Assignment On

Emergency Department
[HOSP-619]

SUBMITTED BY- VARNIKA

AIHA, SEM II
 Emergency Department

Emergency department: The department of a hospital responsible for the provision of

medical and surgical care to patients arriving at the hospital in need of immediate care.
Emergency department personnel may also respond to certain situations within the hospital
such cardiac arrests.

The emergency department is also called the emergency room or ER.

A full-fledged emergency department has the following areas of care:

EMS (Ambulance) Coordination Centre

The Emergency Medical Services (Ambulance services) of the hospital is the community's
main access to the hospital in an emergency and is also the most visible part of the
emergency department to the public eye.

The EMS consists of

➢ Fleet of well-equipped ambulances

➢ Emergency medical technicians (EMTs)
➢ Ambulance drivers
➢ EMS Administrator
➢ Biomedical technicians
➢ Radio and telephone operators manning the central call & coordination center
➢ And the emergency department itself

The EMS administrator must be a qualified emergency medicine physician himself or at least
be well trained in EM. Most often the head of the EM department will be the EMS
administrator. EMS systems administered by non-medical personnel are known to be highly
inefficient.
Triage

Every emergency department has a triage or triaging area to sort incoming patients.

Triage can be defined as the prioritization of patient care based on the severity of injury /
illness, prognosis, and availability of resources.

For those responsible for the triage of patients arriving in the emergency department, the
purpose of triage is to determine to which predesignated patient care area the patient should be
sent. The locations to which the patients are 'triaged' establishes priorities for care.

The most common triaging system is the 4-level system.

Priority I (Immediate) - Patients have life threatening injuries or conditions that are
survivable with immediate treatment. Examples: Airway compromise, tension pneumothorax,
shock, cardiac arrest, seizures, etc.

Priority II (Delayed) - Patients require definitive treatment but no immediate threat to life
exists. Patients may remain stable for 10 to 20 mins. Examples: Limb injuries, lacerations with
haemorrhage controlled, high fever, altered sensorium, severe pain, etc

Priority III (Minimal) - Patients have minimal injuries or minor conditions and are
ambulatory. Examples: Sore throat, abrasions and superficial lacerations, chronic self-limiting
disorders, etc.

Priority 0 (Expectant / Dead) - Victims are dead or have lethal injuries and will die despite
treatment.

Examples: Devastating head and chest injuries, 3rd degree burns over most of the body,
destruction of vital organs, etc.

Those needing immediate medical care are taken to resuscitation areas, while the dead are
moved directly to the morgue.

The severely but less critically injured are taken to major trauma-medical areas, where they are
further assessed, and initial treatment commenced.

The walking injured are directed to the minor surgery-primary care treatment area, often
located in outpatient clinic areas.
Resuscitation area

This area is dedicated to the immediate care of patients and victims in cardiac arrest, airway,
breathing and circulation compromise. The 'Resus' area consists of two or more resuscitation
beds (sometimes up to 12) with all resuscitative equipment (monitors, defibrillators, airway,
intubation & surgical equipment) available at an arm's distance including paediatric
resuscitation kits.

A patient maybe shifted to the Resus area from outside or from an area within the hospital or
emergency department itself.

All priority I patients are managed here.

Rationale: Early recognition of conditions requiring time-sensitive management saves lives.

A standardized approach in a designated resuscitation area ensures that the sickest patients in
the emergency unit are clearly identified and receive necessary life-saving care. Dedicated
resuscitation areas ensure that essential material resources are accessible and providers are
aware of critical patients as soon as possible.

❖ Upon arrival to the emergency unit, all patients are

❖ Patients triaged as “red” are immediately transferred to the resuscitation area.
❖ Triage personnel alert emergency unit staff as patients are transferred to the
resuscitation area (e.g., overhead announcement).
❖ Alert triggers an immediate response of clinical personnel to the resuscitation area.
❖ Pre-hospital providers or bystanders remain until report is given to the receiving
medical team.
❖ Patients in the resuscitation area are the top staff priority.
❖ The emergency unit ideally has other staff not assigned to the resuscitation area that
continue to care for lower acuity patients.
❖ Initial assessment and resuscitation are followed by monitoring and re-evaluation.
❖ After initial resuscitation, team leader releases additional providers to care for other
patients.
❖ Care plan (diagnostic, management and disposition) is developed before the team
leaves the resuscitation area.
Trauma Care Centre

A trauma centre (or trauma centre) is a hospital equipped and staffed to provide care for
patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or
gunshot wounds. A trauma centre may also refer to an emergency department (also known
as a "casualty department" or "accident & emergency") without the presence of specialized
services to care for victims of major trauma.

Levels of Trauma Centre

▪ Level 1: Essential to the development of a trauma care system is the designation of

definitive trauma care facilities. The trauma care system is a network of definitive
care facilities that provides a spectrum of care for all injured patients. These lead
hospitals should be the highest level available within the trauma system.

▪ Level 2: A Level II Trauma Centre is able to initiate definitive care for all injured
patients. Elements of Level II Trauma Centres Include: 24-hour immediate coverage
by general surgeons, as well as coverage by the specialties of orthopaedic surgery,
neurosurgery, anaesthesiology, emergency medicine, radiology and critical care.

▪ Level 3: Level III trauma centres are smaller community hospitals that have services
to care for patients with moderate injuries and the ability to stabilize the severe trauma
patient in preparation for transport to a higher-level trauma centre. A Level III Trauma
Centre demonstrates an ability to provide prompt assessment, resuscitation, surgery,
intensive care and stabilization of injured patients and emergency operations .

