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Emergency medical aid, promotion tools &planning

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Emergency medical aid, promotion tools &planning

  1. 1. Emergency medical aid, promotion tools&planning in hospitals Presented by- dr.priyanka
  2. 2. EMSEmergency medical services (EMS) are a type of emergency service dedicated to providing acute medical care and/or transport to definitive care, to patients with illnesses and injuries, which the patient or the medical practitioner, believes constitutes a medical emergency.• Emergency medical services may also be locally known as: first aid squad emergency squad, rescue squad, ambulance squad, ambulance service, ambulance corps or life squad.• The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions,The key services in the emergency medical services system include:• emergency medical dispatch;• emergency medical response and medical care;• emergency medical transport; and• inter-facility medical transportation
  3. 3. CASUALTY• Casualty Department is a medical treatment facility, specializing in acute care of patients who present without prior appointment, either by their own means or by ambulance. The emergency department is usually found in a hospital or other primary care center.
  4. 4. OBJECTIVESThe province is committed to ensuring emergency medical service systems deliver pre-hospital care within the following guiding principles:• Emergency medical services are safe and effective.• There will be a base level standard of pre-hospital care across the province.• When there is a medical emergency, the ambulance response and transport will be as timely as possible.• Emergency medical services are a part of the broader health system to ensure access.• Emergency medical services will be sustainable over time.• EMS will have the opportunity to work with their regional health authority and be involved in the planning process for emergency medical service delivery.
  5. 5. PurposeEmergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery.This common theme in medicine is demonstrated by the "star of life". The Star of Life showed here, where each of the arms to the star represents one of the 6 points. These 6 points are used to represent the six stages of high quality pre-hospital care, which are_• Early detection - Members of the public, or another agency, find the incident and understand the problem• Early reporting - The first persons on scene make a call to the emergency medical services and provide details to enable a response to be mounted• Early response - The first professional (EMS) rescuers arrive on scene as quickly as possible, enabling care to begin• Good on-scene care- The emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident• Care in transit- the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey• Transfer to definitive care - the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians
  6. 6. Levels of careA category of emergency medical service which is known as medical retrieval• The levels of service available will fall into one of three categories; Basic Life Support (BLS), Advanced Life Support (ALS), and care by traditional healthcare professionals, meaning nurses and/or physicians working in the pre-hospital setting and even on ambulances.1)Basic life support• First responder A first responder is a person who arrives first at the scene of an incident• Ambulance driver• Ambulance care assistant (ACA)• Emergency medical technician (EMT)• Emergency medical dispatcher (EMD)2)Advanced life support (ALS)• Paramedic (EMT-P)• Critical care paramedic (CCEMTP)• Paramedic practitioner / Emergency care practitioner3)Traditional healthcare professionals• Registered nurse (RN)• Physician
  7. 7. Critical conditions handled HEAD INJURY CHEST PAIN COPD ASTHMA BROUGHT DEAD UNCONCIOUS PATIENTS GYNAC. PATIENTS CLW SUTURING PAEDIATRIC PATIENTS FRACTURE PATIENTS UNKNOWN RTA PATIENTS
  8. 8. CRITICAL CONDITIONS HANDLED 1)Anaphylaxis Severe, life- threatening allergic reaction Occurs as reaction to an allergen TreatmentCauses • If nauseated, lie down on the side• Food like nuts, milk, eggs, fish • If feeling faint, lie down, legs raised• Insects • In case of breathing difficulty, sit up• Vaccines • First time patients should be hospital treated• Medications like antibiotics, anesthetics • Epinephrine injections – effective treatment• Some tropical insects, plants, animals • Continuous monitoring mandatory• Unknown causes • Severity/ response / prior episodes determine treatmentSymptoms Prevention• Tingling / warm sensation • Avoid allergens as far as possible• Itchiness / Rash • Those at risk should carry adrenalin auto-injector• Swelling of areas around mouth / throat • Inform school authorities, if children at risk• Restricted air-ways • Children should wear food allergy badges• Reduced oxygen level in brain • Emergency protocols necessary in schools/ work• Signs of asthma place• Vomiting • Educating the public is vital• Diarrhea• Low blood pressure• Palpitations / feeling faint• Loss of consciousness
