Dr. Saleh Fares on EM in the United Arab Emirates

Published on December 17, 2015
As President of the young Emirates Society of Emergency Medicine (ESEM), Dr. Saleh Fares and his fellow society members have worked closely with each other to tighten training and clinical practice protocols, and advocate broader recognition and support for EM from both the people and the government of the United Arab Emirates. We talked with Dr. Fares about the recent and upcoming projects of the ESEM society, and his hopes for EM in the UAE and the broader Middle Eastern region.

EPI: How has the Emirates Society of Emergency Medicine (ESEM) changed since its inception?

Dr. Saleh Fares: When we started ESEM, in August 2012, our hope was to gather the emergency medicine (EM) community in the United Arab Emirates to work together and develop the infrastructure of EM in the country. Those efforts actually went quite a long way. We managed to attract many emergency physicians (EPs), EM residents, and medical students, and that broad range of support from our members really boosted and empowered the society and enabled us to achieve many completed projects and successes. We offer opportunities for EM trainees and residents to become involved with our activities as volunteers or as speakers, depending on their level, which many have found to be very exciting and rewarding. So the key was to bring everyone in the field together, and ESEM has served as a good medium for that. In the past, many of us EPs in the UAE were a fragmented group, for lack of a better term, but now it seems everyone knows each other on a first name basis. We gather very frequently for various activities and meetings, scientific activities, and to contribute to the future of EM in the UAE.

ESEM was recently awarded the privilege of hosting the International Conference on Emergency Medicine (ICEM) in Dubai in 2021, which is a big achievement for a young society just over 3 years old. We also hosted an IFEM symposium in Abu Dhabi in June 2015. Over the past 3 years I think we’ve been one of the most—perhaps the most—active EM society in the Middle East, and that’s brought a lot of good attention to us.

EPI: How do you think ESEM members and activities have influenced performance metrics of Emirati EM practice and outcomes thus far?

Fares: ESEM has helped reshape the UAE’s perspective of EM as a whole, although that’s a subjective evaluation. A way to do that is by devising and sharing and discussing clinical practice guidelines, which results in more scientific activities, which then inform and hopefully improve processes, which then improve clinical outcomes. It’d be difficult for me to cite figures, because one of the weaknesses here in the region is good data—but we are working on that.

We believe that, based on our collaborative efforts, we will be seeing favorable outcomes in the UAE, and hopefully the region, at least in terms of decreased mortality and morbidity in many of the emergency diseases, such as trauma, acute coronary syndrome, and so forth. We now have a STEMI network in Abu Dhabi and Dubai, for a start, and ESEM played a strong role in bringing that about, which I believe is bringing much improved outcomes and decreasing the door-to-balloon times in the region.

We are preparing for a big campaign on first-aid training. The UAE doesn’t have a responder protection law, more commonly known as a Good Samaritan law, and that presents a big disincentive to the community for intervening in the field when there’s a first-aid need. So we are hoping to train the community and to encourage them to participate and not shy away from such important interventions. This will truly save many lives!

We are also working on establishing a role in the credentialing process for emergency physicians. ESEM will hopefully be able to guide the accreditation, and the evaluation and the credentialing process, for EPs in the UAE. We do frequently make recommendations for staffing, equipment, and so forth. ESEM members also contribute to medical protocols. For example, we recently published an ultrasound credentialing curriculum, which was supported by IFEM and was the first such ultrasound document to be published on the IFEM website. Formal EM and EM subspecialty training is moving forward strongly in the UAE. we currently have 5 EM residency programs across the country. Although we have subspecialists and experts in toxicology, intensive care, emergency ultrasound, disaster medicine, and pre-hospital care, for example, we have yet to formalize EM subspecialty training and fellowships within the country. But that’s on the horizon.

EPI: You received medical training in Europe, completed your EM residency and EM board in Canada, and completed a disaster medicine fellowship in the United States. How has your international perspective informed your practice of EM in the Middle East?

