10 -Kelantan Private 1 - 0 -Kelantan Total 28 0.18 10 0.06Sabah & WP Labuan Public 83 - 19 -Sabah & WP Labuan Private 4 - 0 -Sabah & WP Labuan Total 87 0.26 19 0.06Sarawak Public 60 - 12 -Sarawak Private 19 - 0 -Sarawak Total 79 0.32 12 0.05


79


Table 6.4 Number and Density of Psychiatric Evaluation Rooms and Decontamination facilities in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTORPSYCHIATRIC EVALuATION ROOMS DECONTAMINATION fACILITIES

NO.PER 10,000

POPuLATIONNO.


Malaysia Public 7 - 63 -Malaysia Private 0 - 12 -Malaysia Total 7 0 75 0.03Perlis Public 0 - 0 -Perlis Private na na na naPerlis Total 0 0 0 0Kedah Public 0 - 8 -Kedah Private 0 - 2 -Kedah Total 0 0 10 0.05Kedah & Perlis Public 0 - 8 -Kedah & Perlis Private 0 - 2 -Kedah & Perlis Total 0 0 10 0.05Pulau Pinang Public 1 - 3 -Pulau Pinang Private 0 - 0 -Pulau Pinang Total 1 0.01 3 0.02Perak Public 1 - 6 -Perak Private 0 - 0 -Perak Total 1 0 6 0.03Selangor & WP Putrajaya Public 1 - 8 -Selangor & WP Putrajaya Private 0 - 1 -Selangor & WP Putrajaya Total 1 0 9 0.02WP Kuala Lumpur Public 2 - 2 -WP Kuala Lumpur Private 0 - 1 -WP Kuala Lumpur Total 2 0.01 3 0.02Selangor & WP Putrajaya & WPKL Public 3 - 10 -Selangor & WP Putrajaya & WPKL Private 0 - 2 -Selangor & WP Putrajaya & WPKL Total 3 0 12 0.02Negeri Sembilan Public 0 - 1 -Negeri Sembilan Private 0 - 0 -Negeri Sembilan Total 0 0 1 0.01Melaka Public 0 - 3 -Melaka Private 0 - 0 -Melaka Total 0 0 3 0.04Johor Public 0 - 7 -Johor Private 0 - 5 -Johor Total 0 0 12 0.04Pahang Public 0 - 5 -Pahang Private 0 - 0 -Pahang Total 0 0 5 0.03Terengganu Public 0 - 2 -Terengganu Private 0 - 0 -Terengganu Total 0 0 2 0.02Kelantan Public 1 - 3 -Kelantan Private 0 - 1 -Kelantan Total 1 0.01 4 0.03Sabah & WP Labuan Public 1 - 10 -Sabah & WP Labuan Private 0 - 0 -Sabah & WP Labuan Total 1 0 10 0.03Sarawak Public 0 - 5 -Sarawak Private 0 - 2 -Sarawak Total 0 0 7 0.03


Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

80


Table 6.5 Number and Density of Ambulances and Ambulance Services in Emergency & Trauma Departments in Hospitals by State and Sector, 2010

STATE SECTOR

AMbuLANCES(fuNCTIONINg)

AMbuLANCE RuN(EMERgENCY RESPONSE)

AMbuLANCE RuN(INTERfACILITY)