  9. 9. Animal breaks ASTHAMA • It is a chronic lung diseaseSymptoms • It creates narrowing of air passagesof the lung Produces• Skin break difficulty in breathing.• Bruise / puncture Symptoms• Cuts,Bleeding • Wheezing• Swelling and redness of the area • Cough and cold• Oozing of fluid • Tightness in the chest Treatment • Disturbed sleep• Calm the affected person • Breathlessness• Wash hands before attending to wound Asthma Triggering Factors• Wash wound with soap & running water • Colds and viruses• Apply antibiotic ointment • Irritants like Cigarette smoke, scent, pollution• Dress using sterile bandage • Cold air or change in weather• After first aid, medical treatment must be sought quickly • Physical exertion• Suturing may be required • Allergens like dust, mite, pollen, furs• Tetanus booster / antibiotics required • Some medications• Treatment depends on type / location of wound • Infections• Prevention • Stress• Avoid keeping wild animals as pets Treatment• Choose a pet that is friendly to children • Anti-inflammatory drugs include:• Train the pet to obey commands a. Steroid Inhalers• Vaccinate your pet b. Sodium Chromoglycate Inhalers / Capsules • Treatment –Bronchodilators • Common bronchodilators include: a. Salbutamol Inhalers b. Terbutaline Tabs • Consult your Pulmonologist
  10. 10. BURNS Second-degree burns• Injuries due to heat/ chemicals/ electricity/ radiation• Common heat injuries due to fire, hot liquids, steam • Burns extends to middle skin layer, dermis Burns due to heat / chemicals – through skin • Swelling, redness and pain observed contact • Burnt area may turn white on touch• Severe burns affect muscles, fat and bones • Blisters develop, that ooze a clear fluid• Older people/ children - particularly vulnerable • Scars may develop Categories of burns • Restricts movement, if injury occurs at jointFirst-degree burns • Dehydration may occur• Injuries are superficial / mild • Healing time varies, depends on extent of injury• Swelling & redness of the injured area Treatment• Pain develops • Clean the affected area thoroughly• No blisters seen • Gently dry• Burned area becomes white on touch • Apply antibiotic cream over affected area• Takes 3-6 days to heal • Skin graft may be required Treatment • Hospitalization is essential• Remove patient from heat source Third-degree burns• Remove the burnt clothing • Damage occurs to all 3 skin layers• Run cool water over burnt area • Destroys adjacent hair follicles, sweatglands, nerve• Gently clean the injured area endings• Gently dry • Scars develop• Apply anti biotic such as Silver Sulphadiazine • Dehydration occurs resulting in shock• Use a sterile bandage to cover burns • Symptoms may worsen with time• Take tetanus vaccination. • 90% body surface injury results in death • 60% injury in elderly, fatal • Treatment • Requires immediate hospital care • Dehydration treated through intravenous fluid supply • Oxygen is administered • Periodically run clean cool water over burns
  11. 11. Overview CHOCKING• Occurs when foreign object is lodged in windpipe• This blocks oxygen supply to brain Treatment• Choking could be fatal, if first aid not given • Heimlich maneuver and CPR –2 techniques Causes Heimlich maneuver - an emergency procedure to• Swallowing a large piece of food help someone who is choking because food is• Swallowing food that is not well chewed lodged in the trachea• Eating food quickly Heimlich manoeuvere• Eating and talking If person is unable to talk, try Heimlich maneuver Forces• Consuming alcohol before a meal the diaphragm up to the lungs Creates an artificial cough• Wearing dentures • Heimlich Maneuver on a standing person Symptoms • Stand behind the person• Hands will grasp throat • Form a fist with one hand• Breathlessness • Place fist below ribcage, thumb inward• Noisy breathing • Hold the fist with other hand• Inability to cough • Keep arms off ribcage• Skin, nails and lips may turn blue • Give four inward and upward thrust• Loss of consciousness • Repeat till the object is ejected • Same method is used for a child too Heimlich maneuver On an Unconscious Person • If person is lying down, straddle the person with your knees • Place heel of one hand above waistline • Place other hand over the first • Give four inward and upward thrust • Repeat till object is coughed out
