Casualty, emergency and trauma A to Z

Casualty, emergency and trauma

1. Dr . Tushar Chokshi M.D. ( Anesthesiology ) TMC 1 Practicing Anesthesiologist in Vadodara since 27 years President of Association of Practicing Anesthesiologist ( APA ) Regular National Faculty on the subject of Smartphone in Anesthesia and Medical Practice Developed most economical video laryngoscope first time in India

2. Three Questions How many of you are working in casualty ? Have you ever attended any casualty patient? Do you upgrade or update your knowledge ?

3. My L ecture Outline Understanding Role & Responsibilities of a CMO in Casualty Department Communication skills for a Medical Officers in Casualty Department Dealing with Patients and their Relatives in medical or surgical Emergencies Responsiveness and Alertness of Casualty Team

4. What is Casualty According to Dictionary - A person or thing, who is hurt or killed during an accident, war and harmed, lost or destroyed or badly affected by event or situation The word "casualty" has been used since 1844 in civilian life

5. In  civilian   usage a casualty is a person who is killed, wounded, or injured by some event, and is usually used to describe multiple deaths and injuries due to violent incidents or  disasters   Casualty I n   military   A person in  military service ,  combatant  or  non-combatant , who becomes unavailable for duty due to several circumstances, including  death , injury, illness, capture and  desertion

6. C asualty D epartment also known as E mergency department  ( ED ) Accident & Emergency Department  ( A&E ) E mergency room ( ER ) E mergency ward  ( EW)

7. This department is usually found in   Government Hospitals Semi Government Hospitals Trust Hospitals Corporate and Multi-Specialty Hospitals Factory Hospital Factory medical Center Major Public areas like Airports and Railway Stations Private Hospitals and Nursing Homes Super speciality Hospital

8. Casualty (Emergency) Service Department * It is OPD or IPD * No man’s Land * Bridge between hospital and community * Provides first impression on patients and their relatives

9. * It provides immediate care to the patients ( surgical / medical ) * Emergency treatment for diagnostic and therapeutic patients * Receives traumatic and accident patients * Main department for mass casualty and sudden epidemic of disease * Ultimately motto of casualty dept is to give resuscitation and life saving treatment to all patient * Runs 24 X 7 hours through out the year

10. Medical Person appointed or in charge of this department is called as Casualty Medical Officer (CMO) or Emergency Physician (EP)

11. Understanding Role & Responsibilities of a CMO in Casualty Department

12. What is the Role of CMO He is chief medical doctor in treatment of any casualty He is captain of ship and takes independent and mature decision in favor of patient He is communicator, coordinator and cooperator between emergency and other departments of hospital He is directly and primarily responsible for giving answer and advice to the patient and his relatives about the medical condition He makes good balance amongst emergency staff of all levels He can decides for admission, further assistance and advice of colleagues and seniors and authorities

13. Responsibilities of CMO Provides first aid treatment Provides immediate relief and management of patients arriving in medical of surgical emergencies Refers patients to appropriate department or to other hospital for further management Attends all medico-legal formalities regarding casualty cases He is primarily responsible for proper documentation of casualty patients from A to Z Checks regularly all equipment and backups

14. Responsibilities of CMO He sees that Casualty dept. functions day and night on all days including Sundays and general holidays In his absence, he should contact senior medical officer or authorities by telephone Being a captain of casualty dept. he assigns proper functions and responsibilities to other staffs In medicolegal case police should be contacted on phone ( for dying declaration or FIR ), but do not wait for the police, to start treatment He should confirm that in casualty any patient should be treated in first golden hour

15. Responsibilities of CMO CMO is responsible for conducting training programmes and recommending/sponsoring officers/employees of the Department for various training programmes He will conduct periodical progress and review meetings of the Casualty Department He is also responsible for receiving any complaints from the patients or relatives about over all care and taking necessary steps to rectify the same Sometimes CMO also has to carry out any other duties assigned by authorities from time to time regarding his department

16. Responsibilities of CMO Patients should not be referred to other hospitals without consultation with the appropriate Senior Medical Officer In mass casualty he should always take other senior members and staff help In unknown and alone cases coming to casualty he should start the treatment according time, space and situation without any delay He will take lead for review meeting all casualty dept. staff regularly to improve at the best level and takes the suggestion and guides to others Finally he should be calm, cool, quite, cooperative, familial and social in rendering his services

17. a) A patient who needs emergency medical care should be treated and admitted. b) In case there are no vacant beds, the patient has to be given all due care. c) The doctor/ medical officer shall make necessary arrangements to get the patient transferred to another hospital in an ambulance d) He will first ascertain whether the recipient hospital has beds. e) Patient will be accompanied by an RMO during the transfer f) In no case will the patient be left unattended at any time for want of beds g) Attending doctor will document all details – condition of the patient, treatment given, etc. and will write his name in a clear, legible hand and put his complete signature with date and time In Transfer of Casualty patient

18. Common Emergency In Casualty Dept . Shock CVA Cardiac Arrest Overdose Hematemesis and Melaena Abdominal Pain Head Injuries Spinal Injuries Wound Management Paediatric Respiratory Disorders Common Arrhythmias Anaemia Tetanus Prophylaxis Psychiatric Emergencies Chemical Exposure Myocardial Infection Chest Pain Diabetic Ketoacidosis Jaundice Epilepsy/Convulsions Drowning/Near Drowning Anaphylaxis Snake and Spider Bite Major Trauma Burns Asthma Common Fractures The Febrile Child Eye Injuries The Unconscious Patient Respiratory Failure

