The document discusses challenges in establishing academic emergency medicine and trauma care models in India. It outlines the current status of emergency care, which faces issues like lack of standardized training and infrastructure. It also summarizes efforts taken to advance academic emergency medicine in India, such as fellowship programs and the establishment of academic societies and journals. However, challenges remain around lack of consensus on training programs and specialty recognition. The document advocates for developing an indigenous academic model and increasing leadership and collaboration to strengthen emergency and trauma care systems in India.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
Hemorrhage is the leading cause of preventable death following trauma. Non-compressible hemorrhage is of particular concern as these patients require emergent intervention and many will die prior to anatomic hemostasis. For years, left anterior thoracotomy, the “ED thoracotomy”, was the standard of care for temporary proximal aortic occlusion, but survival remained dismal. Endoluminal aortic occlusion which was actually first described in the 1950s. With the increasing use of endovascular therapies for a wide variety of vascular disease, the “REBOA” (Resuscitative Endovascular Balloon Occlusion of the Aorta) began to be reported for use for ruptured abdominal aneurysms in the 2000s. Since that time, interest in its use in trauma has been increasing with a variety of basic science studies and early clinical series and case reports documenting potential benefits. Although no large randomized trials, or even large observational studies, are available, use of the REBOA is considered standard of care in many centers. Typically the REBOA is placed via the femoral artery either percutaneously or via a cut down and the aorta is occluded with a balloon placed over a wire by standard Seldinger-type technique. The balloon can be placed in “zone 1” just above the diaphragm to provide occlusion to the abdominal viscera and pelvic vasculature or in “zone 3” at the aortic bifurcation to provide inflow control to the pelvis and lower extremities. Injuries are then addressed and the balloon is carefully deflated taking care to avoid metabolic collapse from reperfusion. One main limitation of this technique is that the currently approved device in the United States requires a 12F sheath which requires an open femoral artery repair which obvious can be associated with significant complications. There are a huge number of unanswered questions about the use of REBOA in 2015:
1. Who are the appropriate patients in whom use may be beneficial?
2. How long can a balloon be inflated and the aorta be occluded before irreversible ischemic damage to the viscera occurs?
3. How long can the aorta be occluded before the metabolic consequences of reperfusion are lethal?
4. What is the effect on cerebral and cardiac perfusion when a REBOA is placed and afterload is acutely increased? Is it favorable or “too much”?
5. Who are the appropriate providers to place a REBOA? Only surgeons? Emergency Medicine physicians? Medics in the field?
6. How do we best train providers to place the REBOA?
7. How to we assure competency of providers?
8. Will lower profile devices make the technique more accessible and be associated with fewer complications?
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
Hemorrhage is the leading cause of preventable death following trauma. Non-compressible hemorrhage is of particular concern as these patients require emergent intervention and many will die prior to anatomic hemostasis. For years, left anterior thoracotomy, the “ED thoracotomy”, was the standard of care for temporary proximal aortic occlusion, but survival remained dismal. Endoluminal aortic occlusion which was actually first described in the 1950s. With the increasing use of endovascular therapies for a wide variety of vascular disease, the “REBOA” (Resuscitative Endovascular Balloon Occlusion of the Aorta) began to be reported for use for ruptured abdominal aneurysms in the 2000s. Since that time, interest in its use in trauma has been increasing with a variety of basic science studies and early clinical series and case reports documenting potential benefits. Although no large randomized trials, or even large observational studies, are available, use of the REBOA is considered standard of care in many centers. Typically the REBOA is placed via the femoral artery either percutaneously or via a cut down and the aorta is occluded with a balloon placed over a wire by standard Seldinger-type technique. The balloon can be placed in “zone 1” just above the diaphragm to provide occlusion to the abdominal viscera and pelvic vasculature or in “zone 3” at the aortic bifurcation to provide inflow control to the pelvis and lower extremities. Injuries are then addressed and the balloon is carefully deflated taking care to avoid metabolic collapse from reperfusion. One main limitation of this technique is that the currently approved device in the United States requires a 12F sheath which requires an open femoral artery repair which obvious can be associated with significant complications. There are a huge number of unanswered questions about the use of REBOA in 2015:
1. Who are the appropriate patients in whom use may be beneficial?
2. How long can a balloon be inflated and the aorta be occluded before irreversible ischemic damage to the viscera occurs?
3. How long can the aorta be occluded before the metabolic consequences of reperfusion are lethal?
4. What is the effect on cerebral and cardiac perfusion when a REBOA is placed and afterload is acutely increased? Is it favorable or “too much”?
