Emergency

Department
Hardeep Sam Balkees
EMERGENCY DEPARTMENT

● The function of the Emergency Unit is to receive, stabilise and manage patients.
● Many patients visit the ED first, and are oftentimes admitted as inpatients,especially
for those with non-acute illnesses.

● It is recommended that Hospitals

that do not provide this service
should display the same on the
exteriors.
● And should provide the location of
the nearest Hospital with an
Emergency Service.
● The ED has two main entrances – one for walk-in patients,
and one for those brought in by ambulance.
● The ED has access to the surgery and imaging departments
to continue care for patients in those units.
Types of emergency departments
On the basis of nature of injuries, depth of injuries, population, size of hospitals, ED is classified as follows.

Stand by emergency Department

offers Laboratory Services, X-ray and
ECG capabilities performed by staff
specially trained in emergency room
care.

Referral emergency refers Patients

from Emergency Department (ED) to
Inpatient specialist Teams.

Major emergency deals with

recognition of sudden cardiac arrest,
heart attack , stroke etc.
Location of the ED
● Should be on the ground floor.
● Direct access from the main road
● Separate approach, other than OPD with spacious parking
area.
● Location adjacent to OPD.
● A helipad is required for major trauma center, hilly or
unapproachable areas.
 A patient with serious injuries in need of imaging
does not want to be pushed through an entire
hospital for people to see them. With the imaging
department close by, they’re easily transported
directly to where they need to be. Likewise, the lab
is nearby for staff to move quickly to the ED to
collect information from patients and gain results
in a timely manner.

This diagram shows the typical layout for an ED

The ambulance drop off, the public access walk-in

and vehicle drop off, the various sub-departments
within the ED, as well as access points and the
relationships between each areas are shown here.

Site of the Emergency Department; EDs need to be

placed in an area of the hospital that is easily
accessible to Emergency vehicles entering the site.
Van Wert County Hospital’s ED Addition
PLANNING
The Emergency Unit may be configured in a number of models that may influence facility design
including
● FAST-TRACK
Specific patient groups may be assessed and treated via a separate ‘fast’ track to other EU
presentations. This may occur at the triage point, or immediately after triage but in a separate
zone. Patient types suitable for this area may include contagious diseases, minor injuries,
ambulatory paediatrics. Assessment and treatment may be carried out in Consult / Examination
rooms.
● GROUPING BY PATIENT ACUITY
Patients of similar acuity (urgency) or staff intensity may be treated in the same zone. Facilities
for this model will include separate areas for resuscitation, acute monitored beds, acute non
monitored beds and ambulatory treatment spaces. There may be separate entry points (or
triage points) for the different areas. Staff may be separately allocated to different areas for each
shift, and may require separate Staff Stations and private workspace.
● GROUPING BY SPECIALTY
Patients may be managed in different areas according to the specialty of service they require e.g.
acute treatment, complex investigation, complex discharge planning, or paediatrics. Patients
may be triaged from a central arrival point, or from separate ambulance and ambulant entry
points. Within each Functional Area, patients would be prioritised according to acuity. In this
model, separate staffing for each area is required, which would also include separate
workspaces for staff.
FUNCTIONAL AREAS
● ENTRANCE / RECEPTION / TRIAGE:

- The entrance to the Emergency Unit must be at grade-level, well-marked, illuminated, and
covered. It shall provide direct access from public roads for ambulance and vehicle traffic, with
the entrance and driveway clearly marked. A ramp shall be provided for pedestrian and
wheelchair access. Temporary parking should be provided close to the entrance.

- The Reception / Triage and Staff Station shall be located where staff can observe and control
access to treatment areas, pedestrian and ambulance entrances, and public waiting areas. This
area requires a duress alarm. The Reception / Triage area should have clear a vision to the
Waiting Room, the children’s play area (if provided) and the ambulance entrance. The Reception
/ Triage Area may perform observations and provide first aid in relative privacy.
● PATIENT TREATMENT AREAS:

○ Assessment and treatment areas including Resuscitation, Acute Treatment bays/

rooms, Seclusion Room and Decontamination Facility, Paediatric patient areas,
Procedure Rooms
○ Short-Stay Ward/ Emergency Medicine Unit/ Observation Unit;
○ Primary Care Area - for patients with low acuity conditions;
○ Stepdown Area - for patients awaiting test results, considered safe, but requiring
observation prior to admission or discharge.
● STAFF AND SUPPORT AREAS:

○ Clean and Dirty Utility Rooms

○ Store rooms
○ Linen
○ Waste Holding/ Cleaners rooms
○ Staff amenities, administrative and teaching functions;
○ Ambulance facilities.

