EMRGENCY MEDICAL

DEPARTMENT

PREPARED & PRESENTEDBY: DR. KAYWAN N GALA

DIFFERENT PICTORIAL ELEMENTS OF EMS
DIFFERENT NOMENCLATURE FOR EMS
OR EMS MAY INCORPORATE

• Emergency medical department

• Emergency surgical department
• Trauma center
• Casualty department
• Critical care department
• Accident & emergency department ( A & ED )
• In india – aapatkalin rugnalaya ( Local language )
Components of EMS
• It starts from pre hospitalization care
• A toll-free 108/1298 call is received by a communications officer who
collects and records all facts regarding the emergency.
• The information is then transferred to the dispatch officer who identifies
the closest Global Positioning System-enabled ambulance to the scene of
emergency and gives instructions for dispatch of the ambulance.
• Medical emergencies such as fracture, fever, and syncope are responded to
by Basic Life Support (BLS) ambulances;
• emergencies such as cardiac arrest, seizures, snake bite, unconsciousness,
burns, and pregnancy-related emergencies are usually managed by an
Advanced Life Support (ALS) ambulance.
GOALS
1) To provide priority care for individuals who require immediate medical
attention as per triage guidelines.
2) To provide rapid resuscitation, stabilisation and referral of critically ill patients.
3) To provide necessary definitive medical care to stabilise an emergency
condition within discretion of the doctor doing screening of patients.
4) To provide continuity in care through mechanisms for admission, treatment,
discharge and or referral to another facility.
5) To ensure that all the patients coming to emergency are assessed by qualified
individuals.
6) To provide Pre-hospital care by serving as base station for referral transport
services.
Introduction
• Emergency services is a vital component of hospital services
because injury is always unexpected and unplanned and if not
treated urgently can result in damage, deformity and death.
• The patients entering an emergency department can be saved only
if they arrive at the right time, at the right place, receives the right
treatment and right resources.
• The aspect of speed, accuracy and sympathy are important in the
emergency department.
Definitions
• Emergency has been defined as a condition determined clinically or
considered by the patient or his/her relatives as requiring urgent
medical services, failing which, it could result in loss of life or
limb……………WHO
• Medical emergency is a situation when patient requires urgent &
high quality medical care to prevent loss of life or limb and/or to
initiate action for the restoration of normal healthy life.
Importance
• Public perception & opinion of a hospital is often based on their
visit to the accident & emergency department
• This facility, usually accounts for a significant number of all hospital
admissions
• Effective functional operations in the department are important
variables for staff, patient & visitors satisfaction
Functions
1) To treat unexpected patients with life threatening conditions.
2) To provide services at all 365 days in a year.
3) To provide immediate, appropriate and life saving care.
4) To provide services in efficient and effective manner.
5) To be sensitive to emotional needs of the patients and their
relatives
6) To liaise with courts and police in emergency.
7) To be ready for disaster and mass casualty.
Types of Emergency Departments
• Type I : Large hospital with all specialists available round the clock
• Type II : Emergency room physician available round the clock
where specialists on call
• Type III : Standby emergency facilities with physician & nurse on
call
• Type IV : Referral emergency service where only nurse is available.
First aid & refer
 Planning
• Location
• Should be located on the ground floor
• Direct access from the main road
• Separate approach, other than OPD with a spacious parking area
• Located adjacent to OPD with minimum cross traffic
• Well lighted & boldly sign posted both for day & night
• A helipad is required for major trauma centers, hilly or unapproachable areas
• There should be close proximity between the Resuscitation area, Acute
Treatment areas for non-ambulant patients and treatment areas for ambulant
patients, as staff may require to rush from one place to another.
• Adequate provisions for the safety of the A&ED staff, patients, and visitors must
be designed and implemented.
Interrelationship
• Close relationship with:
• OT
• ICU
• Blood bank
• Laboratory
• OPD
• Mortuary
• Some authorities recommend a close relationship with CCU as well
• Many sub-depts like OT, Diagnostics etc may be required in the dept
itself
Work & Traffic flow
Lay out 1
• Core type
• Treatment spaces situated around a central point in which emergency dept
personnel work
• Ideally, there should be a corridor outside the treatment area through
which the patients enter the cubicles
• Support rooms( plaster cast room, obstetrics & gynae room) are along the
periphery of the corridor
• Greatest freedom of movements for emergency dept personnel
Core Design
Lay out 2
• Arena type
• Essentially a core plan design without the periphery corridor
• Provides a good view of all the cubicles from the nursing & physician work
areas
• Less fatigue as distances are less
• Best suited for emergency depts that are smaller in size
Arena design
Lay out 3
• Corridor type
• Many variants possible depending on the size of the
dept
• Desirable plan for large emergency depts
• Separate space is provided for each specialty
Corridor plan
Entrance
• Separate from main hospital entrance
• Separate entrance for ambulant & stretcher bound patients
coming by ambulance
• Should be well marked & illuminated
• It should open into spacious lobby
• Porch outside the lobby to protect the unloading of the patients
from rain & sunlight
• Approach to lobby should be in the form of ramp & steps
• Approach & access should be appropriate to usage by the disabled
Reception & information area
• Entrance should open in to a large open space with reception desk in
front
• Trolley, stretcher & wheel chair parking area
• It should be adjacent to triage area
• Should be close to waiting area
• Should have communication links such as telephones
• Worship room, grief room, flower, chemist & book shop
• Space for medico-social worker, toilets, registration & records
• BIS has recommended 1.75 sqm per hosp bed for the reception area
Trolley bay