Major Trauma

Major trauma is any injury that has the potential to cause prolonged disability or death. There
are many causes of major trauma, blunt and penetrating, including falls, motor vehicle
collisions, and stabbing and gunshot wounds.
Consultation rooms

Consultation is the act of seeking assistance from another physician(s) or health care
professional(s) for diagnostic studies, therapeutic interventions, or other services that may
benefit the patient.

Consultation room where a doctor examines and talks to patients.

Since majority of the patients coming to an ED do not have an emergent problem, they are
assessed and treated on outpatient basis in the consultation rooms.

Minor Procedure Room

Procedures like washing, dressing & suturing of wounds, reduction & splinting of fractures &
dislocations, and other minor surgical procedures are done here.
Minor surgical procedures are defined as a set of procedures in which short surgical techniques
are applied on superficial tissues, usually with local anaesthesia, and minimal complications,
that usually do not require postoperative resuscitation and need minimal equipment, many of
which are used daily, and can be easily and safely performed in a short amount of time during
clinic visit.
General practitioners should have an optimal infrastructure and medical furniture in a minor
surgery operating room. It is important to manage the instruments and materials involved for
basic and advanced surgery.
Also, for a good clinical practice in minor surgery, it is necessary that general practitioners
handle anaesthesia techniques (local anaesthetic infiltration and regional blocks) and have
knowledge of the body areas of risk in minor surgery and the topographic anatomy of the skin
for the right performance of surgical procedure.
The patients should be informed about the procedure and its technical details before asking
them to sign the informed consent form.
Major Operating Rooms

An operation theatre complex is the "heart" of any major surgical hospital. An operating
theatre, operating room, surgery suite or a surgery centre is a room within a hospital within
which surgical and other operations are carried out.
Operating rooms are spacious, easy to clean in a cleanroom, and well-lit, typically with
overhead surgical lights, and may have viewing screens and monitors. Operating rooms are
generally windowless and feature controlled temperature and humidity. Special air handlers
filter the air and maintain a slightly elevated pressure.
Electricity support has backup systems in case of a black-out. Rooms are supplied with wall
suction, oxygen, and possibly other anaesthetic gases. Key equipment consists of the operating
table and the anaesthesia cart.
In addition, there are tables to set up instruments. There is storage space for common surgical
supplies. There are containers for disposables. Outside the operating room is a dedicated
scrubbing area that is used by surgeons, anaesthetists, ODPs (operating department
practitioners), and nurses prior to surgery.

Different Types Of Operating Rooms

Hybrid O.R.: Hybrid operating room requirements are usually based around imaging,
like CT, MR, C-arm or other types of imaging, being brought into surgery. Bringing
imaging into or adjacent to the surgical space means that the patient doesn’t have to be
moved during surgery, reducing risk and inconvenience.

Integrated O.R.: Patient information, audio, video, surgical and room lights, building
automation, and specialized equipment, including imaging devices, could all
communicate with one another.

Integrated O.R. is sometimes installed as a functional addition to an operating room to

integrate the control of several devices from a single console and offer the operator
more centralized access for device control.

Digital O.R.: A digital O.R. is a setup in which software sources, images and operating
room video integration is made possible. All this data is then connected to and displayed
on a single device. This goes beyond simple control of devices and software, allowing
also for the enrichment of medical data within the operating room.
Observation units

Observation care is a well-defined set of specific, clinically appropriate services, which include
ongoing short-term treatment, assessment, and reassessment before a decision can be made
regarding whether patients will require further treatment as hospital inpatients or if they are
able to be discharged from the hospital.

Observation services are commonly ordered for patients who present to the emergency
department and who then require a significant period of treatment or monitoring to decide
concerning their admission or discharge.

Observation units are dedicated units built to provide efficient protocol-based care to patients
with well-defined diagnoses or presenting symptoms such as chest pain, asthma, and
congestive heart failure.

Prayer Room

Prayer room is an important part of any emergency department since patients and victims are
very sick or dying.
It provides privacy for the relatives and attenders of the patients to perform any religious
activities or prayers.
The prayer room usually is an empty room without any pictures or images so that people from
any religious background can use it.
Bad news is sometimes broken here. Patients who have died are kept here temporarily to be
viewed by grieving relatives and attenders.
24 Hour Internet Services

A 24-hour internet access is a must to any ED since patients with unknown and difficult
diagnoses must be dealt with in short spans of time. Internet provides access to online journals,
poison and toxicological information, other emergency departments and various reading
material.

Health Applications of the Internet

Many health-related processes stand to be reshaped by the Internet. In clinical settings, the
Internet enables care providers to gain rapid access to information that can aid in the diagnosis
of health conditions or the development of suitable treatment plans.
It can make patient records, test results, and practice guidelines accessible from the
examination room. It can also allow care providers to consult with each other electronically to
discuss treatment plans or operative procedures.
At the same time, the Internet supports a shift toward more patient-centered care, enabling
consumers to gather health-related information themselves; to communicate with care
providers, health plan administrators, and other consumers electronically; and even to receive
care in the home.
The Internet can also support numerous health-related activities beyond the direct provision of
care. By supporting financial and administrative transactions, public health surveillance,
professional education, and biomedical research, the Internet can streamline the administrative
overhead associated with health care, improve the health of the nation's population, better train
health care providers, and lead to new insights into the nature of disease.

Consumer Health
Consumer health is one of the areas that could be most dramatically reshaped by the Internet.
Consumer health refers to a set of activities aimed at giving consumers a more pronounced role
in their own health and health care, ranging from the development of tools for self-assessment
of health risks and management of chronic diseases, to home-based monitoring of health status
and delivery of care.
This area is like public health (discussed later in this chapter) in that it aims to provide
consumers with the information and tools needed to improve their health, but it is less
concerned with the detection of regional outbreaks of disease and is not part of government-
based reporting structures.