  12. 12. Cardiac Arrest• Often caused by abnormal heart rhythm THE VITAL STEPS Clear the airway• This aberrant rhythm is ventricular fibrillation(VF) • Assess if the person is conscious / breathing• During VF heartstops pumping blood • Lay the person on his back on a hard surface• Patient may stop breathing • Using a head tilt -chin lift open his airway• No pulse may be detected • Check for breathing sound• A shock to the heart, called defibrillation, required • If not breathing, start mouth-to-mouth breathing Defibrillation stops VF, restores heart function Mouth- to-mouth breathing What is CPR? • Pinch the persons nostril shut• Emergency life-saving measure • Seal his mouth with your own• Combination of rescue breathing & chest • Give the first breath, lasting one second compressions • Watch if chest rises• Done on unconscious/ non-breathing patient • If it rises, give second rescue breath• Done on persons suffering cardiac arrest • If it does not rise, give a head tilt- chin lift• Also for near-drowning/ asphyxiation/ trauma cases • Now give second rescue breath• CPR conducts defibrillation Restore circulation through compression• Supports heart pumping for short duration • Place heel of your palm on patients chest• Allows oxygen to reach brain • Place your other hand above first• Buys time till help arrives Keep elbows straight• More effective when done as early as possible • Push down using upper body weight (compress) Caution • Push hard and fast• Ribs/heart/lungs/ liver may be injured • After 30 compressions, clear airway• After CPR, medical attention should be given • Give two rescue breaths • This is one cycle • Give 100 compressions /minute • Continue CPR till medical help arrives
  13. 13. • Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someones breathing or heartbeat has stopped. In 2010, the American Heart Association updated its guidelines to recommend that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions.• Heres advice from the American Heart Association:• Untrained. If youre not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive (described in more detail below). You dont need to try rescue breathing.• Trained, and ready to go. If youre well trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.• Trained, but rusty. If youve previously received CPR training but youre not confident in your abilities, then just do chest compressions at a rate of about 100 a minute.• The above advice applies to adults, children and infants needing CPR, but not newborns.• CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.• When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. A person may die within eight to 10 minutes.• To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED).• Before you begin Before starting CPR, check:• Is the person conscious or unconscious?• If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"• If the person doesnt respond and two people are available, one should begin CPR.— unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute & call local emergency number.• If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.
  14. 14. • Remember to spell C-A-B• In 2010, the American Heart Association changed its long-held acronym of ABC to CAB — circulation, airway, breathing — to help people remember the order to perform the steps of CPR.Circulation: Restore blood circulation with chest compressions• Put the person on his or her back on a firm surface.• Kneel next to the persons neck and shoulders.• Place the heel of one hand over the center of the persons chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.• Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.• If you havent been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.Airway: Clear the airway• If youre trained in CPR and youve performed 30 chest compressions, open the persons airway using the head-tilt, chin- lift maneuver. Put your palm on the persons forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.• Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the persons breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isnt breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you havent been trained in emergency procedures, skip mouth-to-mouth rescue breathing and continue chest compressions.Breathing: Breathe for the person Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or cant be opened.• With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the persons mouth with yours, making a seal.• Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesnt rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.• Resume chest compressions to restore circulation.• If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If youre not trained to use an AED. Do not use an AED for babies younger than age 1.Continue CPR until there are signs of movement or emergency medical personnel take over.
