WAD-2025, Anesthesiology in Health emergencies.pptx

Anesthesiology in Health emergency: Essential Emergency and Critical Care.

1. ANAESTHESIOLOGY IN HEALTH EMERGENCIES DR. RAVIKIRAN H M MBBS, DNB DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE ADMO, CENTRAL HOSPITAL, MALIGAON

2. "Wall Drawing #1111 Circle with broken bands of color" by Sol LeWitt, created in 2003. This piece is characterized by concentric circles divided into colorful segments, resembling a vibrant, abstract target or a complex puzzle. The colors are arranged in broken bands, meaning they don't form continuous rings but are interrupted and varied, adding a dynamic visual rhythm to the work. 

3. INTRODUCTION R aise awareness of the indispensability of anaesthesiologists in health emergency and critical care settings. Spotlight the critical and multifaceted role anaesthesiologists play in managing health emergencies. Aims to identify best practices and strategies for responding to challenges ranging from natural or man-made disasters to hospital-based emergencies.

4. INTRODUCTION cont … Definition: Event or set of circumstances that demand immediate action to preserve public health, protect life, protect property, or provide relief to any stricken community overtaken by such circumstances; o r that reaches such a dimension or degree of destructiveness as to warrant the governor’s declaring a state of emergency. 3 key criteria: Situation is exigent, anticipated or potential harm would be calamitous and the harm can not be avoided through ordinary procedures. Power to declare health emergency designated to officials: usually governor.

5. INTRODUCTION cont … Circumstances Infectious disease outbreak: Pandemic, epidemics, emerging diseases Natural and man-made disasters Chemical, Biological and Radiation emergencies Equipment and infrastructure failures: System failure

6. HOW IS IT DIFFERENT? Resource rich place to resource poor place From one country to another: language & cultural changes Lack of food, water, O2, fuel, electricity, telecommunication, transport, blood, fluids, drugs, lab, paramedics, hospital infrastructure New working place Ex: ships, trains Emergency cases: life and limb saving procedure Lack of familiarity with 3rd world infectious disease Ex. Tetanus

7. HOW IS IT DIFFERENT? Cont … Opportunistic infection: Ex. Necrotizing cutaneous mucormycosis during Joplin Tornado Communicable diseases becoz of poor hygiene and sanitary facility Ex: cholera, dysentery-Tsunami Damage to education institute –medical students-clinical practice and exams. Ex: Katrina hurricane Psychological stress Physical: long working hours, inadequate rest Mental: witness pain, suffering, death

8. MULTIFACETED ROLE OF ANAESTHESIOLOGISTS Emergency room: resuscitation and triage Operating room: anesthesia for emergency procedure ICU: intensive care procedures, ventilator and ABC Pain clinic: Pain Rx during mass casualty Non-operating room procedure: Endoscopy, Dental chair, Radiotherapy, Cath lab Labour room Trauma care Palliative care Teaching & research Communication skill, Leadership skill & Team work Anaesthesia

9. ESSENTIAL EMERGENCY AND CRITICAL CARE (EECC) Critical illness is a state of ill health with vital organ dysfunction. High risk of imminent death if care is not provided & potential for reversibility. EECC Represents a core set of interventions that can be delivered to all critically ill patients, regardless of resources. As global efforts to strengthen health systems grow, EECC remains central to providing life-saving care in emergencies.

10. HEALTH CARE SYSTEM Medical college ≠Sub- centre . ICU: Specialized hospital unit equipped to deliver critical care. Not all who have critical illness gets ICU care. ICU care ≠ critical care

11. EECC EECC is a concept & a systems innovation. The care that all critically ill patients should receive in all hospitals in the world. EECC specifies the minimum standards of care required in critical illness.

12. CONCEPTUAL MODEL OUTLINING HOW WE CAN STRUCTURE CARE FOR THOSE WITH CRITICAL ILLNESS

13. EFFORTS REQUIRED TO INTRODUCE EECC

14. VITAL SIGNS DIRECTED THERAPY PROTOCOL Treatment of danger sign increased & Mortality reduced

15. BENEFITS OF HEALTH SYSTEMS WITH EECC A low-cost, cost-effective approach to a huge quality gap No patient group is left behind Increased preparedness and resilience for public health emergencies Improved care and outcomes of critically ill patients in PHC and general wards Increasing the impact of scaling-up EMDS and ICUs Optimizing the impact of scaling-up Oxygen Capitalizing on and protecting the huge recent investments by the government in this space

16. TRANSFORMATION EECC EECC Hospital care Hospital care Surgical care ICU care Surgical care ICU care

17. OPERATIONALIZING EECC IN RESOURCE POOR SETTINGS Ensure readiness & resilience during emergencies Multifaceted strategy: The network, Experts, Policy, Research, Stakeholders, Local implementation, Training, equipment procurement, Government, NGOs https://www.eeccglobal.org/

18. DEVELOP AND IMPLEMENT A STEPWISE PLAN Rapid assessment tools to identify gaps Emergency Box/Trolley: Stock essential supplies. Standard Routines and Checklists: For triage, and care. Training: Focus on essential skills Procurement: Align with identified needs. Develop research agendas

19. Haiti earthquake 2010 (North America): During the first 72 hours, the team witnessed several deaths that may have been prevented had there been the capability to perform thoracic or neurosurgical procedures and one patient died for lack of chest tube drainage (no vacuum available). Nevertheless, the team provided valuable resuscitative care, found time to perform and communicate needs assessments information back to Miami concerning the situation at the airport, and established contacts with local Haitian authorities and US Army and Air Force personnel who took the lead role for coordination and control of air traffic at the airport and later for the overall relief effort during the early stages of the response.   December 7 th 1941: During the Japanese attack on the US bases at Pearl Harbor some of the ether stocks were destroyed and > 1,000 casualties required emergency care, urgent anaesthesia and surgery. With less ether available for many cases, the nurse anaesthetists used IV Sodium Pentothal®, with devastating effects in many of those hypovolaemic , anaemic and septic patients.   L arger numbers of fatalities at Pearl Harbor than the Japanese surprise attack itself

20. REFERENCES WFSA: Anesthesiology in Health Emergencies: Essential Emergency and Critical Care.

21. THANK YOU #AnaesthesiaInAction