Background: Emergency care of traumatic children is an important health subject. The aim of this study was to evaluate the accessibility of Emergency care for traumatic children in terms of management equipment, cause defects, and familiarity of medical staff with training programs. Methods: This descriptive-analytical study evaluated the Emergency departments of all general hospitals in East Azerbaijan province during 2018, based on a checklist with 4 sections and 20 items, rated according to Likert scale from very high (scored 3) to very low (scored 0). For a score less than 3, defect causes were explained in 7 categories. The staff training certificates were considered for early and advanced pediatric life support in an Emergency situation. The staff’ s training certificates in terms of early and advanced resuscitation of children were also surveyed. Data was analyzed by SPSS 21. Results: From among 20 Emergency hospitals, more than 50% were equipped with adequate airway instruments. All of the Emergency departments were provided with oxygen therapy equipment, but more than 70% had no chest tube and ventilator fit for children. More than 70% of them had cardiac monitoring and a sphygmomanometer for pediatric patients; however, less than 50% had a blood transfusion set and a urinary catheter. Only two hospitals had held early and advanced pediatric resuscitation workshops for their staff. Conclusions: This study showed that 19 (95%) of Emergency departments had the potential for early diagnosis and treatment of traumatic children. However, only 2 (10%) of the Emergency staff had enough work experience in this issue. It is necessary to implement training programs for the familiarity of medical staff with pediatric early and advanced life support in Emergency departments.

Patients with bleeding disorders such as hemophilia A, hemophilia B, and von Willebrand disease (VWD) are routinely treated at home, with their care managed in specialized centers. In Emergency situations, these patients often present to their local Emergency department, where their management can represent a challenge to the Emergency physicians and staff who rarely encounter them. Delays in diagnosis and administration of replacement therapy are the factors most commonly identified as predictive of death. Patients and family members are often very well educated in the disease and its management, which can significantly reduce morbidity and mortality. Children with bleeding disorders confer different challenges to the Emergency physician and staff: they may present with no obvious signs of trauma or they may present with bruises consistent with non-accidental injury. All possible causes of bruising/bleeding should be investigated, although treatment should be administered promptly. The initial presentation of a bleeding disorder in the pediatric population is often made in the Emergency department. Treatment of hemophilia A and B requires rapid replacement of the deficient clotting factor, with the desired factor level and dosage dependent on the product used and the hemorrhagic situation encountered. In patients with VWD, the main treatments are desmopressin or intravenous infusion of plasma-derived concentrates containing factor VIII and von Willebrand factor.

The integration of Emergency psychiatric care into basic healthcare services must be given top priority due to the continued prevalence of mental health disorders as a major public health concern. Improving the effectiveness and accessibility of mental health interventions is crucial, especially in primary care settings. Mental illnesses continue to rank among the top ten global causes of burden; they cause 16% of Disability-Adjusted Life Years (DALYs) worldwide, and their economic costs are projected to be around USD 5 trillion. 1 The National health survey by the Indonesian government presented in 2018 in Indonesia revealed that the cases of Severe Mental Disorders (SMD) were 7 per 1000 population or a total of 1.6 million individuals. 2 Among the individuals with SMD, 15.1% have not sought treatment, and 48.9% of those who are taking medication do not adhere to their medication regimen. The high number of SMD cases is not matched by easy access to healthcare services. 2 This is evident from the high treatment gap in mental health issues, which exceeds 90%, indicating that fewer than 10% of mental disorder cases receive standard management. Primary healthcare providers play a key role in the early detection and crisis management of mental health issues, but the lack of resources and specialized training poses a significant challenge. 3 There is an urgent need to establish protocols and training programs that enable primary healthcare practitioners to identify and address mental health crises effectively. This involves the development of standardized assessment tools, enhancing collaboration with mental health specialists, and ensuring access to crisis intervention resources. By incorporating Emergency psychiatric care into the primary healthcare setting, 4 we can reduce the stigma associated with mental health issues and facilitate a more holistic approach to healthcare. Furthermore, addressing Emergency psychiatric care in the primary healthcare setting can contribute to early intervention, preventing the escalation of mental health crises, and reducing the burden on Emergency departments. 5 , 6 This shift towards a more comprehensive and integrated approach is in the same line with the overarching goal of achieving equality between mental and physical healthcare. In conclusion, addressing the integration of Emergency psychiatric care into basic healthcare services is necessary to tackle the growing burden of mental health disorders in Indonesia. To effectively address this issue, policymakers, healthcare organizations, and professionals should prioritize several key recommendations. Firstly, Indonesian policymakers need to prioritize mental health in national healthcare agendas by allocating adequate resources and developing policies that promote the integration of Emergency psychiatric care into primary healthcare services. This proactive approach will ensure that mental health receives encompass the attention and resources it deserves within the healthcare system. Secondly, there is a crucial need to invest in training programs for primary healthcare practitioners. These programs should focus on enhancing their capacity to identify, assess, and manage mental health crises effectively. Specialized training in mental health assessment and crisis intervention techniques will better equip healthcare providers to respond to the needs of individuals experiencing mental health emergencies. Moreover, collaboration between primary healthcare providers and mental health specialists should be strengthened. This collaboration will ensure timely access to specialized care and resources for individuals in crisis. Adequate funding should be allocated to support the integration of Emergency psychiatric care services into existing healthcare systems. By implementing these recommendations, Indonesia can take significant strides toward improving access to Emergency psychiatric care and addressing the mental health needs of its population.