5. Who are the appropriate providers to place a REBOA? Only surgeons? Emergency Medicine physicians? Medics in the field?
6. How do we best train providers to place the REBOA?
7. How to we assure competency of providers?
8. Will lower profile devices make the technique more accessible and be associated with fewer complications?
A 3ª Edição do Building Global Innovators é uma iniciativa do MIT, ISCTE e Caixa Capital direccionada a start-ups.
Candidaturas abertas até 31 de Maio.
Christianity: Christian Beliefs Contrasted with Other ReligionsFreddy Cardoza
What are the major beliefs of Christianity? What are the major divisions of the Christian faith and how did they develop? What is an Evangelical Christian and why are those foundational beliefs so important to Christians? How do the major beliefs of Christianity compare to other world religions? And finally, don't all religions teach essentially the same thing? We'll consider these and more issues in this final part of the four part series on World Religions.
This Slideshare presentation is a partial preview of the full business document. To view and download the full document, please go here:
http://flevy.com/browse/business-document/Total-Quality-Management-TQM-152
Total Quality Management (TQM) is a holistic approach to long-term success that views continuous improvement in all aspects of an organization as a process and not as a short-term goal. It aims to radically transform the organization through progressive changes in the attitudes, practices, systems and structures.
By teaching this presentation, employees will understand the importance of making a personal commitment to quality, focus on satisfying both internal and external customer requirements, and working as a team to improve quality.
This training presentation includes quality philosophies from key quality leaders such as W. E. Deming, J. M. Juran and Philip Crosby, and provides a summary of process management, steps for TQM implementation, key tools and techniques for total quality as well as the key business excellence and quality management models.
Explain importance of early, consistent EM education for all medical students.
Discuss opportunities to engage & have impact throughout the 4 year curriculum.
Highlight learning communities, the “How to be a doctor course”, and EMIG.
Evaluate factors that influence a student’s choice of specialty as related to above.
Journal Club - Mortality after Fluid Bolus in African Children with Severe In...Farooq Khan
Critical Appraisal of:
Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364:2483-95
Research in International Emergency Medicine: Scope, Impact and Challenges
EBM Topic: Subgroup Analysis
NUR 532 Nursing Leadership and the Healthcare System i0321.docxcherishwinsland
NUR 532: Nursing Leadership and the Healthcare System| i03/21/2016
Nursing Leadership and the Healthcare System
Course Description
Three hours per week theory. Prerequisite: Permission of nursing faculty and successful completion for NUR
506. Students will explore and analyze the role of the nurse leader as it relates to the healthcare system.
Included in this analysis is the delivery of safe, effective, and efficient patient care. The course focuses on
the business of health care, including the internal and external environment, financing of health care, and
resource management and utilization. The legislative and regulatory processes as they are related to changing
the health care system are explored.
Course Objectives
Upon completing the course, the student will be able to:
• Analyze and evaluate the US health care delivery system and key functional components
• Critique various delivery systems and patient care models and the advantages/disadvantages of each.
• Analyze the role of the advanced practice nurse in the context of an ever-changing health care delivery
system
• Evaluate the concepts of health and disease, risk factors, and the role of health promotion and disease
prevention
• Explore various types of health services professionals, practice requirements, and qualifications of health
services administrators
• Evaluate the role of medical technology in healthcare delivery
• Evaluate both regulatory and market-oriented approaches to contain costs in healthcare systems
• Articulate federal and state laws, regulations, and payment systems which affect the provision of care and
the organization’s finances.
• Identification of issues of access for vulnerable populations
• Identification of issues in healthcare delivery, standards, and outcomes
• Discuss future trends and how they will affect health care delivery
• The expanding role of nursing leadership in assessment and planning related to current healthcare issues
• Examine the magnet status journey and the 14 Forces of Magnetism
ii
Topic Outline
1. Patient-centered care in clinical practice
2. Roles and functions of patient care team members
3. Healthcare delivery systems and patient care models
4. Federal and state payment systems
5. Role of the governing body of the healthcare organization
6. Utilization of research findings
7. Organizational cultures and structures
8. Non-healthcare constituents within the community
9. Incorporating evidence-based research into nursing practice
Teaching Strategies
• Assigned Readings
• Online Discussion Activities
• Collaborative Learning Teams
• Guest Speakers
• Lecture/Discussion
• Discussion Boards
• Student Presentations
• Written Projects
Evaluation Methods
All students will be evaluated using the following methods:
Discussion Board (8 @ 25 points each) 200
Poster: Comparison of U.S. Health System with one other Country 125
Health care environment and sy.
