5 Most common Emergencies

Medical emergencies are life-threatening situations that necessitate immediate treatment. Your
actions during these emergency situations can mean the difference between life and death. You can
do so by recognising and responding to warning signs in such circumstances. The following are some
of the most common medical emergencies that people face:

1. Bleeding

Cuts and wounds cause bleeding, but serious injury can also result in internal bleeding that is not
visible.

Not all cases of bleeding require emergency medical attention; many can be treated at home with
first aid after consulting with a pharmacist or GP.

However, you must seek emergency medical attention

 If you are unable to control the bleeding after administering first-aid treatment.

 There appears to be an object within the wound or it appears to be deep.

 Tissue or bone can be seen.

When there is a significant amount of blood loss, the injured person may become ill, appear pale,
dizzy, and, in some cases, lose consciousness. If this occurs, immediate medical attention is required.

2. Breathing Difficulties

There is a broad range of reasons why someone may have breathing difficulties. Asthma attacks,
allergic reactions (anaphylaxis), and coughs or colds are examples.

Breathlessness can occur during exercise or physical activity, but if it occurs suddenly or
unexpectedly, it can be a red flag.

When someone has breathing problems, they may experience some or all of the following
symptoms:

 Pain when taking deep breaths or a tight feeling in their chest

 They are feeling out of breath or unable to catch their breath.

 Shallower or faster breathing than usual

 Noisy breathing, such as a wheeze, gasp, or whistle

When someone is having difficulty breathing, they may become panicked, which can further impair
their breathing.
3. Heart attack

A heart attack is a potentially fatal medical emergency in which the supply of blood to the heart is
suddenly cut off.

Heart attacks are more common in adults, but they can happen to children and teenagers as well.

If you suspect someone is having a heart attack, call us at Arsh hospitals emergency
number immediately and inform them that someone is having a heart attack.

If you are having a heart attack, you may notice some of the following symptoms:

Chest pain, such as pressure, tightness, or squeezing in the centre of the chest

Pain radiating from the chest to the left arm. In some cases, arms, as well as the neck, jaw, back, and
stomach, can be affected.

 Breathing difficulties or shortness of breath

 Wheezing or coughing

 Being or feeling sick

 Dizziness or light headedness

 Sweating

 Anxiety or a sense of impending doom

While severe chest pain is one of the most common symptoms of a heart attack, some people do not
experience severe pain and instead experience discomfort similar to indigestion.

4. A Stroke

A stroke is a potentially fatal medical condition that occurs when the blood supply to a portion of the
brain is cut off.

This can occur as a result of a blood clot or bleeding in the brain.

Time is the most important factor for someone who is having or has had a stroke. The sooner
someone receives emergency medical treatment, the less likely it is that long-term damage will
occur.

If you suspect that someone is having or has had a stroke, call our Arsh emergency number right
away and inform them that someone is having a stroke.
5. Seizures and Fits

Fits and seizures can occur in people with epilepsy, but they can also occur in people who do not
have such a diagnosis.

A fit or seizure can cause involuntary and uncontrollable jerking, twitching, or shaking of a portion or
the entire body.

Another type of fit or seizure can involve no or minimal movement of the body, as well as the
appearance of a person staring into space. A person in this situation is unlikely to respond when
spoken to.

It’s important to remember not to move or try to stop someone from shaking if they’re having a fit
or seizure unless they’re in danger.

It is critical that one should seek medical attention after having a fit or seizure. If someone is known
to have fits or seizures, they may have a medical plan in place that specifies what steps must be
taken following the fit.

ACCIDENT AND EMERGENCY (A&E) CARE UNIT

1 GENERAL:

All admissions to the hospital shall be through the A & E unit. All patients will be triaged on arrival to
the A & E unit. The maximum duration of stay of a patient in the A & E will be 4 hours after which the
patient will be admitted to a CONTINUE CARE UNIT, the SHORT STAY UNIT (SSU) or an INTENSIVE
CARE UNIT depending on care needs.

A specialist for the patient’s long term continuum care must be identified and that specialist’s team
should be notified within 1hour by the A & E team unless patient can be discharged from the A&E.

No patient should be sent to an unmonitored continuum care bed if there are major safety concerns
due to unstable vital signs. Such patients may remain in the observation area even if the patient is
admitted under a continuum care physician for more than 4 hours, but not indefinitely without a
plan of management.

