Peran fisioterapi

dalam kondisi
kedaruratan
Farid Rahman

Program Studi Fisioterapi FIK UMS

Tanggung Jawab Primer
• The primary responsibility of physiotherapists in the ED is the assessment of mobility and function.
The target population is primarily the frail elderly, however many other patient populations require
such services, including patients with MSK injuries.
• The purpose of the assessment is to determine the most effective treatment plan that allows the
patient to be discharged home safely including: 1) discharge from the ED; 2) remain for observation,
treatment, and re-assessment prior to discharge; 3) admission to the hospital; or 4) transfer to
respite care, placement or home with additional support services.
• Physiotherapy or physical therapy provision in the hospital emergency department is a growing area
of practice. Physical therapists can help patients start on the road to recovery early in the injury
process, facilitating the possibility to improve outcomes in certain injury types. Patients receiving
emergency department physical therapy benefit from the physical therapist’s expertise in
musculoskeletal, respiratory and vestibular conditions

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Program Studi Fisioterapi FIK UMS
• The National Ambulatory Care Reporting System in Canada (2014-2015) suggests
that the leading reason to consult an ER for MSK pain includes cervical and
lumbar regions. Emergency departments would benefit from an experienced
physiotherapists with sharp clinical reasoning and diagnostic skills. 

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Program Studi Fisioterapi FIK UMS
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Program Studi Fisioterapi FIK UMS
Poin Sukses Tugas Fisioterapi di Departemen Kedaruratan

• Direct, front-line access to a physiotherapist (no referral required)

• Acting as the educational Subject Matter Expert (SME) for other clinicians within the department
• Early identification of Yellow / Red Flags (MSK or Systemic)
• Appropriate MSK advice and care given to the patient during the acute phase of healing
• Timely referral to outpatient physiotherapy services (as deemed appropriate)
• Allows for appropriate clinical intervention for various degrees of medical emergencies
(appropriately sharing the evaluation roles among health care providers)

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Program Studi Fisioterapi FIK UMS
 Red Flag dan Yellow
Flag

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Program Studi Fisioterapi FIK UMS
Perbedaan nyeri
sistemik dan
muskuloskeletal

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Program Studi Fisioterapi FIK UMS
Poin Sukses Tugas Fisioterapi di Departemen Kedaruratan

• Stretches the available finite ED resources,as there is a sharing of the triage burden
(liberating nurses, doctors, specialists for non-MSK complaints).
• Early access to physiotherapy in ED is associated with reduced pain and disability
levels
• A possible health care model that can increase the efficiency of emergency
departments
• A potential decrease in wait times for patients
• A potential decrease the demand on outpatient orthopedic services
• Increased patient satisfaction for early access to rehabilitation specialist
• Aresponse to a need for greater workforce flexibility and improved service provision
to meet growing patient demand
• A truly interdisciplinary approach to patient care
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Program Studi Fisioterapi FIK UMS
Pengaruh kepada pasien
• Physiotherapists also have a role as frontline primary health care providers, in the
ED, in the assessment and diagnosis, within scope, of patients with MSK injuries.
Physiotherapy services provided in the ED decreases wait times to access
healthcare services and ultimately time spent by patients in the ED.
• Physiotherapy in the ED provides patients with individualized treatment plans
targeted to addresstheir discharge concerns resulting in high patient satisfaction.
Physiotherapy management of soft tissue injuries in the ED results in high levels
of patient satisfaction.
• Physiotherapy assessment and management of patients presenting to the ED
decreases length of stay (LOS) in the ED and wait times without any increase in
adverse events. Physiotherapy management of MSK injuries in the ED reduces
disability.

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Program Studi Fisioterapi FIK UMS
Outcome Measure

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 CASE EXAMPLE

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 Treatments for Sprains & Strains

• FIRST STAGE – to reduce swelling and pain

• RICE therapy (Rest, Ice, Compress, Elevate) for
the first 24 to 48 hours
1. Rest the injured area (reduce regular exercise or
activities as needed)
2. Ice the injured area, 20 minutes at a time, four to
eight times a day (cold pack, ice bag, or plastic bag
filled with crushed ice and wrapped in a towel can be
used)

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Program Studi Fisioterapi FIK UMS
 Treatments for Sprains & Strains

3. Compress the injured area, using bandages, casts,

boots, elastic wraps or splints to help reduce swelling

4. Elevate the injured area, above the level of the heart, to help
decrease swelling while you are lying or sitting down

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Program Studi Fisioterapi FIK UMS
 Treatments for Sprains & Strains

• Health care provider may recommend an anti-inflammatory

drug such as aspirin (Bayer), ibuprofen (Advil, Motrin),
naproxen sodium (Aleve) or acetaminophen (Tylenol) to help
decrease pain and inflammation

• If moderate sprain, may require use of mobility aids, such as

a cane, crutches, a walker or wheelchair
• If severe sprain, may need surgery to repair torn ligaments,
muscles or tendons

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Program Studi Fisioterapi FIK UMS
 Treatments for Sprains & Strains

• SECOND STAGE – Rehabilitation

1. Physical therapy/exercise program:
designed to help reduce swelling, prevent
stiffness and restore normal, pain-free
range of motion (during first week after
injury)

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Program Studi Fisioterapi FIK UMS
 Treatments for Sprains & Strains

2. Increase strength and flexibility (about

second week after injury); usually more
demanding exercises to improve function

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 TRIASE
PASIEN
Klasifikasi kondisi pasien

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Pengaruh kepada pasien
• Physiotherapy in the ED improves patient outcomes and acts as a bridge to
community services that improve mobility and overall physical functioning.

• Physiotherapy provided in the ED improves patient outcomes, such as pain control,

and disability and facilitates and ensures safe discharge home.

• Improvements in safety and function resulting from physiotherapy interventions in

the ED allow patients to live in the community longer.

• Physiotherapy in the ED facilitates discharge planning and access to other services

and provides community information and mobility aids to patients in a timely
manner resulting in a more efficient system.
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Program Studi Fisioterapi FIK UMS
Luaran Intervensi Fisioterapi Kedaruratan

Physiotherapy in the ED improves patient outcomes and reduces the rate of

return visits to the ED. Patients also report high satisfaction with physiotherapy
services in the ED secondary to the improvements in function. Inclusion of
physiotherapy services in the ED facilitates referrals to other inpatient and
outpatient programs improving both the efficiency and continuity of care. An
improvement in the continuation of care supports a safe return home and return
to the community.

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Program Studi Fisioterapi FIK UMS
Pelayanan Fisioterapi pada Departement
Emergency

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Program Studi Fisioterapi FIK UMS