Dr Raja Saravanan, Senior Anaesthetist and Critical Care Expert, Prashanth Hospitals emphasises that navigating and communicating between the experts to fix best solutions, treatment and response will go a long way in creating strong benchmarks and reference points for diagnosis and treatment protocols
Emergency and critical care units are one of the major lifesaving backbone of any hospital to effectively handle and coordinate in any kind of emergency. Navigating and communicating between the experts to fix best solutions, treatment and response will go a long way in creating strong benchmarks and reference points for diagnosis and treatment protocols. Technological advancement and rapid response system equips the team of paramedics to immediately provide the best support system in times of medical emergency.
Expert handling
Emergencies at hospital are to be handled with more caution and experience as the encounters in Emergency Rooms (ER) differs from general treatment of a patient. Emergency Departments are the most active and critical Department of a hospital because of the constant flow of incoming patients suffering from either acute illness or injury or trauma etc. A typical ED consists of nurses, doctors, and physicians who address wide range of critical medical complications such as cardiac arrests, strokes, fatal injuries, pregnancy complications, asthma etc. We must have experts to handle the patients in critical care with requisite experience ranging from 5 years of experience in ICU service coupled with good CME points.
Immediate patient management response
While handling different cases, it becomes significant to have strong expertise by Doctors in the ER on diagnosis as it helps in the process of quicker and accurate diagnosis, and also be clear on guidelines of treating medical emergencies. Advance trauma life support guidelines is mandatory for ER attendant. And every year there will be an assessment on advance trauma life support guidelines. It is necessary to follow these guidelines because the management/handling of patients begins with first contact with the patient’s emergency condition. For example, when there is a trauma patient in the ambulance, the immediate patient management begins when the ambulance initiates the process of treating him/her. Nowadays, ambulance have all equipment and systems with built-in life support system to handle all kinds of emergencies.
Crucial first 60 minutes
The first 60 minutes after a traumatic injury or accident is the most crucial period that determines the patient’s outcome being termed as the Golden Hour, as it could be a life saver or a miss. It is best advisable to act in the golden hour since it reduces the critical impact as well as opens a window of opportunities when an intervention is made with precision and at the right time. It has been observed that sooner a trauma victim reaches the emergency care unit, better chance of their survival. This intervention has shown a considerable impact on the mortality of a patient in the past. The window time can differ patient to patient basis. For example, the time to treat a stroke can vary vis-à-vis cardiac arrest as both have speculated time of window for treating.
Speciality based training
The ICU takes care of mainly three specialities in India: Anaesthesia, General Medicine and finally Pulmonology with critical care experience. As per Indian Critical Care guidelines, any person who has dedicated over 5 years working only in Critical care sector can also handle a tertiary intensive care if he/she is updated on a regular basis also with some requisite mandatory CME points. Training in this field is crucial for the systematic approach of the patients and we term the first component of the systematic approach to the trauma patient as primary survey. The purpose of the primary survey is to identify life-threatening injuries and initiate appropriate resuscitation. And the secondary survey is a rapid but thorough head-to-toe examination assessment to identify all potentially significant injuries which can affect the patient’s lifestyle. Primary survey’s objective is to prevent compromise of life whereas secondary survey is done to prevent compromise on impairment or paralysis of the body or organs. It is mandatory to ensure to run this survey for every patient to provide care. Everybody working in the Emergency Room and anyone from the ICU liaising should mandatorily have Advanced cardiac life support and Advance trauma life support.
Technological disruption as a differentiator: Telemedicine
Previously, it was shooting in the blind without the use of technology, especially since diagnosis and treatment were purely clinical in approach. But with the introduction of high-end technology, the treatment and care has been optimized in further narrowing it to effective patient care. Ultrasound and CT scan are the first line devices used in an ER. Some major technologies used for trauma care are tissue sealing devices, ventilators, non-invasive cardiac output etc. Previously in the initial years, emergency room were manned by medical officers whereas nowadays ER is manned by appropriate ER trained physicians. So they are generally swift and experts in acting independently as anaesthetists and physicians. The ER team should constantly be updated on the encounters they are going to handle with the help of technological capabilities.
Ambulances also have advanced tele-medicine capabilities to provide the immediate lifesaving support system right from when patients are taken in, thus avoiding critical complications for the patient facing emergency.
Awareness for the public
Communicating awareness and first responders response system to the public is very crucial. We need to ensure that other stakeholders like police personnel, auto, cab and lorry drivers as well as people having roadside stalls etc. need to be equipped with the best strategy to save lives and immediately help in effectively responding to a medical emergency case.
Though there are many advancements in trauma care such as use of defibrillators in public places for emergencies and fully equipped ambulance with portable Defibrillators etc., the common man lacks knowledge and awareness on how to act during a trauma incident. They are not equipped with simple practices and techniques to tackle these situation. It is high time to be aware of Trauma Care and impart the techniques through outreach, awareness camps and doctor talks with demonstration and mock drills etc. This should be organised and presented by ER physician. Emergency Response program for general public will also reduce the mortality.
Collaborations and tie-ups
Referrals by clinics or hospitals in taking proactive initiative to save lives by referring or helping patients in critical condition to undergo treatment or surgery to nearby hospitals with advanced care and support also builds or establishes a reliable network of working in a Hub and Spoke model.
So when you have the team of experts along with well-known collaborators to create a difference in this sphere, we must working on frequent public engagements to train the public. We need to frequently engage with national and international experts through panel discussions, knowledge sharing forums, workshops, industry tie-ups and research collaborations. Training, hiring and equipping high-tech experts like nurses, anaesthetists and doctors in this field will go a long way in establishing remarkable standards in emergency and trauma care. Working on a regular basis with the Central and State government to ensure trauma care and emergency response is strongly communicated the public is the need of the hour. Public events need to strongly reinforce the significance of emergency response preparedness to save lives and reduce mortality.