Accident & emergency


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Accident & emergency

  1. 1. Accident & Emergency Department Brig (Dr) V C Kapila
  2. 2. Introduction <ul><li>EMS is an integral part of any hospital </li></ul><ul><li>Microcosm of the hospital as a whole </li></ul><ul><li>“ Front door” of the hospital </li></ul><ul><li>Portal of entry that interacts with the highest volume of patients requiring critical care </li></ul>
  3. 3. Definitions <ul><li>Emergency has been defined as a condition determined clinically or considered by the patient or his/her relatives as requiring urgent medical services, failing which, it could result in loss of life or limb……………WHO </li></ul><ul><li>Medical emergency is a situation when patient requires urgent & high quality medical care to prevent loss of life or limb and/or to initiate action for the restoration of normal healthy life. </li></ul>
  4. 4. Importance <ul><li>Public perception & opinion of a hospital is often based on their visit to the accident & emergency department </li></ul><ul><li>This facility, usually accounts for a significant number of all hospital admissions </li></ul><ul><li>Effective functional operations in the department are important variables for staff, patient & visitors satisfaction </li></ul>
  5. 5. Functions <ul><li>Provision of immediate & correct life saving treatment at all times & for all situations </li></ul><ul><li>Collection of casualties </li></ul><ul><li>Rapid institution of BLS to critically ill at site, en route & in hospital </li></ul><ul><li>Information centre to render advice on telephone or in person on simple medical queries </li></ul><ul><li>Capacity & capability to provide effective management during disaster situations </li></ul>
  6. 6. Functions….. <ul><li>Liaison with courts & police in a medico-legal cases </li></ul><ul><li>Provision of ambulance services </li></ul><ul><li>Act as information & communication center especially during disasters </li></ul><ul><li>To provide education, training & research </li></ul>
  7. 7. Types of A & E Departments <ul><li>Type I : Large hospital with all specialists available round the clock </li></ul><ul><li>Type II : Emergency room physician available round the clock where specialists on call </li></ul><ul><li>Type III : Standby emergency facilities with physician & nurse on call </li></ul><ul><li>Type IV : Referral emergency service where only nurse is available. First aid & refer </li></ul>
  8. 8. Planning <ul><li>Location </li></ul><ul><ul><li>Should be loc on the ground floor </li></ul></ul><ul><ul><li>Direct access from the main road </li></ul></ul><ul><ul><li>Separate approach, other than OPD with a spacious parking area </li></ul></ul><ul><ul><li>Loc adjacent to OPD </li></ul></ul><ul><ul><li>Well lighted & boldly sign posted both for day & night </li></ul></ul><ul><ul><li>A helipad is required for major trauma centres, hilly or unapproachable areas </li></ul></ul>
  9. 9. Interrelationship <ul><li>Close relationship with: </li></ul><ul><ul><li>OT </li></ul></ul><ul><ul><li>ICU </li></ul></ul><ul><ul><li>Blood bank </li></ul></ul><ul><ul><li>Laboratory </li></ul></ul><ul><ul><li>OPD </li></ul></ul><ul><ul><li>Mortuary </li></ul></ul><ul><ul><li>Some authorities recommend a close relationship with CCU as well </li></ul></ul><ul><ul><li>Many sub-depts like OT, Diagnostics etc may be required in the dept itself </li></ul></ul>
  10. 10. Work & Traffic flow
  11. 11. Lay out <ul><li>Core type </li></ul><ul><ul><li>Treatment spaces situated around a central point in which emergency dept personnel work </li></ul></ul><ul><ul><li>Ideally, there should be a corridor outside the treatment area through which the patients enter the cubicles </li></ul></ul><ul><ul><li>Support rooms( plaster cast room, obstetrics & gynae room) are along the periphery of the corridor </li></ul></ul><ul><ul><li>Greatest freedom of movements for emergency dept personnel </li></ul></ul>