  15. 15. Electric shock fractures Injuries caused when electric current passes through Types body Source may be natural or man-made • Open fracture: Skin breaks causing open wound What happens during electric shock? • Closed fracture: Skin not broken • Complicated fractures: Damage of adjacent organs • Makes you fall down • Stress fracture: Hairline crack due to repeated • Muscle contraction stress • Seizures • Greenstick fracture: In childrens flexible bones • Dehydration Symptoms • Burns • Severe pain • Difficulty in movement • Fractures • Swelling/ bruising / bleeding • Clotting of blood • Deformity / abnormal twist of limb • Tissue death (narcosis) • Tenderness on applying pressure • Respiratory/Heart/Kidney failure First-aid Steps to follow • Depends on type & location of fracture • Do not attempt to move the victim from current For open fractures source • Control bleeding before treatment • Rinse and dress the wound • First step is to switch off the current source • For open / closed fractures • Otherwise, move the source using a wooden • Check the breathing stick Attend to the victim • Calm the person • Check for breathing No breathing, do Cardio • Examine for other injuries pulmonary resuscitation (CPR) • Immobilize the broken wound • Call emergency medical aid • Apply ice to reduce pain / swelling • If breathing, do a physical examination • Consult a doctor • Treat for minor burns • DO NOT • Re-establish vital functions • Massage the affected area • Straighten the broken bone • Excessive burns may require hospitalization/ • Move without support to broken bone surgery &Supportive care must be provided • Move joints above / below the fracture
  16. 16. GastroenteritisOverview Treatment• Gastroenteritis is inflammation of stomach and intestines • Adequate rest is advised• Can affect- any one, any age, any time• Symptoms prominent in children • Drink plenty of fluids to prevent• Depending on cause, it may last for a day or a dehydration week • Gradually eat easy -to-digest food• Use of drugs like aspirin can increase the risk• Causes • Avoid eating if nauseated• Bacteria contaminated food / water • Do not give water to a child with• Viral infection• Stress gastroenteritis• Irregular/ improper diet • Give other prescribed rehydration• Reaction to a new food liquids• Reaction to medication• Symptoms • Or give a mixture of salt and• Vomiting glucose in water• Nausea• Diarrhea • Avoid aspirin• Cramps/Abdominal pain• Dehydration• Weakness• Fever/Chills, occasionally•
  17. 17. Head InjuryHead trauma is an injury that affects the brain / skull Treatment For mild injury-• Head injury may be closed or penetrating • Apply ice to injured area to minimize swelling Causes • The size of the bump is not related to the severity of injury• Road traffic accidents • Observe the patient carefully for signs of bleeding• Accidents at home / work For moderate to severe injury-• Assault • Check the patients breathing pattern• Fall • If necessary do Cardio Pulmonary Resuscitation• Sports (CPR)• Symptoms • In case of bleeding, press area with a clean cloth• Loss of consciousness- for short or long duration • If the cloth soaks, place a fresh cloth over the first one• Bleeding • Do not remove debris from the wound• Vomiting • If person is vomiting turn on the side and lower the• Fluid discharge from nose head• Loss of hearing, vision, taste, smell • To minimize spine injury- hold head, neck and body in• Speech-related problems one line• Irregular heart beat • Immobilize the patient• Seizures • If unconscious, treat it like a spinal injury• Paralysis • Keep the head in alignment with spine• Coma • Get immediate medical help• Change in personality Consult a DoctorWhen the following occur seek medical• Mental health-related problems help-Bleeding • Fluid discharge from nose, mouth, ears,Vomiting • Loss of consciousness • Confusion / Restlessness / Irritability Slurred speech / Convulsion ,Blurred Vision,Low breathing • Fracture/ Stiff neck • Loss of sensory abilitiesInability to move one or more limbs
  18. 18. Poisoning Causes Treatment• Medications • Seek immediate medical help• Drug overdose • Check for signs like burns around mouth, breathing• Occupational exposure difficulty or vomiting• Cleaning detergents/paints • Induce vomiting if poison swallowed• Carbon mono oxide gas from furnace, heaters • In case of convulsions, protect the person from self• Insecticides injury• Certain cosmetics • Position the victim on the left till medical help• Certain household plants, animals arrives• Food poisoning (Botulism) For inhalation poisoning Symptoms • Seek immediate emergency help• Blue lips • Hold a wet cloth to cover your nose and mouth• Skin Rashes • Open all the doors and windows• Difficulty in breathing • Take deep breaths before you begin the rescue• Diarrhea • Avoid lighting a match• Vomiting/Nausea • Check the patients breathing• Head ache • Do a CPR, if necessary• Giddiness/drowsiness • If the patient vomits, take steps to prevent choking• Double vision Steps to Avoid• Abdominal/chest pain • Avoid giving an unconscious victim anything orally• Palpitations/Irritability • Do not induce vomiting unless told by a medical• Loss of appetite/bladder control personnel• Numbness • Do not give any medication to the victim unless directed by a doctor• Muscle twitching • Do not neutralize the poison with limejuice/honey• Seizures• Weakness• Loss of consciousness