The Emergency Physician will decide the appropriate consultant from the continuum care unit who
will be responsible for the patient.

Every patient should have an admission & care plan as soon as possible.

MULTIDISCIPLINARY ACCIDENT AND EMERGENCY - SHORT STAY UNIT (SSU)

An A & E- SSU is a unit managed within and by the Emergency Department, unless otherwise
decided centrally or locally and whose prime orientation is to manage acute problems for patients
with an expected length of stay that will be less than 24 hours.
● An SSU shall only be established to complement busy Emergency Services

● The SSU shall be physically separate from the A & E acute assessment area

➡ Admission Criteria to A & E SSU

● Patients admitted to an A&E SSU are under the care and management of the A&E or otherwise
decided locally.

● Only the A&E Consultant or the A&E Senior Medical Officer (SMO) on duty shall approve
admissions to the A&E SSU. After-hours approval shall be delegated to the A&E Medical Officer in
charge of the shift.

❍ The A&E Consultant or the A&E SMO shall approve admissions to the A&E SSU only if the patient
has a specific diagnosis and plan of management to be achieved within 24 hours.

❍ The A&E Consultant or the A&E SMO shall only approve admissions to the A&E SSU if the patient
has an expected length of stay of less than 24 hours.

● The A&E Consultant or the A&E SMO shall ensure patients admitted to the A&E SSU:

❍ receive ongoing observation and investigation

❍ are medically reviewed every four hours, at a minimum, or more often if clinically indicated.

Ministry of Health and Indigenous Medicine

❍ Patients who deteriorate and require acute emergency intervention while admitted to the A&E
SSU, shall be retransferred to the clinically appropriate area of the A&E to continue treatment.

➡ Discharge Criteria from A & E SSU

● The A&E Consultant or the A&E SMO or A&E Medical Officer in charge of shift after hours shall
authorize all discharges from the A&E SSU.

● If discharge of a patient from the A&E SSU is within four hours of admission to the A&E SSU

● Prior to authorization of discharge of a patient from the A&E/ SSU, the authorizing clinician shall
update the patient’s clinical records with details of the medical condition, treatment provided and
follow up planned if indicated.

● for any patient who has been in a SSU for 24 hours, the A&E Consultant, A&E SMO or A&E Medical
Officer in charge of shifts after hours shall review the patient, document the management plan and
discharge from the SSU, or transfer the patient to the clinically appropriate unit.

THE CARE RESPONSIBILITY OF THE PATIENT

● Accident & Emergency Department will be managed by Emergency Physicians or specialists with
emergency care training until Emergency Physicians are available in the country with the help of
other teams where appropriate.
● Initial ownership of all un booked patients will rest with the A&E Consultant, the A&E SMO or ED
Medical Officer in charge of shift after hours

● All booked admissions will be admitted under the relevant consultants.

● All booked transfers also will be admitted under the relevant consultants.

● Once the initial triage and resuscitation is done those who need admission will be

informed to the relevant team of the continuum care department within 1 hour.

● Any patient once admitted to A & E needs to be assessed and stabilized by the A & E team (with
expert opinion from other specialties as required eg: surgery, medicine, pediatrics, anesthesia,
cardiology etc.)

● Once the patients care is accepted by the specialist team and the patient is stabilized the patient
should be transferred to the relevant care facility (continuum care units / SSU/ ICU).

● Safe handing over of patients to continuum care must be ensured

● Any deterioration of the patient whilst in the A& E must be attended to by the A&E staff and
managed accordingly. The relevant responsible specialist team needs to be informed about the
incident if the patients care has been already accepted by a specialist team.

● Any patient with unstable vital signs should not be moved out from the A&E without stabilization,
unless for a therapeutic procedure which is needed to stabilize the patient 4 Ministry of Health and
Indigenous Medicine and this procedure cannot be carried out in the A&E. (e.g. intervention
radiology, coronary angioplasty, pacing)

● If a specialist team is not accepting the care of the patient upon initial referral the A&E Consultant,
A&E SMO or the A&D Medical Officer in charge of shift after hours should convinced the appropriate
specialist team to accept the care of the patient. (A&E staff will not be routinely involved with
referring to multiple teams unless there is a specific need).

● Poly trauma patients- The A&E Consultant, A&E SMO or the A&E Medical Officer in charge of shift
will decide the most life threatening injury or the injury needing most attention and inform the
relevant team, to whom the patient will then belong.