● Waiting Area
○ There must be facilities available such as adequate sitting accommodation, drinking
water, toilets, telephones, public address system to call relative of patient to inform about
patient’s condition etc.
○ Space for trolleys & Wheel Chairs
○ When the patient is brought to casualty by an ambulance, taxi, private car, stretcher, staff
at reception counter should quickly arrange for wheel chair or trolley depending on the
situation.
○ It is desirable to have one ‘intensive care trolley’ also known as ‘crash cart’.
○ Minimum floor area:The waiting area should measure at least 4.4 m2 / 1000 attendances
per annum.
● Resuscitation Area
○ This area is dedicated to the immediate care of patients and victims in cardiac arrest,
airway and breathing and circulation compromise.
○ The ‘Resus’ area consists of two or more resuscitation beds (sometimes upto 12) with
all resuscitative equipment (monitors, defibrillators, airway, intubation & surgical
equipment) available at an arm’s distance including pediatric resuscitation kits.
○ A patient may be 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.

● Space for Security & Police Constable

○ Casualty department is likely to get victims of assaults, riots etc.
○ As medicolegal cases need to follow prescribed procedural formalities, it is necessary
to have police constable’s counter at the waiting hall entrance.
● Space for patient brought dead
○ When the patient is declared dead on arrival, i.e. dead body is brought by the families
members or police & no treatment has been carried out, it need to be handed over to
police for further disposal. As the procedural formalities are likely to take some times, it is
desirable to keep the body at a place which is not visible to other incoming patients &
persons waiting in the waiting hall. In the event of disaster, number of dead bodies is likely
to be more. After labeling the bodies they may be sent to mortuary & handed over relatives
or police after completing procedural formalities.

● Examination Room
○ In this room, two or three examination tables separated by curtains are available.
○ It should be possible to carry out life-saving first aid procedure like cardiopulmonary
resuscitation on this table before sending the patient to observation ward.

● Treatment Room
○ In this, Minor procedure like catheterization, suturing of small wounds, dressing, bandaging
etc. can be carried out.
● Observation Area
○ Depending on the patient load 4 to 8 beds may be placed in this area.
○ Those patients may be kept in observation ward who are waiting to be evaluated by a
particular speciality, waiting for emergency medical procedure etc.

● Storage Space
○ In this area, linen, consumable items like drugs, dressing material, equipments can be
stored.
○ Minimum floor area for storage:the minimum acceptable floor area for storage is
2.2meter sq. /1000 patient attendances per annum.
DISASTER MANAGEMENT AND TRIAGE
Any accident that damages systems or people often requires a multifunctional response and
recovery effort. Without an appropriate emergency planning, it is impossible to provide good care
during a critical event.
It is essential to categorize and to prioritize patients with the aim to provide the best care to as
many patients as possible with the available resources. Triage assesses the severity of patients to
give an order of medical visit.

The Australasian Triage scale (ATS)

All patients presenting to an emergency
department should be assessed by a nurse
or a doctor. The triage assessment generally
goes on no more than 2–5 min. Patients who
are waiting are processed again, to see if
their condition deteriorated. The nurse or the
doctor may also initiate the assessment or
initial management, according to
organizational guidelines.
LAYOUTS
The ED is One of the “Front Doors” to a Hospital

Many patients visit the ED first, and are oftentimes admitted as inpatients. The ED can be the first impression of a hospital for
many patients.

The ED has access to the surgery and imaging departments to continue care for patients, and is a securable unit in the event
of a criminal event of major emergency.

We should identify the community that will access the facility, the average number of patients the hospital sees daily, the
hospital’s master plan and their goals for the future, and many other variables. The goal is to correctly size the department in
order to adequately serve the patient population.
Metropolitan Health
Hospital, Wyoming, Mich.,
HUM, Haiti