The Minutes That Matter

Running emergency departments and ambulance services in Pakistan convinced Dr. Junaid Razzak of a hard truth: By the time many patients reached the hospital, the most decisive moments for survival had already passed.

“No matter how good we were in the emergency department, we were still losing people because they were coming in late, or they were coming in poorly cared for. That initial lifesaving period was lost,” says Dr. Razzak, a professor of emergency medicine at Weill Cornell Medicine and an attending physician at NewYork-Presbyterian/Weill Cornell Medical Center who has spent much of his career building and studying emergency care systems in Pakistan.

Dr. Razzak’s work has been anchored at Aga Khan University in Karachi, where he founded the Centre of Excellence for Trauma and Emergencies (CETE) in 2019. In initiatives across the country, he and his colleagues have worked across multiple levels of response, building the country’s first multi-hospital trauma registries, running disaster simulations with police and ambulance crews and testing tools like smartphone apps for first responders. Now based at Weill Cornell Medicine since 2021, Dr. Razzak continues to direct CETE through a research collaboration between the two institutions.

The center’s flagship effort, the Pakistan Life Savers Programme, trains ordinary citizens in basic lifesaving skills like CPR and bleeding control to intervene on the spot in events like cardiac arrest or injury.

The goal is scale. More than 500,000 Pakistanis have completed the volunteer program since 2020, with a target of 10 million. Its curriculum has also reached 5 million high school and college students across multiple provinces.

In Karachi, Dr. Razzak confronted another crisis unfolding inside ambulances. “A shocking number of children were dying during transport every day, anywhere from five to 25,” he says.

Paramedics were often on their own, treating children or infants without any specialized pediatric training. Dr. Razzak and his colleagues responded with a pilot program linking ambulances to pediatric emergency physicians via live video. Physicians help assess breathing, calculate fluids, treat shock and steer other early decisions that can determine whether a child survives the trip.

Dr. Rahul Sharma, chair of emergency medicine at Weill Cornell Medicine and emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell, praises Dr. Razzak’s approach to this work. “What’s remarkable is that Junaid doesn’t try to replicate Western emergency systems where they don’t fit,” Dr. Sharma says. “Instead, he builds capacity from within the community.”

Working together, the two have applied that approach to another telemedicine project in Pakistan, funded by the National Institutes of Health and administered through Weill Cornell, focused on patients released from emergency departments with uncontrolled hypertension. Through virtual check-ins with community health workers, patients receive ongoing support to stay on top of their medications.

The implications of these studies extend beyond Pakistan. In many rural areas of the United States, similar vulnerabilities persist, including transport delays and bystanders without basic emergency skills. “Junaid’s work offers a blueprint for strengthening our own system,” says Dr. Sharma, who is also the Barbara and Stephen Friedman Professor of Emergency Medicine, “by empowering the people who are there when emergencies begin.”