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONMalaysia Public 681 - 159,753 - 151,344 -Malaysia Private 112 - 9,376 - 11,794 -Malaysia Total 793 0.28 169,129 59.69 163,138 57.58Perlis Public 7 - 2,919 - 3,420 -Perlis Private na na na na na naPerlis Total 7 0.30 2,919 126.09 3,420 147.73Kedah Public 50 - 10,745 - 7,387 -Kedah Private 7 - 117 - 175 -Kedah Total 57 0.29 10,862 55.77 7,562 38.83Kedah & Perlis Public 57 - 13,664 - 10,807 -Kedah & Perlis Private 7 - 117 - 175 -Kedah & Perlis Total 64 0.29 13,781 63.24 10,982 50.39Pulau Pinang Public 32 - 17,696 - 11,644 -Pulau Pinang Private 21 - 2,627 - 3,765 -Pulau Pinang Total 53 0.34 20,323 130.16 15,409 98.69Perak Public 90 - 25,120 - 18,869 -Perak Private 8 - 1,417 - 150 -Perak Total 98 0.42 26,537 112.79 19,019 80.84Selangor & WP Putrajaya Public 65 - 25,631 - 27,573 -Selangor & WP Putrajaya Private 14 - 1,226 - 1,950 -Selangor & WP Putrajaya Total 79 0.14 26,857 48.53 29,523 53.34WP Kuala Lumpur Public 19 - 11,398 - 8,789 -WP Kuala Lumpur Private 11 - 504 - 1,815 -WP Kuala Lumpur Total 30 0.18 11,902 71.07 10,604 63.32Selangor & WP Putrajaya & WPKL Public 84 - 37,029 - 36,362 -Selangor & WP Putrajaya & WPKL Private 25 - 1,730 - 3,765 -Selangor & WP Putrajaya & WPKL Total 109 0.15 38,759 53.76 40,127 55.66Negeri Sembilan Public 30 - 9,335 - 10,915 -Negeri Sembilan Private 9 - 389 - 259 -Negeri Sembilan Total 39 0.38 9,724 95.23 11,174 109.43Melaka Public 14 - 8,482 - 2,064 -Melaka Private 6 - 671 - 1,428 -Melaka Total 20 0.24 9,153 111.47 3,492 42.53Johor Public 55 - 15,398 - 11,931 -Johor Private 9 - 969 - 1,039 -Johor Total 64 0.19 16,367 48.88 12,970 38.74Pahang Public 53 - 9,125 - 10,085 -Pahang Private 6 - 155 - 348 -Pahang Total 59 0.39 9,280 61.83 10,433 69.52Terengganu Public 40 - 3,799 - 4,673 -Terengganu Private 1 - 10 - 16 -Terengganu Total 41 0.40 3,809 36.77 4,689 45.26Kelantan Public 60 - 4,701 - 16,186 -Kelantan Private 3 - 36 - 491 -Kelantan Total 63 0.41 4,737 30.77 16,677 108.32Sabah & WP Labuan Public 90 - 7,237 - 10,657 -Sabah & WP Labuan Private 0 - 0 - 0 -Sabah & WP Labuan Total 90 0.27 7,237 21.97 10,657 32.36Sarawak Public 76 - 8,167 - 7,151 -Sarawak Private 17 - 1,255 - 358 -Sarawak Total 93 0.38 9,422 38.13 7,509 30.39


81


Table 6.6 Number and Density of Visits to Emergency & Trauma Departments by State and Sector, 2008-2009 and 2010

