Emergency treatment of patients, whether inpatients or out patients, requires prompt response from the consultants as any delay in treatment can jeopardize the chances of recovery and defeat the very purpose.
Hospital should have a documented roster of consultants (first and second on-call) of all the specialties. The roster should be seen and signed by all the consultants.
The emergency response time must be the minimum possible (not more than 30 minutes) in case the hospital has senior residents on duty round the clock to initiate immediate emergency measures pending the arrival of the consultant on call.
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The actual time taken from the emergency call to the actual physical arrival of the consultant should be recorded in the emergency call register and monitored by the heads of departments as well as the management.
In smaller hospitals, where Senior Residents (SRs) of all the disciplines may not be available round the clock, the response time should not be more than 15 minutes.
Delay or non-availability of consultants in cases such as Road Traffic accidents with multiple grievous injuries, Acute Myocardial Infarction (MI), Cerebrovascular Accident (CVA), Acute Severe Respiratory Distress, or Fetal Distress, has resulted into loss of many lives which could, perhaps, have been saved with timely treatment.
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Every hospital/nursing home, therefore, must put in place an effective system to ensure availability of expertise in a reasonably quick time.
1. System of Emergency Call Codes for Quick Response:
Emergency situations due to some or the other cause (mass casualties, accidents, fires, food poisoning, building collapse inside or outside the hospital) keep occurring, requiring the hospitals to spring into action at the quickest speed so as to save the maximum possible lives/limbs/organs depending upon the kind of emergency. All emergencies have some common characteristics such as:
i. Potential to cause serious damage in terms of human lives and /or property
ii. Disruption of normal patient care activities
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iii. The extent of damage potential can be limited by the level of anticipation and preparedness to meet the emergency
iv. The speed of response to the emergency is the single most important factor in limiting the losses.
It has been seen that hospitals being very busy places, it takes a lot of time to get the people to reach the site. Even informing the staff about the emergency takes time, especially during the odd non working hours.
It has been found that a system of emergency call codes put in place, as practiced in many hospitals, can be the quickest mode of communication and ensuring a speedy response. It involves:
1. Identifying and listing all the probable/common emergencies.
2. Allocating a unique code such as color code to every emergency situation.
3. Preparing a prioritized list of people to be informed in each situation along with their contact numbers (reviewed and updated).
These are the officials (with requisite expertise) called on first priority to establish command and control over the situation and ensure smooth and speedy management of casualties.
4. Preparing a standard brief message (for every emergency situation) to be passed on to all concerned. The message may include the barest essential information such as:
Emergency: ‘CODE RED’
Place: Name of the location
Message: Come Fast
Activate Emergency Response
5. The information may be programmed into the computer system at the control room as well as the hospital telephone exchange.
7. On occurrence of emergency whoever first detects it, informs the doctor in-charge casualty, telephone operator/front desk who further activate the system.
All that it may require is to click the code for the specific emergency and feed the location. The system will transmit the message to all concerned, simultaneously, and even to the staff and public in the hospital through the public address system.
8. The message may be announced three to four times, at short intervals, for the staff concerned to hear and respond.
9. Other staff is called as per the detailed SOPs immediately, after the initial announcement.
10. If the staff expected to respond, because of any situation beyond control, is unable to respond immediately, he must, on hearing the emergency code, inform the exchange operator/front desk or contact some alternate staff member to respond to the call.
11. On hearing, the announcement of emergency code, The Emergency response team (first priority staff) is expected to rush to the spot and, after quick assessment, take control and start managing the emergency as per the Standard Operating Procedure (SOP) applicable.
They also keep allocating the duties to the other staff as they report. 12. Some of the emergency situations where speed of response can be crucial are:
i. Fire
ii. Mass casualties due to accidents, food poisoning, etc.
iii. Cardiopulmonary arrest
iv. Riots by patients/public
v. Leakage of toxic gases (such as during fumigation)
vi. Physical assault, molestation, rape, abduction of child
vii. Violent patient attendant
viii.Radiation leak/major spill of RA material
ix. Bomb threat (terrorist attack).
2. Policy on Treatment of Energy Cases:
Instances have been happening all over the country, where patients in critical condition were refused treatment when brought to the hospital simply because the patient was a medicolegal case or was too poor to pay the bills.
Many lives have been lost because of such callous conduct on the part of doctors. The obligation of doctors to treat each and every emergency case (unless beyond the competence) regardless of the paying capacity or the medicolegal status, has been clearly and categorically spelt out in the judgment by Supreme Court of India in Parmanad Katara Vs Union of India and others.
Hospitals, therefore, must ensure that all possible medical assistance is provided in all situations to all patients approaching for medical help.