Prehospital and Emergency Care of Neurosurgical Care in

Pre-hospital and Emergency Care of Neurosurgical Care in Thailand Chaiwit Thanapaisal MD. , FRCST, FRCNST Khon Kaen University Thailand

Thailand Area 513, 120 sq. Km. Population 67 million

13 Regions of Health Care Each region Cover 4. 5 – 5 million population

Pre-hospital Care

Private Foundation run pre-hospital care more than 100 years

Call 1669 Medical Emergency all over the country

Emergency Care

Motorway Fast Track Transfer System MULTIPLE INJURY / HEAD INJURY SEPSIS STEMI HIGH RISK PREGNANCY STROKE CRITICAL NEWBORN

Mortorway Fast track

Major Problem of HI • Delayed @ emergency room • Delayed CT Scan • Delayed Operation

Head Injury Fast Tract

Head Injury Fast Tract Inclusion • Moderate to severe head injury • Need craniotomy

Key Indicators for HI Fast Tract • Time in Emergency Room < 60 min. • Door to CT Scan < 120 min. • Door to OR < 240 min.

Results ( one 500 beds provincial hospital with 2 neurosurgeons) Before After Goal ER Time < 60 min. 41% Door to CT Scan < 67% 120 min. Door to OR < 240 min. 55% 62% 85% 90% 82% 90% Over all Mortality 31% 20% 37%

Easy numbers Total Thai Doctors 50, 000 Total Thai Surgeons 5, 000 Total Thai Neurosurgeons 460 10 % of Thai Surgeons 1% of Thai doctors

58 25 55 - 25 54 25 50 - 49 44 25 118 25 45 - 28 25 44 39 25 40 - 25 25 35 - 34 74 25 25 30 - 9 46 25 11 35 24 52 11 -2 25 25 25 19 - 25 19 25 15 - 25 500 450 400 350 300 250 200 150 100 50 0 400 460 333 259 167 92 74 67 49 60

Thai Neurosurgeon Total Active Female Working in Bangkok Working outside Bangkok Provincial hospital have NS 460 430 18 (4%) 195 (45%) 235 (55%) 80%

Training Institute Bangkok 7 Chiangmai 1 Pratumtani 1 Songkla 1 Khon Kaen 1

Current Status • Total 27 resident position/year • New neurosurgeons 20 -25/year • Female neurosurgeons 3 -5/year • Total Neurosurgeons 460 • The country needs 400 more neurosurgeons

Annual Meeting • Full moon lunar day of the 3 rd month for 3 days (Makabucha day) • 20 -22 February 2017

Thank You for your attention