Francesca Rubulotta talks about disproportionate care in ICU. Disproportionate care is disproportionate in relation to the expected prognosis.
Moreover, this can lead to moral distress among clinicians who think they are offering inappropriate care. There is mounting research and evidence pointing to the existence of disproportionate care.
Furthermore, stress and burnout cause increased miscommunication and lead to low performance and concentration. Stress leads to absenteeism or in many cases, presenteeism.
Presenteeism is when someone just shows up for work but does the bare minimum. Francesca shows the financial burden caused by absenteeism across various countries.
Francesca points out that only 14% of employees feel engaged in their jobs. Moreover, data shows that companies which keep their employees engaged have higher rates of performance. Such companies have managers who are more engaged and approachable.
Francesca discusses various studies that look at the appropriateness of care in ICU.
She talks about the CONFLICUS, APPROPRICUS and DISPROPICUS studies, all of which point to the moral stress experienced when clinicians are forced to give inappropriate care.
We must ask whether inappropriate care occurred and why. The three major factors influencing the perception of inappropriate care are client related situations, work characteristics and personal characteristics. 27% of healthcare providers (HCP) report at least one of their patients are mismanaged per day. Furthermore, 63% say that inappropriate care happens all the time.
There are multiple reasons for disproportionate care taking place. Studies show that nurses associated inappropriate care to interpersonal factors while physicians ascribed it to prognostic uncertainty.
Francesca discusses the methods used and results obtained in the DISPROPICUS study and self-awareness and individual development in ICU.
According to her, these future studies will help to find solutions to the problems regarding disproportionate care. Evidently, authentic leaders, who can inspire others, are the need of the hour.
For more like this, head to our podcast page. #CodaPodcast
Specialist and Associate Specialist (SAS) doctors are highly experienced and highly skilled doctors working in the UK NHS. Now SAS doctors can register with their employer to be recognised as 'Autonomous Practitioners'. The GMC has published guidance on becoming a recognised Autonomous Practitioner and doctors are encouraged to develop evidence of their skills in leadership, management and research. These slides provide a clear rationale for an SAS Leadership Fellow programme to support SAS doctors in their medical careers.
Health workers knowledge and attitude towards palliative care in an emerging tertiary center in south west Nigeria
Assessment of caregiving burden of family caregiver of advanced cancer patients and their satisfaction with the dedicated inpatient palliative care provided to their parents
Gamma knife is considered unsuitable for lesions larger than 10cc. In this presentation, the author- Prof Deepak Agrawal- Gamma-Knife expert and an accomplished neurosurgeon shows how this size criteria is a myth
The appointment system was the vision of Dr Deepak Agrawal and supported by Prof MC Misra, director AIIMS.
NIC helped in developing the software and implementation was done by AIIMS Team (Tripta Sharma) and NIS (Nusring informatics specialists) led by Ms Metilda Robin
More from All India Institute of Medical Sciences (20)
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Global Challenges in implementing Emergency and Trauma Care Models
1. Global Challenges in implementing
Emergency and Trauma Care Models
Dr Sanjeev Bhoi MD,FACEE
Associate Professor of Emergency Medicine
JPN Apex Trauma Centre
All India Institute of Medical Sciences
New Delhi-110029,India
5. Time dependent @acute care
• Golden Hour
• Silver Hour
• Bronze Hour
Platinum period of Golden Hour
6. Burden of Trauma
Trauma: It’s a modern epidemic @low to
middle income group countries
– 16,000 person dies due to RTI@ day@ globally
– 90% of mortality @developing nations
– 1,34,000 died in India (2010-11)
– Every 6 min@ RTI @ India
8. World Health Assembly Resolution
60.22 and Its Importance as a Health
Care Policy Tool for Improving
Emergency Care Access and
Availability Globally.
14. Emergency care-Govt .Sector
Ramanujam et al JAPI 2007
• Free care, but quality of care varies
from center to centers.
o Manned by CMOs. Or Non trained staff of junior
grade.
o Lack of equipment and infrastructure
o University hospitals have reasonable care
15. CMO
Casualty medical officer
Acts as a Post man
Usually a non trained Junior
Staff.
Flying Birds
◦ Residents rotate in Other
specialty
◦ usually those who prepare
for PG.
Allagappan K et al
Ann Emerg Med1998
9/27/2013
16. Prehospital and Disaster care
Pre-hospital care underdeveloped.
Disaster response lacks coordination and
communication.
