By

Dr. 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

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 staf
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 staf 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

Administrative facilities:

Reception room

Waiting area for patients, attendants

Public telephone

Duty room for medical staf

Police waiting room

Room for ambulance drivers

Patient record room: Ordinary, MLC

Toilet facilities for staf & 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
diferent specialties
Nursing counter
Minor procedure room
Major OT

Laboratory facilities

Radiological facilities

ECG room

Plaster room

Isolation room

Pharmacy

Blood bank window

Observation room

Minor procedure 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 diferent 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 staf

Nurses:

Staf 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 staf
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 staf

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