STATE SECTORYEAR 2008-2009 YEAR 2010

NO. Of ED VISITSPER 10,000

POPuLATIONNO. Of ED VISITS


Malaysia Public 5,944,538 - 6,862,210 -Malaysia Private 1,198,747 - 1,243,310 -Malaysia Total 7,143,285 2,523.53 8,105,520 2,860.69Perlis Public 68,709 - 75,471 -Perlis Private na na na naPerlis Total 68,709 2,854.55 75,471 3,260.09Kedah Public 446,301 - 544,071 -Kedah Private 27,924 - 71,722 -Kedah Total 474,226 2,371.13 615,793 3,161.64Kedah & Perlis Public 515,010 - 619,542 -Kedah & Perlis Private 27,924 - 71,722 -Kedah & Perlis Total 542,935 2,423.06 691,264 3,172.10Pulau Pinang Public 344,318 - 414,456 -Pulau Pinang Private 112,953 - 141,440 -Pulau Pinang Total 457,271 2,899.07 555,896 3,560.24Perak Public 580,345 - 688,093 -Perak Private 78,697 - 124,576 -Perak Total 659,042 2,753.7 812,669 3,454.20Selangor & WP Putrajaya Public 789,378 - 963,629 -Selangor & WP Putrajaya Private 349,464 - 302,667 -Selangor & WP Putrajaya Total 1,138,842 2,198.71 1,266,296 2,288.00WP Kuala Lumpur Public 474,568 - 489,361 -WP Kuala Lumpur Private 305,621 - 229,131 -WP Kuala Lumpur Total 780,189 4,713.85 718,492 4,290.53Selangor & WP Putrajaya & WPKL Public 1,263,946 - 1,452,990 -Selangor & WP Putrajaya & WPKL Private 655,085 - 531,798 -Selangor & WP Putrajaya & WPKL Total 1,919,031 2,807.78 1,984,788 2,753.17Negeri Sembilan Public 238,179 - 303,013 -Negeri Sembilan Private 61,321 - 49,806 -Negeri Sembilan Total 299,500 2,953.94 352,819 3,455.28Melaka Public 175,248 - 208,613 -Melaka Private 43,073 - 47,930 -Melaka Total 218,320 2,837.9 256,543 3,124.38Johor Public 664,038 - 826,776 -Johor Private 69,303 - 122,697 -Johor Total 733,342 2,166.32 949,473 2,835.69Pahang Public 352,067 - 401,301 -Pahang Private 22,340 - 42,111 -Pahang Total 374,407 2,426.02 443,412 2,954.50Terengganu Public 233,342 - 261,839 -Terengganu Private 8,433 - 1,767 -Terengganu Total 241,775 2,156.59 263,606 2,544.46Kelantan Public 358,653 - 468,306 -Kelantan Private 9,804 - 12,548 -Kelantan Total 368456 2,254.66 480,854 3,123.24Sabah & WP Labuan Public 722,512 - 705,974 -Sabah & WP Labuan Private 9519 - 12,461 -Sabah & WP Labuan Total 732,031 2,225.02 718,435 2,181.31Sarawak Public 496,880 - 511,307 -Sarawak Private 100,296 - 84,454 -Sarawak Total 597,176 2,385.27 595,761 2,410.91


Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

82


Table 6.7 Number and Density of Trauma, Red Zone, One Stop Crisis Centre (OSCC) and Poisoning Cases in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTORTRAuMA RED ZONE OSCC POISONINg