TRIAGE IN THE A&E DEPARTMENT

Triage: A triage system is the basic structure in which all incoming patients are categorized into

groups using a standard urgency rating scale or structure.

Aims:

• To ensure that patients are treated in the order of their clinical urgency

• To ensure that treatment is appropriately and timely.

 • To allocate the patient to the most appropriate assessment and treatment area to get the
right patient to the right resources at the right place and the right time

Triage system:

The process by which a clinician assesses a patient’s clinical urgency.

Urgency: Urgency is determined according to the patient’s clinical condition and is used to
‘determine the speed of intervention that is necessary to achieve an optimal outcome’. Urgency is
Independent of the severity or complexity of an illness or injury. Process: The first contact for all
unbooked admissions is a trained Triage nurse who would be working under the direct supervision
of a Triage Medical Officer. The triage officer performs a brief focused assessment not taking more
than 2-5 minutes and assigns the patient to a triage acuity level. This roughly measures how long a
patient can safely wait to seek medical treatment.

Document details of the triage assessment should include

a) Patient demographics including Name, Age and Sex

b) Date and time of assessment

c) Chief presenting complaint(s)

d) Relevant past medical/surgical history

e) Relevant vital parameters

f) Initial Triage category

g) Name/signature of Triage officer(s)

Design of the Triage area

Triage area should be located at the front of the patient entrance with easy accessibility Its design
should have

a) Examination trolley with privacy

b) Monitoring equipment –Multipara monitor, thermometer (tympanic)

c) Communication device (intercom)

e) Hand washing facilities

f) Strategies to protect staff

g) Triage tool

All A&E departments will use the 4 tier triage acuity scale based on the safe waiting time to initiate
Medical treatment. The designated patient treatment area is decided on the triage category of the
patient.

● Vital clinical parameters used in triage categorization are clearly defined to maintain an inter rate
reliability

● The process by which a clinician assesses a patient’s clinical urgency

PROCESS:

The first contact for all unbooked admissions is a trained Triage nurse who would be working under
the direct supervision of a Triage Medical Officer. The triage officer performs a brief focused
assessment not taking more than 2-5 minutes and assigns the patient to a triage acuity level.

(This roughly measures how long a patient can safely wait to seek medical treatment) Given above

Disease entities of each triage category are defined in detail to quickly establish a triage category
even with a brief presenting complaint.

Re-triage: Clinical status is a dynamic state for all patients. If clinical status changes in a way that will
impact upon the triage category, or if additional information becomes available that will influence
urgency then re-triage must occur.

Key points

1. The same standards for triage categorization should apply to all A&E Department settings. It
should be remembered however that a symptom reported by an adult may be less significant than
the same symptom found in a child and may render a child’s urgency greater.

2. Victims of trauma should be allocated a triage category according to their objective clinical
urgency. As with other clinical situations, this will include consideration of high-risk history as well as
brief physical assessment

3. Patients presenting with mental health or behavioural problems should be triaged according to
their clinical and situational urgency, as with other ED patients.

4. Needs of children in the emergency room differ from the needs of adults,
including:

❍ Different physiological and psychological responses to stressors.

❍ More susceptibility to a range of conditions, such as viruses, dehydration, or

radiation sickness.

❍ Limited ability to communicate with care providers; thus harder to quickly and

accurately assess.

❍ Thus they would need a different vital parameter assessment from adults Paediatric Triage
System
7. STANDARD EQUIPMENT, FACILITIES AND CAPACITY BUILDING REQUIRED FOR AMBULANCES FOR
INTER HOSPITAL TRANSFER OF PATIENTS

Standards for Ambulances

Equipment and supplies

Ambulances are divided into two categories, Basic Life Support (BLS) and Advanced Life

Support (ALS) ambulances. ALS ambulances must have all of the equipment on the required

BLS list as well as equipment on the required ALS list.