  19. 19. Shock Severe Bleeding Severe bleeding involves loss of large amount ofShock is a life-threatening condition .When vital organs blood .This may occur externally through natural fail to get enough blood, shock results openings, like mouth A cut on the skin too can lead• Causes to bleeding Internal bleeding occurs due to an• Severe infections injury to blood vessel• Allergic reactions Causes• Heat Stroke • Accidents/Falls ,Blow to the head• Trauma • Injuries, like scalp wounds• Poisoning • Certain medications• Injury • Illnesses like• Symptoms a. Hemophilia b. Scurvy c. Cancer• Cool, clammy skin ,Dilated pupils d. Thrombocytopenia e. A plastic Anemia f. Leukemia g. Hemorrhage• Vomiting/nausea h. Peptic Ulcer i. Platelet Disorder• Feeling weak ,Confusion j. Liver Disease k. Septicemia• Excitement Treatment• Anxiety • Wash hands well before administering to patient• Shallow/ slow breathingor rapid/ deep • Wear synthetic gloves breathing Weak and rapid pulse • Make the victim lie down .Slightly elevate the legs• Treatment Get emergency medical help. • If possible keep the affected area elevated Meanwhile- • Remove any obvious debris/particle• Make the person lie down on the back • Apply direct pressure using clean cloth/bandage• Raise the legs above head level • Use hand if cloth is not available• If raising the legs is painful, keep the person still • Apply pressure continuously for at least 20 minutes• Check for breathing If not breathing, do Cardio pulmonary Resuscitation (CPR) • Hold the bandage in place using an adhesive tape• Make the person comfortable by loosening tight • Apply direct pressure on the artery if necessary clothes • Squeeze the artery keeping finger flat• Cover the person with a blanket • Continue applying pressure on the wound• If vomiting or bleeding from mouth -turn the patient • Once bleeding stops immobilize the affected part on the side • See a doctor• Do not feed the person orally
  20. 20. Snake Bites TreatmentThousands suffer from snake bites, globally, every year People who live near wilderness/trekkers - • a. Seek Medical help as soon as more prone Even bite from a harmless snake can possible. Meanwhile - cause allergic reaction • Wash wound with soap/water Symptoms • Immobilize the affected area• Fang marks • Keep area slightly elevated• Swelling/severe pain at the site • Apply cool compress/wet cloth to affected part• Bloody discharge from wound • Apply a firm bandage 2-4 inches above bite to• Burning i. Prevent venom from spreading ii.Take care of any bleeding• Diarrhea • b. Monitor for pulse, respiration ,etc• Excessive sweating Prevention• Blurred vision• Numbness/tingling sensation • Do not attempt to kill a snake. • If you spot a snake, leave it alone• Increased thirst • While hiking or in the woods, stay out of tall grass• Vomiting • Do not put your hand into pits/crevices during treks• Fever • Exercise caution while climbing rocks• Loss of muscle co-ordinations• Convulsions• Rapid pulse• Weakness/Dizziness/Fainting•
  21. 21. PLANNING OF CASUALTYThe casualty has evolved into a self sufficient, well-equipped important area of the hospital and is no longer just a two-room unit present in a remote corner of the hospital. It is called Accident and Emergency department (A & E) now and has gained recognition as a separate branch of medicine.• . Casualty should be located on the ground floor and easily accessible both from inside as well as outside the hospital. It should have separate entry and exit points to minimize traffic congestion. The entry point should have a porch to protect the unloading of patient’s from rain and sun. All the doors should be wide, with two way swing to allow easy entry and exit.• The casualty emergency department sign must be promptly displayed outside the facility. The corridors leading to the casualty should be wide enough to allow passage of trolleys and other mobile equipment. There should be a large waiting area for the relatives, trolley bay, canteen, police and security room and toilet facilities outside the casualty. Parking space for ambulance should also be earmarked. The area for medical disasters should be ear marked and can be either part of casualty or adjoining waiting area. The casualty complex should have separate examination, resuscitation & triage cubicles, ECG room, plaster, dressing and x-ray rooms. Cont….