  12. 12. Core Design
  13. 13. Lay out…. <ul><li>Arena type </li></ul><ul><ul><li>Essentially a core plan design without the periphery corridor </li></ul></ul><ul><ul><li>Provides a good view of all the cubicles from the nursing & physician work areas </li></ul></ul><ul><ul><li>Less fatigue as distances are less </li></ul></ul><ul><ul><li>Best suited for emergency depts that are smaller in size </li></ul></ul>
  14. 14. Arena design
  15. 15. Lay out <ul><li>Corridor type </li></ul><ul><ul><li>Many variants possible depending on the size of the dept </li></ul></ul><ul><ul><li>Desirable plan for large emergency depts </li></ul></ul><ul><ul><li>Separate space is provided for each specialty </li></ul></ul>
  16. 16. Corridor plan
  17. 17. Entrance <ul><li>Separate from main hospital entrance </li></ul><ul><li>Separate entrance for ambulant & stretcher bound patients coming by ambulance </li></ul><ul><li>Should be well marked & illuminated </li></ul><ul><li>It should open into spacious lobby </li></ul><ul><li>Porch outside the lobby to protect the unloading of the patients from rain & sunlight </li></ul><ul><li>Approach to lobby should be in the form of ramp & steps </li></ul><ul><li>Approach & access should be appropriate to usage by the disabled </li></ul>
  18. 18. Reception & information area <ul><li>Entrance should open in to a large open space with reception desk in front </li></ul><ul><li>Trolley, stretcher & wheel chair parking area </li></ul><ul><li>It should be adjacent to triage area </li></ul><ul><li>Should be close to waiting area </li></ul><ul><li>Should have communication links such as telephones </li></ul><ul><li>Worship room, grief room, flower, chemist & book shop </li></ul><ul><li>Space for medico-social worker, toilets, registration & records </li></ul><ul><li>BIS has recommended 1.75 sqm per hosp bed for the reception area </li></ul>
  19. 19. Trolley bay
  20. 20. Reception and Information area
  21. 21. Waiting Area <ul><li>Should provide sufficient & comfortable space for waiting patients & relatives/escorts </li></ul><ul><li>Area should be easily observed from reception & triage areas </li></ul><ul><li>Should be appropriately furnished with visual displays on health education & hospital related information </li></ul><ul><li>Should cater for facilities such as drinking water, ladies & gents toilets, television & channel music </li></ul>
  22. 22. Examination & Treatment Areas <ul><li>Triage Area: A separate area or lobby may be used </li></ul><ul><li>Nursing Work Station </li></ul><ul><ul><li>Centrally located to enable staff to monitor patient care areas </li></ul></ul><ul><ul><li>Should preferably include central cardiac monitor station </li></ul></ul><ul><ul><li>Communication links to triage & resuscitation areas </li></ul></ul><ul><li>Doctors Work Area </li></ul><ul><ul><li>Centrally loc for facilitating response to an emergency </li></ul></ul><ul><ul><li>Should provide privacy </li></ul></ul><ul><ul><li>Loc such that doctors & nurses able to view central cardiac monitoring station </li></ul></ul>
  23. 24. Examination & Treatment Area… <ul><li>Acute Treatment Area </li></ul><ul><ul><li>Utilized for management of patients with acute illnesses </li></ul></ul><ul><ul><li>Should be able to fit a standard mobile bed with ample storage & usage space </li></ul></ul><ul><ul><li>Area should include a service panel, examination light, wall mounted sphygmomanometer, emergency call facilities </li></ul></ul><ul><ul><li>2.4m of clear floor space between beds </li></ul></ul><ul><ul><li>Each treatment area requires space of 15 sqm, doors at least 1.3m wide </li></ul></ul>
  24. 25. Acute patient care room
