Understanding Role of Emergency Department

Emergency Department defines an emergency department as a hospital facility that is staffed 24 hours a day, 7 days a week, and provides unscheduled outpatient services to patients whose condition requires immediate attention.

With a competent emergency room team, many lives could have been saved under the guidance of an experienced physician and aided by advanced medical equipment.

The emergency Department is the first point of contact for any critically ill patient, needing immediate medical attention. Modern Emergency Departments are managed by qualified Emergency Physicians and nurses, trained specifically for providing emergent care to save a life or limb.

In order to prioritize treatment for most sick patients, EDs use a tool called Triage which means sorting out. Those patients needing immediate life-threatening measures are treated first. Those with minor ailments may have to wait. After resuscitation and initial stabilization patients are either admitted to the indoor area or discharged to home with a prescription.

A good ED is equipped with monitors, point-of-care diagnostics, essential drugs, and other equipment needed for high-quality medical care to the patient. ED works in close association with other departments like radiology, laboratory, blood bank, etc.

Emergency Physicians are well supported by other clinical specialists for optimum care of the patient. EDs also provide initial critical care for patients waiting for ICU transfer. Accreditation with International and national bodies such as JCI and NABH, ensures that the quality of care is maintained by the ED.

The Evolution of the Emergency Department

Workers' Compensation Plans, railroad companies, and local governments in Europe and the United States provided casualty services in the late mid-19th century.

But the world's first specialized trauma center opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky.

It was further developed in the 1930s by surgeon Arnold Griswold, who also outfitted police and fire engines with medical supplies and trained officers for emergency care on the way to the hospital.

Today, the renowned hospital has its emergency room in its ground floor area with its entrance. Since patients can arrive at any time and with any complaint, this is an important part of emergency care.

The department prioritizes cases based on clinical needs.

Many of the illnesses like stroke and heart attack need time-critical interventions. EDs ensure that an early diagnosis and interventions are performed in this critical time. EDs cater to medical emergencies like poisonings, complications of diabetes, respiratory failure, kidney failure, foreign body obstructions, abnormalities of cardiac rhythm, etc.

Surgical emergencies such as road traffic accidents, assaults, burns, acute pain in abdomen, blockage of blood supply to limbs, bleeding or perforation of intestines, etc. A well-designed and staffed Emergency Department is capable of providing good quality emergency care to not only adults but special population groups such as children, pregnant females, or old age patients

Critical Conditions Handled

Cardiac arrest

Critical conditions are managed cardiac arrest, it may occur in the emergency room, or a patient may be transported to the emergency room by ambulance while still in this state.

Treatment consists of basic life support and advanced life support such as Advanced Life Support and Advanced Cardiac Life Support.

Myocardial infarction

When you go to the emergency room with a myocardial infarction (heart attack), you will likely be classified in the resuscitation area.

You will be given oxygen and monitored, and an early ECG will be done, aspirin given if not contraindicated, or not already managed by the ambulance team; morphine or diamorphine is given for pain; Glyceryl trinitrate (nitroglycerin) is administered sublingually (under the tongue) or buccally (between the cheek and gums) unless the presence of other medications is contraindicated.

An ECG showing ST segment elevation suggests a complete blockage of a large coronary artery. These patients require immediate reperfusion (reopening) of the occluded vessel.

This can be accomplished in two ways: thrombolysis (anticoagulant medication) or percutaneous Trans luminal coronary angioplasty.

Both are effective in significantly reducing mortality from myocardial infarction. Many centers are now switching to using PTCA unmodified slightly more effective than thrombolysis if it can be given early. This may include a transfer to a nearby center with angioplasty facilities.

Trauma

Major trauma, the term for patients with multiple injuries, often from a car accident or a serious fall, is initially treated in the emergency room.

However, trauma is a separate (surgical) specialty from emergency medicine. Trauma is treated by trauma teams trained in the principles taught in the internationally recognized Advanced Trauma basics.

The services provided in an emergency department can range from X-rays and fixing broken bones to those of a full-fledged trauma center.

A patient's chances of survival are greatly improved when the patient receives definitive treatment (e.g. Surgery or reperfusion) within one hour of an accident (e.g. a car accident) or the onset of an acute illness (e.g. a heart attack).