  22. 22. It should be equipped with modern monitoring and therapeutic modalities, and manned round the clock by physicians and nurses familiar with emergency medical situations.• Nursing staff is the backbone of the casualty and the department should have dedicated nurses. Senior nursing staff can look after the day-to-day running of the facility, accounting duties, supervision and implementation of disaster and waste management.• The casualty should be provided with separate outcall and internal call facilities. It is a good idea to provide mobile telephone loaded with important telephone numbers to the CMO beside a paging system.• The CMO should regularly participate in Advanced Cardiac Life Support and Advanced Trauma Life Support programmes and disaster drills conducted by the hospital from time to time. The hospital administration should have a dedicated person to look after the casualty.• A round the clock receptionist is mandatory to make the casualty cards and interact with the patients, and should be provided with a computer connected to the hospital network for direct billing, data access, data retrieval and report generation. Involvement of medical social worker in the casualty provides help to the patients as well as the relatives.• The casualty often encounters the problem of extra attendants, large crowds, with emotions and tempers running high. Good security arrangement must be provided to ensure the safety of the hospital staff and to prevent any disruption in work.
  23. 23. Suction Machine Basic Utilities Monitor TrolleyStretcher Trolley Dressing Trolley Casualty Trolley Hospital Wheelchair SPO2 MONITORInstrument Trolley DEFIBRILLATOR OXYGEN CYLINDER
  24. 24. MLC’sCases that are to be treated as medico-legal• 1. All cases of injuries and burns –the circumstances of which suggest commission of an offence by somebody.• 2. All vehicular, factory or other unnatural accident cases specially when there is a likelihood of patient’s death or grievous hurt.• 3. Cases of suspected or evident sexual assault.• 4. Cases of suspected or evident criminal abortion.• 5. Cases of unconsciousness where its cause is not natural or not clear.• 6. All cases of suspected or evident poisoning or intoxication.• 7. Cases referred from court or otherwise for age estimation.• 8. Cases brought dead with improper history creating suspicion of an offence.• 9. Cases of suspected self-infliction of injuries or attempted suicide.• 10. Any other case not falling under the above categories but has legal implications
  25. 25. PROMOTION TOOLSIn most places in the world, the EMS is summoned by members of the public via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation.Service providers -• Government Ambulance Service – Operating separately from the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, almost all emergency ambulances are part of a national health system.• Fire or Police Linked Service – In countries such as the United States, Japan, France, and parts of India; ambulances can be operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truck.
  26. 26. • Volunteers Ambulance Service – Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. They may be linked to a voluntary fire service, with volunteers providing both services. There are charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service across the world on a volunteer basis. (and in others as a Private Ambulance Service),• Private Ambulance Service – Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. non urgent), but in some places, they are contracted to provide emergency care, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. This system has the benefit of keeping emergency crews available all the time for genuine emergencies. These organizations may also provide services known as Stand-by cover at industrial sites or at special events .• Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.• Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.• Charity Ambulance – This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals• Company Ambulance - Many large factories and other industrial centers, such as chemical plants, oil refineries, breweries and distilleries have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.
  27. 27. Improving health system preparedness for mass casualty eventsA commitment from medicine, dentistry, nursing, emergency medical services, hospital systems and public health to improve health system preparedness for terrorism and mass casualty incidents .We in the health professions pledge to make health system preparedness one of our highest priorities. Working with educators, social workers, firefighters, law enforcement, business, community groups, clergy and others, we will support national, state and local efforts to strengthen individual and community preparedness, response and resilience to terrorism and other catastrophic events.• Together, we will work to enable the public health and health care systems to become truly interoperable and integrated, with adequate resources, facilities and training to better coordinate their assigned tasks. As scientists, public servants and humanitarians, we will incorporate everything possible into our professional and advocacy efforts to protect public health and safety in a disaster. We resolve to:• Provide leadership in national, state and local disaster planning and response efforts.• Put disaster preparedness into practice.• Educate ourselves about disaster preparedness and response.• Advocate for solutions based on sound science.To improve health system preparedness mass casualty events:• Collaboration, coordination and planning • Funding• Communications and information exchange • Health system surge capacity• Disaster recovery and health systems • Legislation and regulation• Research
