Published on: November 29, 2013

Pallium India participated in the International Conference on Emergency Medicine held at Vythiri Village in Wynad in northern Kerala on 18 November 2013. We discussed three elements of possible inter-phase between emergency medicine and palliative medicine.

The first was in the area of Pain Management, which, sadly, is very much lacking in any aspect of medical practice in our country.

Second was the area of communication and the need for the emergency medicine team to keep the patient and the family informed and therefore to learn the art and science of it.

And thirdly, about the need to have education, guidelines and protocols for withholding or withdrawing life support in situations of futility of treatment.

Professor V. S. Mahadevan of Stanford University, USA, who had earlier delivered a plenary lecture, responded to this from the audience, by agreeing to the importance of the three elements. He particularly asked a question. Why is it that most hospitals do not have opioids? When he asks for pain medication in India, all that he gets are injections of Diclofenac or Tramadol.

This is a very vital question, Dr. Mahadevan. Of course, there are numerous regulatory barriers to opioid access, which we hope will be removed by the Indian Parliament in its Winter session in December 2013. But we are sure, it is not only a question of regulations. All the regulatory barriers that apply to morphine also apply to Fentanyl, a much more expensive opioid. Why is it that the more expensive Fentanyl is available in many hospitals in many formulations while morphine is not?

Those who participated in the discussion on the subject agreed that closer interaction between emergency medicine and palliative medicine is indeed necessary. Dr. P.P.Venugopalan and team (who organized this conference and facilitated this interaction), Pallium India thanks you. And we congratulate you for taking emergency medicine out into the community and saving many precious lives.