Negative impact in Outcome.
26% has definitive disaster plan.
Position Statement: Academic Emergency Medicine in India: JWG: JAPI 2008
Joshipura MK et al Indian J Crit Care Med 2004
18. Pre-hospital care in India
Bullock cart to Air ambulance
Pre-hospital care underdeveloped.
Usually a transport vehicle
Perhaps reinforcing the existing network of informal providers
of taxi drivers and police
Training, funding quick transport with taxes on roads and
automobile fuels
Regulating the private ambulance providers, could be more
cost-effective in a culture in which sharing and helping others
is not just desirable, but is necessary for overall economic
survival.
Roy et al : Where there are no emergency medical services-pre-hospital care for the injured
in Mumbai, India. Disaster and Pre hospital care 2010 Mar-Apr;25(2):145-51.
19. • Current Status of Emergency and Trauma care
• Current status of Academic Emergency
Department in India
• Academic model for EM and Trauma training
in India.
20. • MCI recognized Academic ED : Infancy
• Non –MCI recognized : Deemed university
Current Status of Academic Emergency
Department
21. • Lack of national consensus
• Parallel departments: Major roadblocks
• Lack of administrative support .
• Lack of Interest among the faculty.
• Lack of Job Security.
• CMO as derogatory.
Hurdles
22. • Manpower not Trained.
• Lack of united advocacy to Medical Council of
India
• Bright young clinicians who once
demonstrated a keen interest in EM have
eventually migrated to other conventional
branches of medicine, due to the lack of MCI
recognition and the lack of specialty status.
Hurdles
23. • Lack of awareness, importance about EM.
• Lack of coordination among Medical colleges.
Hurdles
24. • Degree
• Duration of Course
• Curriculum
• Faculty Development
Hurdle: Lack of Consensus
25. • Apollo Hospital- Hyderabad & Royal College
Of Emergency Medicine-United Kingdom
• Eligibility For PG program(MCEM): MBBS with
MCI registration.
Duration For PG(MCEM): Three years.
Indigenous Efforts
26. Malabar Institute of Medical Sciences
International Fellowship in Emergency
Medicine
Two Year Postgraduate International
Fellowship in Emergency Medicine (IFEM)
under George Washington University U.S.A.
Indigenous Efforts
27. • Positive Impact:
– Awareness about the importance of EM
Negative Impact:
– No uniformity in degree, duration .
– No Structured curriculum exists.
Indigenous Efforts
28. • Parallel Departments did not allow it to grow.
• Acute care is the cream.
EGO and Power Struggle
29. • Lack of administrative support.
• Equipment and staff to man the ED.
Cold Attitude
30. • Lack of Interest among the faculty because of
shift duties.
• Designation of CMO derogatory.
• Job insecurity
• Bright young clinicians who once
demonstrated a keen interest in EM have
eventually migrated to other conventional
branches of medicine, due to the lack of MCI
recognition and the lack of specialty status.
Disinterested Individuals
32. • Recently (Unconfirmed Reports): MCI has
recognized EM as a specialty.
• The criteria for starting MD EM is difficulty to
meet .
• Lack of EM Trained faculty.
• Difficult to motivate people of different
specialty to devote academic time for the
development of Academic ED
Difficult Criteria-MCI
33. Championing Playing for Change
• Leadership
• Ownership
• Making a Team
• Connecting ideas into reality
• Introspecting within
37. Immediate
• Change the Name from
Casualty to Department of
Emergency Medicine.
• Convince the Administration
and the Dean about the
concept of Emergency
Medicine.
• Post dedicated manpower in
ED based on annual patient
inflow.
• Restructure ED based on
existing models
• Train manpower on
resuscitation.
38. • Recognize the specialty of EM as a distinct and
independent basic specialty
• Initiate postgraduate training in EM, thus enabling
EDs in all hospitals to be staffed by trained
Emergency physicians
• Uniform and Democratic tailormade Curriculum
• Ensure that EMs are staffed by trained ambulance
officers.
Long term Measures
46. • Current Status of Emergency care
• Current status of Academic Emergency
Department in India
• Academic model for EM and Trauma care
training in India.
47.
48. EMS is Independent - Infancy
Triage Area (outside or Bedside)
Trauma & Medical Resuscitation Areas
Minor Emergency Area
Intermediate care Area
ENT, EYE, Gyn Rooms
Isolation rooms
Fast Track
Pediatric ED
Laboratory & Radiology in the Department
www.acgme.org
Red,yellow,Green Zones
Academic Emergency Department
49. • Poison Center
• Biodefense Center
• EMS Network with EMS Personnel
• GYN Outpatient Network
• Research Center
• Center for Simulation Technology
• Trained Nurses in various Areas
www.acgme.org
Academic Affiliations
52. Do you have in you to move from
parent speciality to EM??
Leadership
Creating Meta-Leader
53. • Students
• Residents
• Fellows
• Nurses
• Paramedics
Academic Training in Trauma and Emergency
Medicine
54. • Mandatory one month training (Adult, Pediatrics,
EMS)
• ED Medical Student Clerkship Director
• Lectures by EM faculty and Senior Residents
• Procedures, Presentation & Practice
• Central Lines, Foleys,, Chest Tubes, Lacerations,
Joint Reductions, Abscess Drainage. (Daily
Evaluations)
• Students can do elective months
15 days @casualty posting @intern
Emergency Medicine Rotation for Medical
Students
55. • Third Year Surgical Clerkship
• Fourth Year Critical Care Clerkship
• One Month Rotation
• Lectures, Practical Ward Work, Procedures
• Daily Evaluations
• Students can do more Electives
• Students graduate with ACLS Training
Recently started @ Final Professional
Trauma Rotation for Medical Students
56. • Core Need for Training
• Branch of Volume
• Three to Four Years Post Medical School
• Speed, Knowledge and Precision
• Procedures, Protocols, Practice
• Residency Director, Residents, Rotations
• Trauma Rotation Two Months in Three Years
• Elective month available
Emergency Medicine Residency
USA Model
57. • Emergency Department 200 hours per month.
(18 months includes Peads)
• Trauma 80 hours a week for (2 months)
• EMS, Orthopedics, Toxicology, ENT, EYE, Anesthesia, Ne
urosurgery, OB/GYN, Research, Elective, Medicine, MIC
U, CCU, Psychiatry, Radiology (16 Months)
Daily Evaluations & Six Monthly Feedback
Need to develop Locally feasible model
Emergency Residency Rotations
58. • Five Years of Surgical Training
• Annual Contract
• Every Year Trauma Rotation one to two Months
• Second Year is Four to Six Months of Trauma and
Surgical Critical Care
• Ward, OR, Units and Resuscitations are run by the
Trauma Teams
• ED Services are very important to a busy Trauma
Team
Trauma Training in Surgical Residency
59. • Integral Part of the Residency
• Working at Level One Trauma Center
• Six Months of Ortho Trauma Services in Four Years of
Residency
• Orthopedic Service assumes care once cleared by
Surgical Trauma
• Orthopedic Trauma consults on Surgical Trauma
Patients
Residents are posted to Trauma Centre@6months
Trauma Education in Orthopedic Residency
61. • Post Bachelors Training
• ED and Trauma Job Exposure
• Clinical Ladder, Leadership and education
• Regular Training Programs
• EMS Curriculum dependent on Hours to achieve
different status to provide Care
• Training is Mandatory to work in Trauma Areas like
ED and Critical Care
Started Academy for Clinical Emergency Nursing
www.acenindia.org
Nurses and Paramedic Training
62. Mandatory to all Surgical, Emergency and
Health Disciplines including Nurses and
Paramedics
ACLS and PALS is Mandatory
EM, Trauma and Surgical Specialties do ATLS
and NALS
Instructor Status also Available
AHLS is a new Module but not Mandatory
Resuscitation Training
69. The time is ripe for a paradigm
shift, since the country is aware
that emergency care is the felt
need of the hour and it is the right
of the citizen.
David S et al
70. “Miles to walk before we sleep in the Journey from
Casualty to Emergency Medicine.”
Editor's Notes
Whether it’s a bomb blast or Pseunami ,there is chaos in 1st hour which is critical .So how do we sort it out. Tht is the story I am going to tell in next 20min
Whether its ACS,PPH,Stoke,Trauma can stike any time whether its america or Srilanka or India
Whether it US,Europe,australia,
Talk through the stories of USA-3decadesUK-2 decadesIndia-present decade of fight
Similar issues relating to low-to middle income countries where infrastructure,skilled manpower and accountibility is a problem
Talk about the tiers of Heath care In indiaPrimary,secondary and tertiary
EMRI-108 11 states of IndiaPolice still is the first responder
Cements and buildings does not make institutions of learningTalk about ED Area/Trauma center Concept-govt of India project Challenges are to train manpower
Buildings does not make institutesDivided the ED into RED,Yellow and Green zones
ProfessorAddlAssocAssistantLeadership Training is not existant