  28. 28. PLANNING IN HOSPITALSPlanning framework needed?• ensuring access to high quality pre-hospital care,• continuing to provide reliable emergency medical dispatch;• providing access to high quality and consistent patient triage and assessment;• maintaining qualified crews on ambulances;• maintaining well-equipped ambulances• locating emergency medical service stations in the right places to make sure they can respond to calls quickly and efficiently;• coordinating pre-hospital care with other services within the health care system;• ensuring efficient use of resources in the system;• responding to the needs of changing populations in the province;• implementing new technology and standards in emergency medical service delivery
  29. 29. PLANNINGEXTERNAL INTERNAL
  30. 30. External PlanningA disaster plan encompassing both local and regional areas must focus on 3 possible scenarios:• The disaster occurs within the region and is confined and controlled with existing resources.• The disaster occurs in a neighboring region, and regional assets are requested through mutual aid agreements.• The disaster area is the region and requires state or federal assistance for an effective response.Incident command system• In the 1970s, the Fire Suppression Services developed the ICS concept to organize an effective response to major disasters. The ICS structure includes 5 functional units: command, operations, logistics, planning, and finance.• Most disaster plans include similar organizational structures that are often modified depending on normal operations of the various agencies.• In developing a disaster plan, leaders should remember that it is impossible to plan for all contingencies; therefore, plans must be relatively general and expandable. Most disasters that can be contained using local or regional resources have fewer than 100 fatalities and fewer than 500 major casualties. If plans are developed for larger-scale disasters, the plan should focus on the first 48 hours of the disaster until state and federal assistance teams can arrive and to address high initial fatality rates during the first 24 hours.
  31. 31. Internal Planning• Hospital disaster planners must take into account the scenarios including the possibility that the disaster may involve the hospital. For such rare events, aspects of hospital involvement such as mass decontamination, multiple triage and staging areas within the confines of the hospital, recall of critical personnel, and provisioning of adequate supplies and resupply must be anticipated. The Joint Commission (formerly Joint Commission on Accreditation of Hospitals [JCAHO]) requires hospitals to exercise disaster plans periodically and to form disaster committees. These committees should comprise key departments within the hospital, including administration, nursing services, security, communications, laboratory, physician services (including, but not limited to, Emergency Medicine, General Surgery, and Radiology), medical records, and maintenance/engineering.The hospital disaster plan should include protocols and policies that meet the following needs:• Recognition and notification• Assessment of hospital capabilities• Personnel recall• Establishment of a facility control center• Maintenance of accurate records• Public relations• Equipment resupply
  32. 32. Mumbai Helplines | Emergency and Ambulances Services – Mumbai |Important Helplines For Mumbai Emergency Ambulance Service Helplines In Mumbai • VITAL DIRECT AMBULANCE SERVICE NUMBER : PUBLIC HELPLINES MUMBAI Police hotline 100 • Newly Launched, Dial 1298 for Blood Banks 1910 Emergency Ambulance services in Ambulance Services 102 Mumbai. General Complaints 1916 Children Helpline 1098 • MUMBAI EMERGENCY AMBULANCE Mumbai Telephones Special 102 immigrations 176 • THANE EMERGENCY AMBULANCE Mumbai Telephones Assistance 199 Mumbai Telephones Complaint 198 25331552 Emergency Numbers: • NAVI MUMBAI EMERGENCY Accident cases only: 102 AMBULANCE 27572111 Heart Attack: 105
  33. 33. Police Station – Mumbai | Contact Fire Brigades – Mumbai |EmergencyNumbers Of Mumbai Police Stations Fire Stations and Fire Fighters Numbers MUMBAI POLICE VITAL DIRECT Emergency Control Room: 101 NUMBERS : / 309-5991 / 309-5992 / • Police Control Room: 309-5993 / 309-5994 – City: 100 – New Bombay: 757-4929 POWER SUPPLY • BEST 24-hour breakdown • Mumbai 22620111 services • Thane Police Station 25443535 – Fault Control (North): 414- • Navi Mumbai Police Station 6683 27600101 – Fault Control (South): 206- • (Crime Branch Mumbai) 103 6661
  34. 34. CASUALTY IPD MATERIAL & STORE DEPT. OPD ACCOUNT DEPT.OPERATION THEATRE Ksdcs,nzxm,cnkijefsdk HOSPITAL nf,sn,nICAL MRD DEPT. LABORATORY PHARMACY CT SCAN XRAY

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