  25. 27. Resuscitation Room <ul><li>Should have space to accommodate specialized resuscitation bed, allow 360 degrees access to all parts of the patient for facilitating procedures & monitoring </li></ul><ul><li>Imaging facilities should include: </li></ul><ul><ul><li>Overhead X-ray </li></ul></ul><ul><ul><li>Lead lining of walls & partitions between beds </li></ul></ul><ul><ul><li>Radiolucent resuscitation trolley with cassette trays </li></ul></ul><ul><ul><li>X-ray viewing/digital electronic imaging system </li></ul></ul><ul><li>An OT light should be made available </li></ul><ul><li>All electric power should be on emergency stand-by circuits </li></ul>
  26. 28. Resuscitation Room… <ul><li>Ceiling arrangements needs to be carefully planned so that surgical lights, X-ray tracks, curtains & IV racks do not interfere with each other </li></ul><ul><li>If room not directly visible from the work area, it should have alarm line to the nursing work area </li></ul><ul><li>Storage cabinets should have glass panels to facilitate view of stored items & their retrieval as & when required </li></ul><ul><li>Should have O2 & suction outlets </li></ul><ul><li>Patient’s privacy should be ensured </li></ul><ul><li>An area of about 30 sq m is suggested </li></ul>
  27. 29. Resuscitation Room
  28. 30. Observation ward <ul><li>Utilized for patients who have been evaluated & need extended treatment, observation, re-evaluation or time consuming procedures </li></ul><ul><li>A 6 to 8 bedded ward is recommended </li></ul>
  29. 32. Special Treatment Rooms <ul><li>Obstetric room S </li></ul><ul><ul><li>Equipped for pelvic exam </li></ul></ul><ul><ul><li>Evaluation of patients in labour & emergency delivery </li></ul></ul><ul><li>Ophthalmology & ENT rooms </li></ul><ul><ul><li>Equipped with slit lamp & other necessary eqpt </li></ul></ul><ul><li>Dental room S </li></ul><ul><ul><li>Should have a dental chair </li></ul></ul><ul><li>Decontamination room </li></ul><ul><ul><li>Should have a flexible hose shower </li></ul></ul>
  30. 33. Support Areas <ul><li>Radiology </li></ul><ul><ul><li>Size & facility depend on relation & distance from main radiology dept </li></ul></ul><ul><ul><li>Unless the latter is just adjacent a satellite X-ray unit required </li></ul></ul><ul><ul><li>Besides a mandatory mobile unit 300-500Ma unit recommended for a large A & E unit </li></ul></ul><ul><li>Laboratory </li></ul><ul><ul><li>An emergency facility for performing routine blood, urine analysis, bacterial smears & stains required </li></ul></ul><ul><ul><li>Advanced tests such as BGA, biochemistry may be done in main laboratory </li></ul></ul><ul><li>ECG </li></ul>
  31. 34. Support Areas…. <ul><li>Blood Bank </li></ul><ul><ul><li>Closely related to or easy access to blood bank is recommended </li></ul></ul><ul><li>Duty room </li></ul><ul><ul><li>A 9 sqm room with bed, chair, desk lockers, toilet, telephone is required </li></ul></ul><ul><li>Storage area </li></ul><ul><ul><li>An area/alcove for mobile eqpt; mobile X-ray, crash cart, ventilators etc and for storing clean instruments, linen, drugs iv fluids </li></ul></ul><ul><li>Janitors closet </li></ul>
  32. 35. Administrative areas <ul><li>Office for director </li></ul><ul><li>Office for matron </li></ul><ul><li>Conference hall especially for teaching institute </li></ul><ul><li>Pantry: A 7 sqm pantry adequate for providing hot & cold fluid/beverage </li></ul><ul><li>Communication room </li></ul><ul><li>Secretary’s office </li></ul>
  33. 36. Communication <ul><li>Two way radio communication with ambulances & inter communication between hospitals are required outside the hospital </li></ul><ul><li>Intramural communication in the form of PA system, telephone (incl hot line), intercom, computer network etc </li></ul>
  34. 37. Engineering Services <ul><li>OT, ICU, main treatment area and resuscitation areas should be air conditioned </li></ul><ul><li>300 lux lighting is required for general area </li></ul><ul><li>1100 lux for examination area </li></ul><ul><li>Stand by supply should be planned for essential areas preferably for whole department & UPS for life saving equipment </li></ul>
  35. 38. Thank You!