An Introduction To Pre-Hospital Care in Malaysia

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This lecture was delivered to a group of dental students. As such, in this lecture, this subject was dealt with in an as-objective-as-possible manner, and devoid of much socio-political sentiments associated with the problems of pre-hospital care in Malaysia.

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An Introduction To Pre-Hospital Care in Malaysia

  1. 1. KS Chew Emergency Medicine Department School of Medical Sciences Universiti Sains Malaysia
  2. 2.   Transport Mode   Scene Size up   Pre-hospital Patient Assessment
  3. 3. To bring the right patient, via the right mode of transportation, to the right center within the right time
  4. 4.   Land ambulances ◦  Examples: Type A1, A, B, FWD ◦  Private ambulances – for paying cases, often non- emergencies ◦  Patients Transport Van   Water ambulances   Air Ambulances   Motorcycle Squads
  5. 5. TYPE B TYPE A   Immobilization package   Trauma Kit   Triage Card   Stretcher   All Grade B Equipments   Transport Ventilator   Defibrillator   Monitor ◦  Note: Type A1: additional specialized equipments – incubator, mini intensive care facilities
  6. 6.   To reach persons in need as quickly as possible with trained personnel   To stabilize the patient’s condition to prevent further deterioration   To move the patient to a facility capable of providing more extensive care or additional services that will enhance patient outcome   To offer the level of care equal to the receiving institution recognizing the limits inherent in traveling.
  7. 7.   Intra-hospital--transport of a patient from one location to another within the hospital   Inter-hospital--transport of a patient between hospitals   Scene run--transport of a patient from a non-medical site to the nearest available or designated hospital
  8. 8. •  Advantages  –  Door‐to‐door service/no  addi4onal transport  vehicle  –  No landing zone required  –  Ease of personnel training  –  Few weather restric4ons  –  Affordable and generally  reimbursable  –  Family member rides too  •  Disadvantages  –  Mo4on sickness  –  Limited pa4ent access,  light and electrical power  –  Traffic delays  –  Transport 4me  –  Vibra4on/noise (69‐75 dB)  –  Need to carry addi4onal  baReries/AC converters
  9. 9.   Transport‐related problem:   any event (expected @ unexpected), that  impacted adversely on the pa4ent stability    Pa2ent‐related complica2ons:    any difficulty or complica4on, related directly  to the pa4ent’s patho‐physiology.    Equipment‐related problems:     equipment/technical mishaps & transport  environmental factors that could result in  pa4ent instability 
  10. 10. Hub  Ambulance  Centre  Admission  Centre  Relevant  Dept.  Mortuary  OT  Ambulance Base  Sta4on  Hospital  Clinic  NGO  Private  Hospital  Police/Fire  Social Worker  I N T R A  H O S P I T A L  I N T E R F A C I L I T Y
  11. 11. Response Time  Percent %  < 10 min   8.8  10 ‐20 min  38.3  20 – 30 min  30.9  > 30 min  22.1 
  12. 12. Aim to:  Determining any threats to your own safety  or to the safety of your pa4ents or  bystanders, to determine the nature of the  call, and to decide if you will need addi4onal  help 
  13. 13.   Body substance isolation review   Scene safety   Total number of patients   Essential equipment and resources needed on-scene   Mechanism of injury
  14. 14. Toxic Substances or Hazmat
  15. 15. Mechanism of Injury Motor Vehicle Collision–Head On
  16. 16. Mechanism of Injury: Motor Vehicle Collision–Rear Impact
  17. 17. Mechanism of Injury:   Motor Vehicle Collision–Side Impact 
  18. 18. Mechanism of Injury:   Motor Vehicle Collision–Rollover 
  19. 19. One Nation, One Number 999
  20. 20. Information to relay to when making an emergency call   E = Exact Location - The precise location of the incident   T = Type - The nature of the incident (trauma, non-trauma, heart atack, motor-vehicle accident), including how many vehicles, buildings etc. are involved   H = Hazards - Both present and potential (e.g., explosion, spillage of combustible materials, highly volatile hydrocarbons, chemicals, etc)   A = Access - Best route for emergency services to access the site, or obstructions and bottlenecks to avoid   N = Numbers - Numbers of Casualties, Dead and Uninjured on scene   E = Existing Emergency Services - Which services are already on scene, and which others are required - s0 as not to duplicate services, and for better utilization of services in other concurrently emergency happenings.
  21. 21.   Sorting of patients according to: ◦  ABCDEs ◦  Available resources   Multiple casualties   Mass casualties   Stay and play versus Scoop and Run
  22. 22. Good Early Trauma Management Impacts 100% 50% 0% Immediate Deaths Early Deaths Late Deaths % of Deaths
  23. 23.   Time is a critical factor for the patient with a significant MOI   Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply
  24. 24.   The environment (ie: bottom of stairs, out in the cold, tripod position, pool of blood)   Patient’s MOI/NOI   Patient’s age and sex   Patient’s degree of distress   Listen for the chief complaint   Keep the priority of care in focus
  25. 25. Mechanism of Injury:   Motor Vehicle Collision–Vehicle Interior 
  26. 26.   Are they conscious or unconscious? (if unconscious do CPR quick-check)   Introduce yourself   What’s your name? (oriented to person)   Do you know where you are? (oriented to place)   What day of the week is it? (oriented to day)   How can I help you today? (chief complaint)
  27. 27.   Alert – oriented to person, place, and day (“big three”)   Verbal – cannot answer the “big three” correctly   Painful – either appropriate, inappropriate, or posturing (decorticate/decerebrate)   Unresponsive
  28. 28.   S – signs and symptoms   A – allergies   M – medications   P – pertinent past medical history   L – last oral intake   E – events leading up to
  29. 29.   D – deformity   C – contusions   A – abrasions   P – punctures/penetrations   B – burns   T – tenderness   L – lacerations   S – swelling
  30. 30.   D = Deformity   O = Open Wound   T = Tenderness   S = Swelling
  31. 31.   Time is a critical factor for the patient with a significant MOI   Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply
  32. 32.   The maximum time EMS providers stay on the scene for a critical trauma patient

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