Basic Life Support Ambulances

A. Ventilation and Airway Equipment

1. Portable and fixed suction apparatus with a regulator and a suitable suction tip

2. Portable and fixed oxygen apparatus capable of metered flow with adequate tubing

❍ Variable flow regulator

3. Oxygen-administration equipment

❍ Adequate-length tubing; transparent mask (adult and child sizes), both non re breathing and valve
less, nasal cannulas (ryles tube) (adult, child)

4. Bag-valve mask (manual resuscitator) a. Hand-operated, self-reexpanding bag; adult (>1000 mL)
and child (450–750 mL) sizes, with oxygen reservoir/accumulator; valve (clear, disposable, operable
in hot and humid weather) and mask (adult, child, infant, and neonate sizes)

5. Airways

6. Laryngoscope handles with suitable adult and paediatric blades and extra batteries and bulbs

7. End tracheal tubes, sizes 2.5–5.5 mm uncuffed and 6–8 mm cuffed (2 each), other sizes

optional

8. Stylettes for endotracheal tubes, adult and pediatric

9. Magill (Rovenstein) forceps, adult and pediatric

10. Lubricating jelly (water soluble)

11. Pulse oximeter with pediatric and adult probes

12. Saline drops and bulb suction for infants

B. Monitoring and Defibrillation

All ambulances are to be equipped with an automated external defibrillator (AED) and a multi
para monitor unless ambulance personnel are carrying a monitor/defibrillator. The AED

should have pediatric capabilities, including child-sized pads and cables.

These equipment should be battery operated and be able to work with 12v DC power supply.

Ambulance should have an inverter to power the 230v operated equipment.

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C. Immobilization Devices

1. Cervical collars

❍ Rigid for children aged 2 years or older; child and adult sizes (small, medium,

large, and other available sizes)

2. Head immobilization device (not sandbags)

❍ Firm padding or commercial device

3. Lower extremity (femur) traction devices

❍ Lower extremity limb-support slings, padded ankle hitch, padded pelvic support,

traction strap (adult and child sizes)

4. Upper and lower extremity immobilization devices

5. Impervious backboards (long, short; radiolucent preferred) and extrication device

❍ Short (extrication, head-to-pelvis length) and long (transport, head-to-feet

length) with at least 3 appropriate restraint straps (chin strap alone should not

be used for head immobilization) and with padding for children and handholds

for moving patients

D. Bandages

1. Pre packaged sterile gauze sheets

2. Triangular bandages

❍ Minimum of 2 safety pins each

3. Dressings

❍ Sterile multitrauma dressings (various large and small sizes)

❍ Gauze rolls -Various sizes

4. Occlusive dressing or equivalent

5. Adhesive tape

6. Arterial tourniquet

7.

E. Communication

Two-way communication device between provider, dispatcher, and central control room.

GPS tracking system for monitoring.

F. Obstetrical Kit

1. Kit (separate sterile kit)

2.

G. Miscellaneous

1. Sphygmomanometer (pediatric and adult regular- and large-sized cuffs)- digital

2. Stethoscope

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3. Length/weight-based tape or appropriate reference material for pediatric equipment

sizing and drug dosing based on estimated or known weight

4. Thermometer with low temperature capability-digital

5. Heavy bandage or paramedic scissors for cutting clothing, belts, and boots

6. Cold packs

7. Sterile saline solution for irrigation (1-L bottles or bags)

8. Flashlights (2) with extra batteries and bulbs

9. Blankets

10. Sheets (minimum of 4), linen or paper, and pillows

11. Towels

12. Triage tags

13. Disposable emesis bags or basins

14. Disposable bedpan

15. Disposable urinal

16. Wheeled cot

17. Hight adjustable folding stretcher

18. Patient care charts/forms

19. Lubricating jelly (water soluble)

H. Infection Control*

1. Eye protection (full peripheral glasses or goggles, face shield)

2. Face protection (for example, surgical masks)

3. Gloves,- sterile and nonsterile)

4. Coveralls or gowns

5. Shoe covers

6. Waterless hand cleanser, commercial antimicrobial (towelette, spray, liquid)

7. Disinfectant solution for cleaning equipment

8. Standard sharps containers, fixed and portable

9. Disposable trash bags for disposing of biohazardous waste

10. Respiratory protection (for example, N95 or N100 mask—per applicable local

guidance)

11. Water

I. Injury-Prevention Equipment

1. All individuals in an ambulance need to be restrained. Protective helmets where

appropriate.