Some emergency rooms in hospitals are located near a helipad, which is used by helicopters to transport a patient to a trauma center.

This transfer between hospitals is common when a patient needs advanced medical care that is not available at the local facility. In such cases, the emergency department can only stabilize the patient for transport.

Mental Illness

Some patients come to the emergency department with complaints of mental illness. Many times, patients who appear to be mentally ill and pose a danger to themselves or others may be involuntarily taken to an emergency department by police officers for a psychiatric evaluation.

The ER performs a medical evaluation rather than treating acute behavioral disorders. From the emergency department, patients with severe mental illness can be transferred (in many cases involuntarily) to a psychiatric unit.

In recent years, special units have been developed to relieve hospital emergency services and improve the treatment of psychiatric emergencies.

Emergencies are often the first port of call for medical care for people who self-harm. As such, they are critical to support and can play a role in suicide prevention.

At the same time, according to a study conducted in England, People who self-injure often experience inadequate care in the emergency room.

Classification of the emergency service in emergencies

Level I

• 24 hours service.
• At least one physician experienced in emergency care on call in the ER.
• Internal medicine coverage for senior or senior-level residents for medical, surgical, orthopedic, obstetric-gynecologic, pediatric, and anesthesiology services.

Level II

• 24 hours service.
• At least one physician experienced in emergency care on call in the emergency room.
• Specialist consultation must be available within 30 minutes.

Level III

• 24 hours service.
• At least one doctor on call in the emergency area within 30 minutes.

Level IV

• Able to perform the classification function.
• May direct life-saving first aid to transport to the nearest appropriate facility.

Areas of clinical support

Following are five main reasons why CDS should be used in Hospital Emergencies:

1. Reduce the risk of medication errors. Determining the exact dose of medication can be daunting and especially critical for infants and children in emergency situations.
2. Reduce misdiagnosis. About 10 to 30 percent of medical errors diagnostic error, Cognitive errors, atypical presentations, provider bias, and unusual disease processes are some of the most common causes of misdiagnosis.
3. Improving patient efficiency and performance, unnecessary or inaccurate patient care due to misdiagnosis.
4. Access all information in one place. The ability to access the most up-to-date medical resources in one central location eliminates the need for multiple enrollments or investments in additional resources.

The ED is an ideal environment for tools that help reduce the occurrence of preventable medical errors and adverse events.

Special facilities, training, and equipment

An emergency room requires different equipment and different approaches than most other hospital departments. Patients often arrive in unstable conditions and need treatment quickly.

They may be unconscious and information such as their medical history, allergies, and blood type may not be available. Emergency responders are trained to work quickly and efficiently even with minimal information.

ED staff must also interact effectively with providers of pre-hospital care, such as paramedics, paramedics, and others who occasionally work in an emergency department.

Preclinical providers can use devices unfamiliar to the average doctor. But ED doctors must be experts in the use (and safe removal) of special equipments. Because they have to be able to drive specialist equipment, physicians can now specialize in emergency medicine, and emergency services employ many of these specialists.

Emergency responders have much in common with ambulances and firefighters, paramedics, search and Rescue teams, and civil protection teams. Joint training and practice exercises are often conducted to improve the coordination of this complex response system.

Because time is such a critical factor in emergency treatment, emergency services typically have their diagnostic equipment to avoid waiting for devices to be installed elsewhere in the hospital.

Another important role of Emergency Services is Pre-hospital care which is provided through Advanced Life Support Ambulances by Emergency Medical Technicians under the guidance of Emergency Physicians. Another important role of the department is to provide urgent care in times of disaster like fire, earthquake, floods, or terrorist attacks.

In Emergency department, almost all have radiology rooms staffed by specialized radiographers, and many now have full radiology facilities, including CT scanners and ultrasound machines. Laboratory services can be processed on priority by the hospital lab, or the ER may have its own basic labs (full blood count, blood types, toxicology tests, etc. that need to be returned very quickly).

It is advised to keep the numbers of Emergency Service providers ready in your fast dialing or favorite list to reach out to them in case of any medical emergency. (Max Healthcare – 011-40554055)