NO. Of CASES


NO. Of CASES


NO. Of CASES


NO. Of CASES


Malaysia Public 765,956 - 200,837 - 13,984 - 13,086 -Malaysia Private 70,371 - 25,416 - 0 - 1,041 -Malaysia Total 836,327 295.17 226,253 79.85 13,984 4.94 14,127 4.99Perlis Public 13,374 - 1,304 - 88 - 24 -Perlis Private na na na na na na na naPerlis Total 13,374 577.71 1,304 56.33 88 3.80 24 1.04Kedah Public 88,950 - 20,068 - 1,600 - 468 -Kedah Private 800 - 807 - 0 - 7 -Kedah Total 89,750 460.80 20,875 107.18 1,600 8.21 475 2.44Kedah & Perlis Public 102,324 - 21,372 - 1,688 - 492 -Kedah & Perlis Private 800 - 807 - 0 - 7 -Kedah & Perlis Total 103,124 473.22 22,179 101.78 1,688 7.75 499 2.29Pulau Pinang Public 56,932 - 3,875 - 512 - 1,013 -Pulau Pinang Private 6,647 - 1,675 - 0 - 83 -Pulau Pinang Total 63,579 407.19 5,550 35.55 512 3.28 1,096 7.02Perak Public 75,012 - 19,040 - 694 - 1,548 -Perak Private 3,429 - 1,912 - 0 - 184 -Perak Total 78,441 333.41 20,952 89.06 694 2.95 1,732 7.36Selangor & WP Putrajaya Public 106,795 - 35,031 - 1,956 - 1,619 -Selangor & WP Putrajaya Private 27,434 - 8,327 - 0 - 259 -Selangor & WP Putrajaya Total 134,229 242.53 43,358 78.34 1,956 3.53 1,878 3.39WP Kuala Lumpur Public 59,287 - 17,099 - 1,270 - 1,441 -WP Kuala Lumpur Private 6,782 - 3,078 - 0 - 224 -WP Kuala Lumpur Total 66,069 394.54 20,177 120.49 1,270 7.58 1,665 9.94Selangor & WP Putrajaya & WPKL Public 166,082 - 52,130 - 3,226 - 3,060 -Selangor & WP Putrajaya & WPKL Private 34,216 - 11,405 - 0 - 483 -Selangor & WP Putrajaya & WPKL Total 200,298 277.84 63,535 88.13 3,226 4.47 3,543 4.91Negeri Sembilan Public 54,046 - 12,083 - 1,103 - 885 -Negeri Sembilan Private 4,659 - 3,029 - 0 - 54 -Negeri Sembilan Total 58,705 574.92 15,112 148.00 1,103 10.80 939 9.20Melaka Public 17,554 - 10,292 - 471 - 497 -Melaka Private 1,528 - 979 - 0 - 13 -Melaka Total 19,082 232.40 11,271 137.27 471 5.74 510 6.21Johor Public 97,225 - 17,198 - 1,963 - 1,220 -Johor Private 9,176 - 2,692 - 0 - 98 -Johor Total 106,401 317.78 19,890 59.40 1,963 5.86 1,318 3.94Pahang Public 32,495 - 8,535 - 818 - 696 -Pahang Private 599 - 148 - 0 - 9 -Pahang Total 33,094 220.51 8,683 57.86 818 5.45 705 4.70Terengganu Public 18,900 - 6,887 - 305 - 76 -Terengganu Private 28 - 41 - 0 - 1 -Terengganu Total 18,928 182.70 6,928 66.87 305 2.94 77 0.74Kelantan Public 57,251 - 18,651 - 1,174 - 990 -Kelantan Private 1,522 - 311 - 0 - 0 -Kelantan Total 58,773 381.74 18,962 123.16 1,174 7.63 990 6.43Sabah & WP Labuan Public 41,029 - 12,961 - 1,257 - 941 -Sabah & WP Labuan Private 20 - 3 - 0 - 2 -Sabah & WP Labuan Total 41,049 124.63 12,964 39.36 1,257 3.82 943 2.86Sarawak Public 47,106 - 17,813 - 773 - 1,668 -Sarawak Private 7,747 - 2,414 - 0 - 107 -Sarawak Total 54,853 221.98 20,227 81.85 773 3.13 1,775 7.18


83


Table 6.8 Number and Density of Parenteral Thrombolytics Therapy Administered for Myocardial Infarct at Emergency & Trauma Departments by State and Sector, 2010

STATE SECTOR PARENTERAL THROMbOLYTICS fOR MYOCARDIAL INfARCT

NO. PER 10,000 POPuLATION

Malaysia Public 5,917 -Malaysia Private 567 -Malaysia Total 6,484 2.29Perlis Public 67 -Perlis Private na naPerlis Total 67 2.89Kedah Public 611 -Kedah Private 49 -Kedah Total 660 3.39Kedah & Perlis Public 678 -Kedah & Perlis Private 49 -Kedah & Perlis Total 727 3.34Pulau Pinang Public 250 -Pulau Pinang Private 45 -Pulau Pinang Total 295 1.89Perak Public 652 -Perak Private 28 -Perak Total 680 2.89Selangor & WP Putrajaya Public 1,008 -Selangor & WP Putrajaya Private 183 -Selangor & WP Putrajaya Total 1,191 2.15WP Kuala Lumpur Public 570 -WP Kuala Lumpur Private 120 -WP Kuala Lumpur Total 690 4.12Selangor & WP Putrajaya & WP KL Public 1,578 -Selangor & WP Putrajaya & WP KL Private 303 -Selangor & WP Putrajaya & WP KL Total 1,881 2.61Negeri Sembilan Public 238 -Negeri Sembilan Private 20 -Negeri Sembilan Total 258 2.53Melaka Public 138 -Melaka Private 3 -Melaka Total 141 1.72Johor Public 414 -Johor Private 23 -Johor Total 437 1.31Pahang Public 633 -Pahang Private 5 -Pahang Total 638 4.25Terengganu Public 228 -Terengganu Private 8 -Terengganu Total 236 2.28Kelantan Public 482 -Kelantan Private 0 -Kelantan Total 482 3.13Sabah & WP Labuan Public 321 -Sabah & WP Labuan Private 0 -Sabah & WP Labuan Total 321 0.97Sarawak Public 305 -Sarawak Private 83 -Sarawak Total 388 1.57


Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

84


Table 6.9 Number and Density of Emergency Physicians and Trainees in Emergency and Trauma Departments by State and Sector, 2008-2009 and 2010

STATE SECTOR

EMERgENCY & TRAuMA PHYSICIANSEMERgENCY & TRAuMA

TRAINEES2008-2009 2010 2010

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONMalaysia Public 82 - 93 - 179 -Malaysia Private 0 - 0 - 0 -Malaysia Total 82 0.03 93 0.03 179 0.06Perlis Public 2 - 2 - 0 -Perlis Private na na na na na naPerlis Total 2 0.08 2 0.09 0 0.00Kedah Public 4 - 5 - 11 -Kedah Private 0 - 0 - 0 -Kedah Total 4 0.02 5 0.03 11 0.06Kedah & Perlis Public 6 - 7 - 11 -Kedah & Perlis Private 0 - 0 - 0 -Kedah & Perlis Total 6 0.03 7 0.03 11 0.05Pulau Pinang Public 4 - 4 - 3 -Pulau Pinang Private 0 - 0 - 0 -Pulau Pinang Total 4 0.03 4 0.03 3 0.02Perak Public 5 - 5 - 3 -Perak Private 0 - 0 - 0 -Perak Total 5 0.02 5 0.02 3 0.01Selangor & WP Putrajaya Public 16 - 17 - 18 -Selangor & WP Putrajaya Private 0 - 0 - 0 -Selangor & WP Putrajaya Total 16 0.03 17 0.03 18 0.03WP Kuala Lumpur Public 15 - 21 - 103 -WP Kuala Lumpur Private 0 - 0 - 0 -WP Kuala Lumpur Total 15 0.09 21 0.13 103 0.62Selangor & WP Putrajaya & WPKL Public 31 - 38 - 121 -Selangor & WP Putrajaya & WPKL Private 0 - 0 - 0 -Selangor & WP Putrajaya & WPKL Total 31 0.05 38 0.05 121 0.17Negeri Sembilan Public 2 - 3 - 2 -Negeri Sembilan Private 0 - 0 - 0 -Negeri Sembilan Total 2 0.02 3 0.03 2 0.02Melaka Public 3 - 3 - 2 -Melaka Private 0 - 0 - 0 -Melaka Total 3 0.04 3 0.04 2 0.02Johor Public 5 - 5 - 2 -Johor Private 0 - 0 - 0 -Johor Total 5 0.02 5 0.01 2 0.01Pahang Public 3 - 3 - 1 -Pahang Private 0 - 0 - 0 -Pahang Total 3 0.02 3 0.02 1 0.01Terengganu Public 3 - 4 - 5 -Terengganu Private 0 - 0 - 0 -Terengganu Total 3 0.03 4 0.04 5 0.05Kelantan Public 12 - 14 - 25 -Kelantan Private 0 - 0 - 0 -Kelantan Total 12 0.07 14 0.09 25 0.16Sabah & WP Labuan Public 4 - 4 - 2 -Sabah & WP Labuan Private 0 - 0 - 0 -Sabah & WP Labuan Total 4 0.01 4 0.01 2 0.01Sarawak Public 4 - 3 - 2 -Sarawak Private 0 - 0 - 0 -Sarawak Total 4 0.02 3 0.01 2 0.01