Fares: I was very fortunate to receive the medical training and exposure that I got. Meeting so many pioneers of the field in the continent where EM started, and exchanging ideas with them, enabled me to envision the future of EM in the UAE, and the work I’m doing now is basically just trying to bring that vision to reality. In all the aspects of EM we are focusing on now, from pre-hospital care to boosting the academic level to establishing a really robust emergency response system, being abroad allows me to benchmark our accomplishments to an international level. Our vision of EM in the UAE is a tailored vision. It’s not a cut and paste version of an existing system—it’s a mixture of European, North American and Middle Eastern EM models. It’s a vision to fit the needs of the UAE, and that’s what’s making it work, in my opinion.

EPI: What are some of the greatest challenges faced by EM in the UAE? And some of the greatest opportunities for growth?

Fares: The current challenge, which we are trying to overcome, is the small number of qualified emergency physicians. But at the same time it’s an opportunity, because that’s enabling us to boost and empower residency programs. The other challenge is overcoming the lack of clear understanding of true EM as a science in the region, but that problem is common anywhere EM is new. Recognition is growing, however, thanks to the great work of our members. ESEM was recently recognized as the most successful medical society in the UAE, and there’s strong interest among medical students in pursuing EM as a career. So that by itself started as a challenge, but ended up being an opportunity to expand the specialty itself.

One other main challenge is the lack of an EM “umbrella” organization; for example, we don’t have a governing EM body. ESEM is trying to cover that gap until a formal organization comes about. With the lack of this organizational body comes a lack of funding, but again, as an EM community, our advocacy is starting to get good recognition now.

As for growth opportunities, I think there’s huge need for pre-hospital care here. There’s a lot of potential for expanding and forming a state-of-the art EMS system to serve the country. Given the political heat in the region now, it’s easy to argue that a good emergency medical system, including pre-hospital care and robust emergency care, is a vital part of any healthcare infrastructure investment here.

Despite economic fluctuations in the region, healthcare investment is very well positioned in the UAE, and I’m seeing more investment in emergency healthcare now than before. This may not be as applicable to, let’s say, less acute diseases or less acute subspecialties, but in higher acuity EM there’s a still good bit of support from the government and the private sector. Cost effective and innovative emergency care projects can be an attractive opportunity for support and investment.

Finally, in addition to pre-hospital care, I also see an opportunity for expanding EM training in our academic facilities. The number of universities and hospitals is increasing in the region, many of which are interested in having EM as one of their priorities.

EPI: What is the typical spread of patients who present to the ED in the UAE, in terms of cardiac, trauma, and other presentations?

Fares: It depends. Across the country, EM has historically been used for primary care due to the lack of official primary care in the system. For some time (and this is changing), the majority of cases we’d see in the ED were low acuity—upper respiratory infections, gastroenteritis, etc., and other common complaints, with the minority of cases being high acuity. This is changing now for two or three main reasons, one of which is the increase of primary care access, and the second reason is the improved understanding of emergency medicine and emergency departments. People realize now that there’s no point in waiting in an emergency department for hours if they could get the same treatment somewhere else. Finally, ESEM, as well as the government, are discouraging use of the ED for unnecessary complaints.

EPI: Who are other regional leaders in EM whose work you admire?

Fares: There are many. But I would mention Dr. Ahmed Wazzan, the President of the Saudi Society of Emergency Medicine. He is very active and very humble and also very keen to improve EM in a huge kingdom. Saudi Arabia is a very big country, and the society has been doing a great job with his leadership. The second person I would mention is Junaid Razzak. Dr. Razzak did a great job in Pakistan. Despite the limited resources and the security situation there, he managed to get a great emergency system in Pakistan, but specifically in Karachi, a very busy, heavily condensed city.

EPI: What are the next steps for ESEM?

Fares: The next step for ESEM is to continue growing. We’re supportive of, and eager to collaborate with, regional and international societies. We firmly believe that emergency medicine has no borders and we should all work together. The unique mission of EM is to save lives in what are usually grave or adverse circumstances, and EM is truly a fundamental need in any healthcare sector. So we are eager to participate in many more projects to continue this work and I’m blessed to have a strong team to work with in achieving our goals.

e.g. Global, Research, or India
e.g. Features, Opinion, or Research
Browse by Category
    Most Popular
      Download Latest Issue
      Issue 19