19. Mock Rounds and Rehearsals in Casualty is essential time to time

20. Update your knowledge & Apply that with time, space and situation

21. Proper rest and relaxation are necessary for efficient working and productive treatment

22. Triage Area

23. Triage ( sort out) T he assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties or A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage is used in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated ( Pre Casualty Department Area )

24. Patient selection in triage area 1) Immediate Resuscitation 2) Emergency 3) Urgent 4) Semi-urgent 5) Non-urgent

25. Communication skills for a Medical Officers in Casualty Department

26. Effective communication is central to the smooth functioning of complex clinical environments of casualty department

27. Key Points Different casualty staff members carried different communication burdens relating to their specific role, with more senior staff experiencing higher rates of interruptions B) Examining the nature of interruptions shed light on the types of interruptions; for example, interruptions relating to direct patient management were necessary and important for the safe delivery of patient care Certain organisational practices and cultural attitudes, such as insufficient orientation for junior medical staff and differences in perceptions regarding the responsibilities of roles within the team, were identified as impeding effective communication between Casualty team members D) Potential interventions to improve communication were identified, these included : streamlining telephone and paging processes, formalising and disseminating documentation processes, improving orientation processes and improving understanding of the roles and responsibilities of team membe rs

28. Intra and inter-team communication is influenced by a number of factors. These include both organisational and cultural (professional & team) Organizational Staffing levels Formalised policies and procedures Informal communication practices Department layout & geographical location of team members Shift work, handover at change of shift Workload & time pressures Available channels of communication Cultural (professional & team ) Divisions of power and status Understanding of own and others’ roles Philosophies of care Education

29. Purposes of Communication Patient management Handover Consult Ward management Administration Social

30. Patient management A broad category encompassing all activities related to patient care. D irect patient care assisting patients with activities of daily living, giving medication, providing explanations to patients and their relatives I ndirect patient care documentation , organising procedures, updating or discussing patient care with a colleague

31. Handover Refers to the exchange of information for the specific reason of handing over the care of a patient, for example at the change of shift, when transferring a patient to another ward or handing over information that needs to be addressed by a team member occupying a specific clinical role

32. Consult Refers to the giving or receiving of specialist information to or from clinical staff members, for example an orthopaedic registrar giving specialist advice regarding the management of a patient who presented with a fracture; or when the ED registrar gives specialist advice to a GP calling the hospital (admitting call)

33. Ward management Categorises activities related to running the ward, e.g. bed allocation, rosters, coordinating staff activities etc.

34. Administration Encompasses tasks that are of a clerical nature (that is, a clinical staff member does not necessarily need to carry out these tasks) such as answering phones, transferring calls, locating medical records

35. Social Refers to communication exchanges that are not directly work oriented. Often conversations categorized as ‘social’ will occur at the beginning or end of an interaction that had a direct clinical purpose. Interactions involving social exchanges can help build rapport amongst team members, going some way to creating an environment to good communication as “social linkages are a precondition of information exchange”

36. Parties involved in COMMUNICATION at different level with Nurse Coordinator with Social Coordinator with Other departments of hospitals with staff with patient and relatives with medias and environment

37. Communication S kills Telephone Mobile phone Use of Internet Personal Relations Third Sense Patient examinations ( One minute or Five minutes ) Time to Time Meeting with staff ( physical or virtual ) Use of S ocial Media - WhatsApp - Facebook - Twitter

38. Dealing with Patients and their Relatives in medical or surgical Emergencies

39. How to deal Patient on Arrival ( brought dead, level of consciousness, Panic and frightened ) Differentiate the patient’s condition (emergency level and selection of patient) During Examination ( in presence of relative ) Help of social worker and nursing staff Pain Relief ( must ) and use of charts Immediate treatment Talking with relatives (always in presence of staff) Facts and future condition of patient Golden hour rule

40. Visual Analogue Scale (VAS) Score

41. On Arrival P ain Relief

42. 'Difficult' Patients and Relatives Face reading and body language P atients who are angry, disrespectful, and rude; patients who demand specific drugs or tests, even when they're not indicated; and patients who growl at everyone, act suggestively to the nurses, or ask you to submit a fraudulent bill so the insurer will cover the cost of treatment D raw boundaries with angry patients L earning how to say "no" without being negative Apologies can also win over difficult patients Inform the patient calmly and politely Never delay the treatment and stick to golden hour treatment

43. Dealing with Sudden Death of the Emergency Patient in casualty

44. The CMO treating a patient facing death must : attempt to stabilize the patient relieve pain and discomfort decide whether or not to initiate resuscitation for a cardiac arrest victim or obviously terminally ill patient communicate with the family understand the emotional reactions of all members of the emergency medical service

45. A sudden, unexpected death or impending death is a crisis for the patient, family and emergency department staff. The emergency physician has several responsibilities. These include attempting to stabilize the patient's condition, relieving pain and discomfort, and deciding whether to initiate resuscitation for patients suffering cardiac arrest or terminal illness. The physician must also be sensitive to the psychological needs of the patient and family. It is important for emergency physicians to understand their own emotional reactions, as well as those of other emergency team members

46. Responsiveness and Alertness of Casualty Team

47. At Different Level In calamities ( flood, riots, earthquakes etc ) In Epidemic of diseases (H1N1, Dengue etc ) Factory fires and accidents In acute medical or surgical emergencies Road accidents

48. Mock drill to check alertness of Casualty departments

49. TMC 59 Practical Case Demonstration

50. 1) Brought Dead 2) Burns 3) Chest Pain 4) Accident 5) Epidemic disease 6) Poison 7) Factory accident 8) Routine Emergencies 9) Walk In patient

51. What will you do after this update of casualty ?