85


Table 6.10 Number and Density of Assistant Medical Officers and Staff Nurses With and Without Post basic Training in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTOR

ASSISTANT MEDICAL OffICERS

(WITH POST bASIC)

ASSISTANT MEDICAL OffICERS

(WITHOuT POST bASIC)

STAff NuRSES(WITH POST bASIC)

STAff NuRSES(WITHOuT POST

bASIC)

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONNO.


Malaysia Public 708 - 1,520 - 394 - 1,189 -Malaysia Private 21 - 135 - 103 - 794 -Malaysia Total 729 0.26 1,655 0.58 497 0.18 1,983 0.70Perlis Public 10 - 10 - 1 - 13 -Perlis Private na na na na na na na naPerlis Total 10 0.43 10 0.43 1 0.04 13 0.56Kedah Public 45 - 109 - 21 - 85 -Kedah Private 2 - 3 - 2 - 31 -Kedah Total 47 0.24 112 0.58 23 0.12 116 0.60Kedah & Perlis Public 55 - 119 - 22 - 98 -Kedah & Perlis Private 2 - 3 - 2 - 31 -Kedah & Perlis Total 57 0.26 122 0.56 24 0.11 129 0.59Pulau Pinang Public 35 - 101 - 9 - 44 -Pulau Pinang Private 3 - 18 - 24 - 92 -Pulau Pinang Total 38 0.24 119 0.76 33 0.21 136 0.87Perak Public 97 - 142 - 26 - 51 -Perak Private 2 - 6 - 8 - 89 -Perak Total 99 0.42 148 0.63 34 0.14 140 0.60Selangor & WP Putrajaya Public 59 - 193 - 37 - 167 -Selangor & WP Putrajaya Private 3 - 55 - 21 - 226 -Selangor & WP Putrajaya Total 62 0.11 248 0.45 58 0.10 393 0.71WP Kuala Lumpur Public 44 - 82 - 55 - 203 -WP Kuala Lumpur Private 1 - 23 - 16 - 100 -WP Kuala Lumpur Total 45 0.27 105 0.63 71 0.42 303 1.81Selangor & WP Putrajaya & WPKL Public 103 - 275 - 92 - 370 -Selangor & WP Putrajaya & WPKL Private 4 - 78 - 37 - 326 -Selangor & WP Putrajaya & WPKL Total 107 0.15 353 0.49 129 0.18 696 0.97Negeri Sembilan Public 30 - 82 - 16 - 34 -Negeri Sembilan Private 0 - 1 - 11 - 47 -Negeri Sembilan Total 30 0.29 83 0.81 27 0.26 81 0.79Melaka Public 12 - 61 - 10 - 50 -Melaka Private 0 - 3 - 7 - 51 -Melaka Total 12 0.15 64 0.78 17 0.21 101 1.23Johor Public 68 - 154 - 28 - 97 -Johor Private 4 - 13 - 7 - 58 -Johor Total 72 0.22 167 0.50 35 0.10 155 0.46Pahang Public 55 - 109 - 28 - 70 -Pahang Private 0 - 6 - 1 - 19 -Pahang Total 55 0.37 115 0.77 29 0.19 89 0.59Terengganu Public 38 - 52 - 34 - 55 -Terengganu Private 1 - 2 - 3 - 17 -Terengganu Total 39 0.38 54 0.52 37 0.36 72 0.69Kelantan Public 38 - 116 - 22 - 78 -Kelantan Private 3 - 2 - 1 - 13 -Kelantan Total 41 0.27 118 0.77 23 0.15 91 0.59Sabah & WP Labuan Public 72 - 185 - 44 - 158 -Sabah & WP Labuan Private 0 - 0 - 0 - 24 -Sabah & WP Labuan Total 72 0.22 185 0.56 44 0.13 182 0.55Sarawak Public 105 - 124 - 63 - 84 -Sarawak Private 2 - 3 - 2 - 27 -Sarawak Total 107 0.43 127 0.51 65 0.26 111 0.45