Reception and Information area
Waiting Area
• Should provide sufficient & comfortable space for waiting patients
& relatives/escorts
• Area should be easily observed from reception & triage areas
• Should be appropriately furnished with visual displays on health
education & hospital related information
• Should cater for facilities such as drinking water, ladies & gents
toilets, television & channel music
Examination & Treatment Areas
• Triage Area: A separate area or lobby may be used
• Nursing Work Station
• Centrally located to enable staff to monitor patient care areas
• Should preferably include central cardiac monitor station
• Communication links to triage & resuscitation areas
• Doctors Work Area
• Centrally located for facilitating response to an emergency
• Should provide privacy
• Located such that doctors & nurses able to view central cardiac monitoring
station
Nursing Station
Examination & Treatment Area…
• Acute Treatment Area
• Utilized for management of patients with acute illnesses
• Should be able to fit a standard mobile bed with ample storage & usage
space
• Area should include a service panel, examination light, wall mounted
sphygmomanometer, emergency call facilities
• 2.4m of clear floor space between beds
• Each treatment area requires space of 15 sqm, doors at least 1.3m wide
Acute patient care room
Resuscitation Room
• Should have space to accommodate specialized resuscitation bed, allow 360
degrees access to all parts of the patient for facilitating procedures & monitoring
• Imaging facilities should include:
• Overhead X-ray
• Lead lining of walls & partitions between beds
• Radiolucent resuscitation trolley with cassette trays
• X-ray viewing/digital electronic imaging system
• An OT light should be made available
• All electric power should be on emergency stand-by circuits
cont…..
Resuscitation Room…
• Ceiling arrangements needs to be carefully planned so that surgical
lights, X-ray tracks, curtains & IV racks do not interfere with each other
• If room not directly visible from the work area, it should have alarm line
to the nursing work area
• Storage cabinets should have glass panels to facilitate view of stored
items & their retrieval as & when required
• Should have O2 & suction outlets
• Patient’s privacy should be ensured
• An area of about 30 sq m is suggested
Resuscitation Room
Observation ward
• Utilized for patients who have been evaluated & need extended
treatment, observation, re-evaluation or time consuming
procedures
• A 6 to 8 bedded ward is recommended
Observation ward
Special Treatment Rooms
• Obstetric roomS
• Equipped for pelvic exam
• Evaluation of patients in labour & emergency delivery
• Ophthalmology & ENT rooms
• Equipped with slit lamp & other necessary eqpt
• Dental rooms
• Should have a dental chair
• Burn rooms
• Should have adequate facility to treat different degree of burn
Support Areas
• Radiology
• Size & facility depend on relation & distance from main radiology dept
• Unless the latter is just adjacent a satellite X-ray unit required
• Besides a mandatory mobile unit 300-500Ma unit recommended for a large A & E unit
• Laboratory
• An emergency facility for performing routine blood, urine analysis, bacterial smears &
stains required
• Advanced tests such as BGA, biochemistry may be done in main laboratory
• ECG
cond….
Support Areas….
• Blood Bank
• Closely related to or easy access to blood bank is recommended
• Duty room
• A 9 sqm room with bed, chair, desk lockers, toilet, telephone is required
• Storage area
• An area/alcove for mobile eqpt; mobile X-ray, crash cart, ventilators etc and for storing
clean instruments, linen, drugs iv fluids
• Janitors closet
Administrative areas
• Office for director
• Office for matron
• Conference hall especially for teaching institute
• Pantry: A 7 sqm pantry adequate for providing hot & cold
fluid/beverage
• Communication room
• Secretary’s office
Communication
• Two way radio communication with ambulances & inter
communication between hospitals are required outside the
hospital
• Intramural communication in the form of PA system, telephone
(incl hot line), intercom, computer network etc
Engineering Services
• OT, ICU, main treatment area and resuscitation areas should be air
conditioned
• 300 lux lighting is required for general area
• 1100 lux for examination area
• Stand by supply should be planned for essential areas preferably
for whole department & UPS for life saving equipment
LEGAL MANDATES
• With increase in awareness and expectations the law has
mandated that immediate care should be provided to a patient in
emergency.
• It is now mandatory to provide treatment to patients entering
emergency departments (Supreme Court of India; Parmanand
Katara vs. Union of India AIR1989SC 2039).
• Failure to comply is considered as an act of negligence.
• At the present level of care and with the high volumes of patients
entering government hospitals the proportionality of cases of
medical negligence could be astounding.
MANPOWER REQUIREMENT FOR ACCIDENT,
EMERGENCY AND TRAUMA DEPARTMENT
• Supervisory personnel like Resident Medical Officer or Emergency In charge
• Medical Officers
• Staff Nurses
• Emergency Medical Technicians
• Staff for Minor OT
• Registration Clerk
• Data Entry Operator
• Lab technician
• Security staff
• Group D staff
• Housekeeping
STANDARD CONCEPTS RELATED
EMERGENCY DEPARTMENT
• 1. GOLDEN HOUR - ‘The first hour after injury largely determines a
criticallyinjured person’s chances for survival, it is also known as the
Golden Time.
• 2. TRIAGE - It is a process of setting priorities for treatments for a
patient or a group of A&E patients. The sorting of patients into
priority categories is performed by an experienced staff.
• 3.REVERSE TRIAGE - This concept is used to provide extra patient
beds during public health emergency
STANDARD PROTOCOLS FOR
EMERGENCY DEPARTMENT
• 1. Receiving of the patient
• 2. Registration of the patient
• 3. Identification of the patient
• 4. Initial assessment of patient
• 5. Reassessment of patient
• 6. Shifting/ transfer of patient within hospital
• 7. Referral of patients
• 8. Discharge of the patient
DISASTER MANAGEMENT
• DEFINITION - According to WHO - A disaster is defined as a series disruption of
functioning of the society, causing widespread human, material and environmental
losses which exceeds the ability of the society to cope with its own resources.

