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PLANNING AND ORGANIZATION OF EMERGENCY SERVICES DR.N.C.DAS

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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 . Most common cause of trauma /injury is road traffic accident. It is the fourth major killer after 3 ‘C’ C ommunicable diseases C ancer C ardio vascular Popularly it is known as disease of urbanisation or curse of rapid development.

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TRAUMA SERVICES A. Accidents are the disease which arrives without notice. Resulting in damage, deformity or death. INJURY UN EXPECTED UN PLANNED UN ANNOUNCED DAMAGE DEFORMITY DEATH

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SEVERITY OF THE CONDITION <ul><li>3.5 million people die every year because of road traffic accidents </li></ul><ul><li>10-15 million are injured every year due to vehicular and other accidents </li></ul><ul><li>There is one Death every 50 seconds </li></ul><ul><li>One get injured in every 2 seconds </li></ul>

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TRAUMA SERVICES Because of the nature of its severity, un expectedness and fatal outcome A special branch of trauma care medicine has been started in large hospitals with trained trauma care physicians and surgeons. All efforts are made to provide all essential care and investigation in the same premises to save the life of trauma patients. Even to minimise the delay in treatment, the trauma care is provided at the site of accident in the form of basic and advance life care support.

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BASIC AND ADVANCE LIFE SUPPORT (CARDIO PULMONARY RESUSCITATION) <ul><li>BASIC LIFE SUPPORT </li></ul><ul><li>Given 1to 4 minutes </li></ul><ul><li>A - Airway </li></ul><ul><li>B - Breathing </li></ul><ul><li>C - Circulation </li></ul><ul><li>ADVANCE LIFE SUPPORT </li></ul><ul><li>Given 5to 8 minutes </li></ul><ul><li>D - Defibrillator </li></ul><ul><li>E - ECG </li></ul><ul><li>F - Fluid and drugs </li></ul><ul><li>G - Gauze parameters </li></ul><ul><li>H - Human and Machine function </li></ul>

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TYPES OF EMERGENCY SERVICES Depending on size of hospital, nature of injuries, population and catchments Area. The services may be: EMERGENCY MAJOR EMERGENCY AND DISASTER MANGT. REFFERAL EMERGENCY BASIC EMERGENCY OR ROUTINE WITH SP. ON CALL STAND BY EMERGENCY

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AIMS AND OBJECTIVE EMERGENCY RIGHT TREATMENT RIGHT TIME RIGHT PLACE RIGHT RESOURCES SCIENCE SYMPATHY SPEED

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FUNCTIONS OF EMERGENCY FUNCTION MAJOR SUBSIDIARY <ul><li>To treat un announced patients </li></ul><ul><li>Life threatening and routine </li></ul><ul><li>2. To function 24 hrs x 7 days/ 365 days </li></ul><ul><li>3. Provide immediate appropriate life </li></ul><ul><li>saving care </li></ul><ul><li>4. Service both efficient and effective </li></ul><ul><li>5. Sensitive to emotional needs </li></ul><ul><li>Liase with Courts & Police in MLC </li></ul><ul><li>Relation with Ext hospitals </li></ul><ul><li>Public relation </li></ul><ul><li>Admn. And feedback </li></ul><ul><li>Provide Ambulance Service </li></ul><ul><li>Provide Porter Service </li></ul><ul><li>Information & Communication </li></ul><ul><li>Centre </li></ul><ul><li>4. Education, Training & Research </li></ul>

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PLANNING CONSIDERATION ‘ DESIGN FOLLOWS THE FUNCTION’ PLANNING WORK LOAD PHYSICAL FACILITIES DESIGNING ESSENTIAL REQUIREMENTS ADMINISTRATION STRUCTURE LOCATION

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WORK LOAD <ul><li>20 – 25 % added to expected patient load per year for disaster. </li></ul><ul><li>25 % additional space for future expansion. </li></ul><ul><li>One out of 8 patients admitted is a injured patient. </li></ul><ul><li>Attention to be given to basic emergency as well as separate trauma care. </li></ul>PLANNING PRINCIPLES <ul><li>Accessible to vehicles and patients. </li></ul><ul><li>Provision for vehicles and parking area. </li></ul><ul><li>In – out gates </li></ul><ul><li>Well connected to wards and investigation area. </li></ul><ul><li>Free movement of ambulances and movement of staff. </li></ul><ul><li>Resuscitation at the site of accident and in the hospital. </li></ul><ul><li>Close watch and supervision of patients. </li></ul><ul><li>Well demarcated reception, registration and triage area. </li></ul><ul><li>Well equipped OTs. </li></ul><ul><li>Disaster management protocols & policies. </li></ul><ul><li>Security and Communication system. </li></ul><ul><li>In ground floor illuminated signage to be seen from distance, easy approach </li></ul><ul><li>from main road. </li></ul>

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ADMINISTRATION STRUCTURE MEDICAL SUPERINTENDENT ADDL. MEDICAL SUPERINTENDENT HOD (CASUALTY & EMERGENCY) ECRO CMO ACMO N.S TECH. STAFF PUBLIC RELATION & COMMUNICATION SUPPORTING STAFF SANITATION PORTOR GROUP ‘D’ AMBULANCE SECURITY POLICE POST

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PHYSICAL FACILITIES FACILITIES PATIENT AREA CLINICAL AREA CIRCULATION AREA ADMINISTRATIVE AREA 100 Patients require 1000 sq m area.