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2. Fire extinguisher

3. Traffic-signaling devices (reflective material triangles or other reflective, nonigniting

devices)

4. Reflective safety wear for each crew member

J. Vascular Access

1. Crystalloid solutions, such as Ringer’s lactate or normal saline solution (1000-mL

bags × 4); fluid must be in plastic containers; type of fluid may vary depending on

local requirements

2. Antiseptic solution (alcohol wipes and povidone-iodine wipes preferred)

3. Intravenous-fluid pole or roof hook

4. Intravenous canulae, 14–24 gauge

5. Intraosseous needles or devices appropriate for children and adults

6. Venous tourniquet, rubber bands

7. Syringes of various sizes

8. Needles, various sizes (1 at least 1½ in for intramuscular injections)

9. Intravenous administration sets

10. Intravenous arm boards, adult and pediatric

K. Other Equipment

1. Nebulizer

2. Glucometer or blood glucose measuring device

3. Large-bore needle (should be at least 3.25 in long for needle chest decompression

in large adults)

REQUIRED EQUIPMENT –ALS AMBULANCES

This include all of the required equipment listed for the BLS ambulance, plus the following

additional equipment and supplies from the following list, on the basis of local need and

consideration of hospital characteristics and budget.

A. Airway and Ventilation Equipment

1. Transport ventilator

B. Cardiac
1. Portable, battery-operated monitor/defibrillator

● With tape write-out/recorder, defibrillator pads, quick-look paddles or electrode, or

hands-free patches, ECG leads, adult and pediatric chest attachment electrodes, adult

and pediatric paddles

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Ministry of Health and Indigenous Medicine

C. Neonatal

1. Transport incubator

E. Medications (Preloaded Syringes When Available)

● Cardiovascular medication such as 1:10000 epinephrine, atropine, antidysrhythmic

agents (eg, adenosine and amiodarone), calcium-channel blockers, β blockers,

nitroglycerin tablets, aspirin, vasopressor for infusion

● Cardiopulmonary/respiratory medications such as albuterol (or other inhaled β

agonist) and ipratropium bromide, 1:1000 epinephrine, furosemide

● 50% dextrose solution (and sterile diluent or 25% dextrose solution for pediatrics)

● Analgesics, narcotic and nonnarcotic

● Antiepileptic medications such as diazepam or midazolam

● Sodium bicarbonate, magnesium sulfate, glucagon, naloxone hydrochloride, calcium

chloride

● Distilled water for injection and sodium chloride for injection

● Additional medications as per local hospital director

Extrication equipment (Optional)

● Wrenches (adjustable) ,Screwdrivers (flat and Phillips head),Pliers, Bolt cutter,

Hammer, Spring-loaded center punch, Axes (pry, fire), Bars (wrecking, crow),

Spreading tools, Hydraulic jack/spreader/cutter combination, Cutting tools, Saws

(hacksaw, fire, windshield, pruning, reciprocating), Air-cutting gun kit, Pulling

tools/devices, Ropes/chains, Come-along, Hydraulic truck jack, Air bags, Protective

devices, Reflectors/flares, Hard hats, Safety goggles, Fireproof blanket, Leather gloves,

Jackets/coats/boots, Patient-related devices, Stokes basket, Shovel, Lubricating oil

,Wood/wedges, Floodlights

Local extrication needs may necessitate additional equipment for water, aerial, or mountain

rescue.

Staff training

Level 1

Course outline—the ambulance services proficiency certificate.

· First aid;

● Induction systems of the body

● Injuries

● General

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● Procedures

● Apparatus

● Maternity

● Medical nomenclature

● Transporting the critically ill

● Care of seriously ill patients, surgical and medical

● Precautions in handling infectious diseases patients

● Care of patients under drug treatment

● Care of mentally ill patients

● Ambulance work when under medical instruction or direct supervision

· Non-medical;

● Information (ambulance service)

● Communications (telephone and radio)

● Equipment

● The patient (professional conduct and relationship with patients)

● The hospital (practice and procedure within hospital)

● Liaison (with hospital transport and other organizations)

● Lifting and carrying

● Light rescue

● Major accidents

● Special types of accidents

● Accidents and sudden illnesses (proceeding to the incident, procedure on arrival,

gathering information)

● Infectious diseases

● Other forms of transport

● Removal of the dead

● Legal information

● Care and maintenance of vehicles

● Ambulance driving

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Ministry of Health and Indigenous Medicine

Level 2

Core syllabus for ambulance personnel

Driving training (mainly non-emergency)

Advanced driving

Ambulance attendant I;

● BLS

● Introduction to the systems of the body

● Lifting, handling, and equipment

● Airway management and resuscitation

● Assisting the nurse

● Infants and children

● Wounds and bleeding

● Infectious diseases

● Law and ambulance staff

● Major incidents

● Poisoning

● Maternity

Paediatric and obstetric emergency care;

● Paediatric care

● Obstetrics and gynaecology