• AIM AND OBJECTIVES:

• To provide effective medical care to the maximum possible people in order to
minimize morbidity and mortality from any mass causality. 
• To prepare the staff and resources of the hospital for effective performance in
different disaster situation.
• To provide the opportunity to plan, prepare and when needed enables a rational
response in case of disaster.
TYPES OF DISASTERS
• Several types of hazards pose a threat to the community and
eventually to hospital:
• 1. Internal disasters, which takes place in the hospital like fire,
explosions, and hazardous material spills.
• 2. External disasters : Incidents involving a large number of casualties
like vehicular accidents, train accidents, fires, bomb blasts, flood,
tsunami, hurricane etc.
• 3. Disaster threats affecting the community like warfare, gas leaks etc.
• 4. Disasters in other communities in the vicinity like outbreak of
disease etc.
PATIENT REFERRAL/ TRANSFER REQUEST

• NAME OF PATIENT: _________________________

• AGE & SEX _________________ Specialty _________________
• Ward No. _______________ Bed No. __________________
• Diagnosis:_____________________________________________________________________
• Date of Referral: _______________________
• Time of Referral________________________
• Doctor In-charge of the case: ___________________________________________
• Nature of Referral (Please tick one only): Immediate/ Urgent/ routine
• Reasons of Referral: Referral request made to (Specify institute name/ Dept):
_______________________________
• Brief clinical notes:
• Signatures of referring person _________________________________________