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PHYSICAL FACILITIES <ul><li>Reception Room / CMO Room </li></ul><ul><li>Resuscitation room; </li></ul><ul><li>Observation beds of different specialties; </li></ul><ul><li>Nursing counter; </li></ul><ul><li>Waiting area for patients / attendants; </li></ul><ul><li>Dressing room; </li></ul><ul><li>Operation theatre; </li></ul><ul><li>Laboratory facilities; </li></ul><ul><li>Radiological facilities; </li></ul><ul><li>ECG Room; </li></ul><ul><li>Plaster Room; </li></ul><ul><li>Isolation Room; </li></ul><ul><li>Linen Room; </li></ul><ul><li>Clean Utility Room; </li></ul><ul><li>Dirty Utility Room </li></ul><ul><li>Public Telephone; </li></ul><ul><li>Space for keeping wheel chair and stretchers / trolleys; </li></ul><ul><li>BID Room; </li></ul><ul><li>Duty Room for Medical Officers; </li></ul><ul><li>Room for Ambulance Drivers </li></ul><ul><li>Police Control Room; </li></ul><ul><li>Toilet facilities for staff/ patients; </li></ul><ul><li>Intensive care beds; </li></ul><ul><li>Stores; </li></ul><ul><li>Blood Bank Window; </li></ul><ul><li>Record room and Offices; </li></ul>

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PATIENT AREA ENTRANCE WAITING AREA Sitting, Water, Toilets POTTER SERVICE WAITING PATIENTS SNACKS BAR PHARMACY REGISTRATION AMBULANCE IN RECEPTION TROLLEY BAY POLICE POST TRIAGE AREA

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TRIAGE AREA It should be between the waiting area and clinical area. 20 ft x 200 ft along with waiting area Immediate ( Red Band ) ICU OT Wards Out Urgent Resuscitation Wards Out ( Green Band ) Non Urgent Casualty Treatment Out ( Blue Band ) Dead or dying Identification Mortuary ( Black Band )

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CLINICAL AREA CLINICAL EXAMINATION AREA STORAGE AREA INVESTIGATION AREA NURSE DESK EMERGENCY WARD (Observation) TREATMENT AREA O.T DRESSING ROOM PLASTER ROOM BURN WARD MLC RECORD DOCTOR DESK RESUSCITATION AREA

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CIRCULATION AREA CIRCULATION CORRIDOORS TROLLEY STAIRS LIFTS RAMPS

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ADMINISTRATION AREA ADMN. AREA ECRO OFFICE PRO NURSE INCHARGE STORE HOD CASUALTY CLERICAL STAFF REGISTERS & RECORDS

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FLOW OF PATIENTS Ambulance Waiting Reception Registration Triage Examination Area Investigation Area O.T ICU Resuscitation Room Ward Treatment Area Observation Area Out

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ARCHITECTURAL DESIGN Major Area - 20 x 20 ft Minor Area - 10 x 10 ft Smooth traffic flow Privacy to the patient DESIGN CORE DESIGN Central treatment desk corridor around. Separate entrance & exit . ARENA TYPE It is a core plan without Periphery corridor CORRIDOR Single Corridor Double Loaded

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EQUIPMENTS AND MATERIALS <ul><li>1. All essential and functioning equipments, ventilator, defrillators, monitor, O.T facility, X-ray, ultrasound, C.T, path labs, ECG Machine. </li></ul><ul><li>Central Gas Pipeline, Plenty & fluids, IV line, Catheters etc. </li></ul><ul><li>Vital essential medicines, neubulizer. </li></ul><ul><li>Dressing materials, plasters, dressings trolleys, minor operating tray. </li></ul><ul><li>Air conditioning, stand by generator. </li></ul><ul><li>Water supply, fire safety. </li></ul>

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EQUIPMENTS <ul><li>Centralized oxygen and suction supply; </li></ul><ul><li>Airway, resuscitation equipment; </li></ul><ul><li>Portable ECG, Cardiac Monitors and Defibrillators; </li></ul><ul><li>Vital and essential medicines; </li></ul><ul><li>I/V equipments and fluids, Nebulizers </li></ul><ul><li>Sufficient supply of cotton gauze bandages and plasters; </li></ul><ul><li>Utility table with different trays like – Tracheotomy, /kidney, Emesis, Basin etc.; </li></ul><ul><li>All equipments used for OT/ICU; </li></ul><ul><li>Adequate and in-working condition of trolleys, wheel chair and fire fighting equipments; </li></ul><ul><li>Imaging equipments like X-ray with dark room facility, USG, CT, MRI; </li></ul><ul><li>Laboratory investigation equipments and reagents </li></ul>

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STAFFING PATTERN <ul><li>SPECIALISTS </li></ul><ul><li>Physicians, Surgeons, Ortho Surgeon, Anaesthetist, Resident Staff and GDMOs ; </li></ul><ul><li>NURSES </li></ul><ul><li>Assistant Matron, Nursing Sisters and Staff Nurses </li></ul><ul><li>TECHNICIANS </li></ul><ul><li>Radiographer, Lab Tech, ECG Tech, OT Tech, BB Tech, Plaster tech. </li></ul><ul><li>Ambulance driver; </li></ul><ul><li>Nursing Asst. </li></ul><ul><li>Ambulance Attendants; </li></ul><ul><li>Safai Karamchari </li></ul><ul><li>Porter </li></ul><ul><li>ADMINISTRATIVE STAFF </li></ul><ul><li>Record clerk, registration clerk and Admission clerk </li></ul>

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POLICY AND PROCEDURE IN EMERGENCY POLICY AMBULANCE SERVICE (Golden hour concept) GRIEVENCE & REDRESSAL DEATH REVIEW MONITORING & EVALUATION OF SERVICE REGISTRATION INVESTIGATION & MANAGEMENT ADMISSION & REFARAL INTERNAL EXTERNAL MEDICOLOGICAL ISSUES & REPORTING MAINTENANCE OF RECORDS

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HOSPITAL ADMINISTRATION MADE EASY http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS