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A full fledged emergency department has the following areas of care:
EMS (Ambulance) Coordination Center
The Emergency Medical Services (Ambulance services) of the hospital is the community's main access to the hospital in an emergency and is also the most visible part of the emergency department to the public eye.
The EMS consists of
The EMS administrator must be a qualified emergency medicine physician himself or atleast be well trained in EM. Most often the the head of the EM department will be the EMS administrator. EMS systems administered by non medical personnel are known to be highly inefficient.
Every emergency department has a triage or triaging area to sort incoming patients.
Triage can be defined as the prioritization of patient care based on the severity of injury / illness, prognosis, and availability of resources.
For those responsible for the triage of patients arriving in the emergency department, the purpose of triage is to determine to which predesignated patient care area the patient should be sent.The locations to which the patients are 'triaged' establishes priorities for care.
The most common triaging system is the 4 level system.
Priority I (Immediate) - Patients have life threatening injuries or conditions that are survivable with immediate treatment. Examples : Airway compromise, tension pneumothorax, shock, cardiac arrest, seizures, etc.
Priority II (Delayed) - Patients require definitive treatment but no immediate threat to life exists. Patients may remain stable for 10 to 20 mins. Examples : Limb injuries, lacerations with hemorrage controlled, high fever, altered sensorium, severe pain, etc
Priority III (Minimal) - Patients have minimal injuries or minor conditions, and are ambulatory. Examples : Sore throat, abrasions and superficial lacerations, chronic self limiting disorders, etc.
Priority 0 (Expectant / Dead) - Victims are dead or have lethal injuries and will die despite treatment. Examples : Devastating head and chest injuries, 3rd degree burns over most of the body, destruction of vital organs, etc.
Those needing immediate medical care are taken to resuscitation areas, while the dead are moved directly to the morgue.
The severely but less critically injured are taken to major trauma-medical areas, where they are further assessed and initial treatment commenced.
The walking injured are directed to the minor surgery-primary care treatment area, often located in outpatient clinic areas.
This area is dedicated to the immediate care of patients and victims in cardiac arrest, airway, breathing and circulation compromise. The 'Resus' area consists of two or more resuscitation beds (sometimes upto 12) with all resuscitative equipment (monitors, defibrillators, airway, intubation & surgical equipment) available at an arm's distance including pediatric resuscitation kits.
A patient maybe shifted to the Resus area from outside or from an area within the hospital or emergency department itself.
All priority I patients are managed here.
Major Trauma / Medical Area
All priority II patients are managed here. This area will have dedicated EM physicians (along with EM nursing staff) looking after the patients directed here. Majority of the ED admitted patients are assessed and managed here.
Since majority of the patients coming to an ED do not have an emergent problem, they are assessed and treated on outpatient basis in the consultation rooms.
Minor Procedure Room
Procedures like washing, dressing & suturing of wounds, reduction & splinting of fractures & dislocations, and other minor surgical procedures are done here.
Major Operating Rooms
Any major emergency surgery can be conducted here by the operating team.
Emergency physicians are usually not involved in any major surgery, even though they maybe qualified in that field.
Patients who need to be admitted and observed for less than 24 hours are placed here. Such patients are those with non cardiac chest pain, acute asthma, vague abdominal pain, minor head injury, acute depression, febrile convulsions, dehydration, etc. Dedicated staff from emergency medicine look after these patients.
Prayer room is an important part of any emergency department since patients and victims are very sick or dying. It provides privacy for the relatives and attenders of the patients to perform any religious activities or prayers. The prayer room usually is an empty room without any pictures or images so that people from any religious background can use it. Bad news is sometimes broken here. Patients who have died are kept here temporarily to be viewed by grieving relatives and attenders.
24 hour internet access
A 24 hour internet access is a must to any ED since patients with unknown and difficult diagnoses must be dealt with in short spans of time. Internet provides access to online journals, poison and toxicological information, other emergency departments and various reading material.
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