Emer

genc

y an

d Tr

aum

a Se

rvic

es in

Mal

aysi

an H

ospi

tals

6

86


Table 6.11 Number and Density of ultrasound Machines and Point of Care Testing used in Emergency & Trauma Departments by State and Sector, 2010

STATE SECTORuLTRASOuND MACHINE fbC MACHINE Abg MACHINE

NO. PMP NO. PMP NO. PMPMalaysia Public 110 - 34 - 41 -Malaysia Private 90 - 27 - 23 -Malaysia Total 200 7.06 61 2.15 64 2.26Perlis Public 1 - 0 - 0 -Perlis Private na na na na na naPerlis Total 1 4.32 0 0 0 0Kedah Public 8 - 2 - 3 -Kedah Private 7 - 2 - 2 -Kedah Total 15 7.7 4 2.05 5 2.57Kedah & Perlis Public 9 - 2 - 3 -Kedah & Perlis Private 7 - 2 - 2 -Kedah & Perlis Total 16 7.34 4 1.84 5 2.29Pulau Pinang Public 6 - 2 - 2 -Pulau Pinang Private 9 - 0 - 2 -Pulau Pinang Total 15 9.61 2 1.28 4 2.56Perak Public 5 - 3 - 3 -Perak Private 3 - 3 - 5 -Perak Total 8 3.4 6 2.55 8 3.4Selangor & WP Putrajaya Public 11 - 7 - 5 -Selangor & WP Putrajaya Private 23 - 9 - 5 -Selangor & WP Putrajaya Total 34 6.14 16 2.89 10 1.81WP Kuala Lumpur Public 9 - 1 - 3 -WP Kuala Lumpur Private 14 - 3 - 0 -WP Kuala Lumpur Total 23 13.73 4 2.39 3 1.79Selangor & WP Putrajaya & WPKL Public 20 - 8 - 8 -Selangor & WP Putrajaya & WPKL Private 37 - 12 - 5 -Selangor & WP Putrajaya & WPKL Total 57 7.91 20 2.77 13 1.8Negeri Sembilan Public 6 - 2 - 6 -Negeri Sembilan Private 1 - 0 - 0 -Negeri Sembilan Total 7 6.86 2 1.96 6 5.88Melaka Public 3 - 2 - 2 -Melaka Private 1 - 0 - 0 -Melaka Total 4 4.87 2 2.44 2 2.44Johor Public 6 - 4 - 4 -Johor Private 21 - 7 - 6 -Johor Total 27 8.06 11 3.29 10 2.99Pahang Public 8 - 1 - 0 -Pahang Private 0 - 0 - 0 -Pahang Total 8 5.33 1 0.67 0 0Terengganu Public 9 - 2 - 5 -Terengganu Private 0 - 0 - 0 -Terengganu Total 9 8.69 2 1.93 5 4.83Kelantan Public 12 - 3 - 3 -Kelantan Private 2 - 1 - 1 -Kelantan Total 14 9.09 4 2.6 4 2.6Sabah & WP Labuan Public 14 - 2 - 3 -Sabah & WP Labuan Private 1 - 0 - 0 -Sabah & WP Labuan Total 15 4.55 2 0.61 3 0.91Sarawak Public 12 - 3 - 2 -Sarawak Private 8 - 2 - 2Sarawak Total 20 8.09 5 2.02 4 1.62

Abbreviation: na – not applicable; PMP – per million population

CHAPTER 6 EMERgENCY AND TRAuMA SERVICES IN … · The highest ratio of trained nurses in emergency...

Documents

Transcript of CHAPTER 6 EMERgENCY AND TRAuMA SERVICES IN … · The highest ratio of trained nurses in emergency...