3. emergency department

ByDr. P. Jhansi Rani

Dr. P. Phani Kumar

What Is Emergency

• Sudden illness or injury requiring immediate physicians attention to prevent the danger and delay in treatment to save the precious part or life with minimum disability or death

• A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour".

Emergency Department

• An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance.

• In 2009, the Medical Council of India declared Emergency Medicine as a distinct specialty and from 2010 MD course in Emergency Medicine is started in India.

Signage:

There is a widespread usage of directional signage in white text on a red background across the world, which indicates the location of the emergency department, or a hospital with such facilities.

Types Of Emergency Services

• Depending on the size of hospitals, nature of injuries, population and catchments area, the services may be classified as:

Major Emergencies:• Major Trauma due to road accidents or others• Cardiac arrest• COPD: Chronic Obstructive Pulmonary Disease, Asthma

Disaster Emergency:Includes internal or external disasters

Location: Usually located on the ground floor Illuminated signage to be seen from distance Easy approach from main road Accessible for patients and ambulances

Location: As it serves as a main entrance for hospitals during night, it must be

accessible to vehicular and public transportation

Department should be close to registration, medical records, radiology units

Laboratory services including blood bank should be accessible

Located near to elevators to proceed to surgery without loss of time

Design• The entrance should be large

enough to admit one or more ambulances along with stretchers.

• Ramp should be provided for wheel chairs

• Entrance should be sheltered to protect ambulance patients from the weather conditions while unloading

• In & Out gates should be present

• Facilitate good public relations

• Free movement of staff

• Sufficient parking area

Functions of Emergency Department

Emergency care treatment ranges from elementary first aid to sophisticated surgical services

Major Functions:

TRIAGE: The objective is to ensure that " The Right patient receives the Right treatment at the Right time".

Major Functions:

Disaster Preparedness:

• Every hospital must have a well established and well rehearsed contengancy plan to cover any external or internal disaster.• Emergency department has an active role to play in coordinating with disaster

committee of the hospital• Emergency staff are trained to recognize the nature of relative severity• In the Triage area, patients are rapidly sorted and sent to appropriate treatment

areas

Major Functions:

• To provide 24 x 7 x 365 Support• Treatment for major trauma• Cardio-Pulmonary resuscitation• Splintage & casting for orthopaedic fractures• Treatment for Mental illness• Observation of critically ill patients• Liaise with courts and police in medico-legal cases• Maintain good public relations• Maintain relations with other hospitals

Subsidiary Functions:

• Ambulance service

• Information & Communication center

• Education training & research

• Code Blue Procedure

Physical Facilities of ED

• Reception room• Waiting area for patients,

attendants• Public telephone• Duty room for medical staff• Police waiting room• Room for ambulance drivers

Administrative facilities:• Patient record room: Ordinary, MLC• Toilet facilities for staff & patients• Prayer room• Clean utility room• Dirty utility room• Space for keeping wheel chairs,

stretchers and trolley• cafeteria

Clinical facilities:

• Triage room• Resuscitation room• Observation beds of different

specialties• Nursing counter• Minor procedure room• Major OT

• Laboratory facilities• Radiological facilities• ECG room• Plaster room• Isolation room• Pharmacy• Blood bank window

Minor procedure Room

Observation room

Blood Bank

Emergency Equipment:

• Centralized oxygen & suction supply

• Airway, Resuscitation equipment

• Portable ECG, Cardiac monitors and Defibrillators

• Vital and Essential Medicines• I/V equipment and Fluids,

Nebulizers

Emergency Equipment:

• Sufficient supply of cotton gauze bandages & plasters

• Utility table with different trays like – Tracheotomy, Kidney, Emesis, Basins etc

• All equipment used for OT, ICU• Adequate and in working condition of

trolleys, wheel chairs and fire fighting equipment

• Imaging facilities like X-ray with dark room facility, MRI, USG, CT

• Laboratory investigation equipment

Staffing in Emergency Dept.

Specialists:• Physicians• Surgeons• Ortho surgeons• Anesthetist• Resident staff

Nurses:• Staff Nurse• Nursing Sister• Assistant Matron

Staffing in Emergency Dept.

Technicians:• Radiographers• Lab technicians• ECG technicians• OT technicians• Plaster technicians• Ambulance attendants• Nursing assistants• Pharmacist

Other Personnel:• Ambulance Driver• Security• Safai Karmachari• Helpers

Policy of Emergency Dept.

• Policy to be compiled and made available to all staff members• To formulate document and periodically review and update policies• Procedure and reporting for medico legal cases• Notifiable deaths• Procedure for disposable of bodies, autopsy, morgue procedures• Maintain Accident and emergency room register• Release form procedures

Challenges in Emergency Dept.1. Over Crowding

• Function of a department is hindered by an inability to treat all patients in an adequate manner• Overcrowding causes inadequate patient care which leads to poorer patient outcomes

2. Violence against ED staff

Steps to improve emergency department efficiencies:

• Triage• Reorganized space into pods• Staffing changes to facilitate patient flow• Required emergency medical service personnel to provide advance notice of ambulance arrivals

so that a bed could be preassigned• Multidisciplinary team to develop and use care plans for non-emergent patients who repeatedly

present with chronic pain issues

Thank You