Background In Pakistan, currently there is only one institution, which offers postgraduate residency training program. Doctors from other specialties manage emergencies. Pakistan is vulnerable to natural and manmade emergencies. Therefore, our objective was to evaluate the emergency care knowledge of physicians across four districts of Sind province, Pakistan.

Methods This was a cross-sectional study conducted between January and February 2009. The study included a convenience sample of 141 physicians staffing public and private sector health system. We developed a 35-item physician knowledge test derived from the Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) curriculum. The instrument was validated through pilot testing on 23 senior students at the Aga Khan University Medical College.

Results Scores were uniformly poor, across all levels of physician training (p 0.34), tiers of care provided (0.74), public versus private (p 0.6) and districts (p 0.055) surveyed. The overall mean score was 11 (SD 5) of 35, and not one of the 141 physicians surveyed achieved a score above 20. Scores were low on several fill-in questions, such as on basic treatments for acute myocardial infarction (9% of respondents answered correctly), interpretation of electrocardiograms (3%) and the steps in basic life support (8%).

Conclusion The knowledge deficit was severe and this likely compromises the ability of health facilities to use their available supplies most effectively. Better physician training would likely be the single most cost-effective way to ensure the optimal use of existing resources for emergency care in Sindh.