Introduction to Emergency Care
For CHO/SN
LEARNING OBJECTIVES
By the end of the session participants will be able to:
• Understand what is emergency care.
• Know and understand emergency conditions.
OVERVIEW OF BURDEN OF DISEASE
According to the Global Burden of Disease (GBD) estimates for the country-
• 62% of deaths in 2016 were due to non-communicable diseases,
• 11% due to injuries and
• 27% due to other diseases (communicable, maternal, perinatal and nutritional
conditions).
OVERVIEW OF BURDEN OF DISEASE
OVERVIEW OF BURDEN OF DISEASE
• Road Traffic Injuries (RTIs), Acute Myocardial Infarctions
(AMIs) and Cerebrovascular Accidents (CVAs) are the most
commonly cited causes of death and disability in India.
• In 2016, nearly 1.5 lakh lives were lost to road traffic injuries
alone.
INTRODUCTION TO
EMERGENCY CARE
• Emergency and Trauma Care is one of the newer services which is being
introduced in expanded package of services to be made available at the HWCs.
• Emergency and trauma care services require immediate medical care- reach an
appropriate health facility for treatment within an hour.
• These conditions are life-threatening - right care at the right time.
WHAT IS AN EMERGENCY ?
• The group of conditions which need immediate medical care and
intervention are called as emergencies.
• These conditions are non-discriminatory as well as time bound.
• Why Non-discriminatory??
• Why Time bound??
INTRODUCTION TO
AN EMERGENCY
• Emergencies that are commonly encountered in the community may range from
accidents and trauma to emergencies arising out of chronic diseases like NCDs.
• Trauma is one of the most common emergencies that occur in the community and
a major reason for morbidity and mortality in India.
CONTD…
• A common example is an accident
leading to severe bleeding or a person
suffering a heart attack
• The broad goal of emergency care is to
intervene as quickly as possible to avoid
life-threatening morbidity and death in
emergency and trauma cases.
EMERGENCY CARE
Emergency care refers to the care provided to the victim in
the ‘Golden Hour ’ (usually the hour following an accident)
before/while reaching the appropriate health facility, in
order to prevent death or serious disabilities.
EMERGENCY SERVICES IN INDIA
• In India, till now emergency services were confined to tertiary level only. The
absence of organized emergency care at primary and secondary health care level
further worsens the situation.
• Therefore, to ensure timely intervention for better survival, comprehensive
emergency services should be made available round the clock at the primary
level with assured referral linkages wherever required.
• Emergency management at primary level can be initiated even with limited
resources by ensuring community preparedness and awareness.
• Provision of a proper platform including infrastructure, capacity building of human
resource which would keep the community organized and trained on a
regular/permanent basis, is essential to enable them to respond in an effective
and organized manner.
PLATFORMS OF
CARE / SERVICE DELIVERY
• It is important to practice certain technical protocols at HWC (SHC/ PHC/UPHC)
which help in efficient delivery of emergency services and minimize the risk of
acquired infections while managing the patients during emergency.
• Some of the important components for this are good ambience, patient friendly
facilities, computerized registration, infection control practices, bio medical waste
management, autoclave and laundry.
SERVICES DELIVERY FRAMEWORK
The emergency conditions in health, which will require timely identification
and management, can be largely categorized into 3 types:
• Trauma/Accidental/Injuries
• Burns
• Medical and Surgical Emergency
SERVICES DELIVERY FRAMEWORK
Trauma/Accidental/Injuries:
• This refers to any sudden physical injury caused by an external force.
Medical and Surgical Emergency:
• Medical emergency is “the sudden onset of a medical or surgical condition
manifesting itself by acute symptoms of sufficient severity (including severe
pain) such that the absence of immediate medical attention could
reasonably be expected to result in placing the patient’s health in serious
jeopardy.”
MANAGEMENT OF VARIOUS
CONDITIONS AT
COMMUNITY OR FACILITY LEVEL
• Most emergencies start at home. Hence, any system to promote early
recognition of emergency conditions should be based in the community.
• Community action aims to empower people to gain control over decisions
affecting their lives in their community and larger society.
• They need to have knowledge and awareness to identify emergencies and
support the actions required to save lives and in getting the continuum of care.
APPROACHES FOR PROMOTING
EMERGENCY HEALTH CARE IN
COMMUNITY
• Community awareness (Promotive): Identification and response to
critical emergencies both traumatic and non-traumatic (chest pain, stroke,
respiratory problems etc.)
• Medical (Preventive and curative): Directed at early identification of risk factors
like high blood pressure, obesity, high cholesterol levels, deranged blood sugar
levels etc.
• Behavioral (or lifestyle): Directed at behavioral risk factors such as smoking,
poor nutrition, physical inactivity, drunk driving etc.
• Socio-environmental: Directed at risk conditions such as poverty, low education,
insufficient income, unemployment, inadequate housing etc.
• Medico legal: Directed at institutionalizing the medico legal aspect of the
conditions like Pre-MLC reporting to the concerned Police Station, forensic
knowledge for categorization and identification of the injury.
PLATFORMS AND WAYS TO
GENERATE AWARENESS IN THE
COMMUNITY
• Village Health & Nutrition Days (VHNDs), schools and public places:
through mock drills in school/work place, nukkad nataks, puppet shows, etc.
• Guidance to school teachers, volunteers, VHSNC and other self-help groups
for imparting preventive and promotive education on management of emergency
health conditions.
MANAGEMENT OF EMERGENCY
HEALTH CONDITIONS
• Assessment and triaging of the emergency conditions.
• Early transport, (preferably through ALS/BLS) after possible first aid and
stabilization.
• ABCDE management if first responder or trained personnel available.
• Follow up of the emergency cases treated at higher centers.
• Facility/community based rehabilitation (Palliative care).
• Mock drills of the staff at regular intervals to be conducted by the concerned
institute to handle the emergency conditions.
• Development of Digital Referral Directory for ease of coordination and to reduce
the time period.
FOLLOWING EMERGENCY CONDITIONS
NEED PRIORITY REFERRAL AFTER
PROVIDING POSSIBLE INITIAL
MANAGEMENT AND STABILIZATION
• Chest pain
• Breathing problems (difficult breathing, shortness of breath)
• Unconsciousness/Fainting, Disorientation
• Any other life threatening condition
• Life threatening Burns: Cases with more than 5% body surface area, Burn
caused by pressurized steam, chemical acid, electric burn, the person who
has inhaled smoke or is not able to speak.
• Stab wounds/penetrating injury (head, neck, chest, abdomen, upper thigh)
• Massive crush injury of Thigh/Leg/Arm/Forearm injury with massive bleed-
absent distal pulse
• Fracture of Thigh/Leg/Arm/Forearm with exposed bone
• Two or more long bone (Thigh/Leg/Arm/Forearm) fracture
• Abnormal chest wall movement during breathing
• Suspected neck injury
• Multiple injuries
• Spinal injuries
• Suspected sexual assault
• Uncontrollable bleeding, nosebleed
• Acute abdominal pain
• Choking
• Cyanosed infant/child
• Epileptic seizures
• Acute febrile illnesses
• Animal bites, etc.
ROLE OF CHO
• Assessment, triaging, initial management and stabilization of all emergencies
care patients.
• Referral of cases requiring specialized care. This will include facilitation of referral
i.e. arrangement for transport, documentation and prior communication to the
receiving/referred facility.
• Follow up of patients referred to higher centre for emergency care.
• Record maintenance, reporting on the appropriate portal, e.g. IDSP.
ROLE OF CHO
• Maintenance of emergency drugs and equipment.
• Co-ordinate and participate in outreach activities.
• Supportive supervision through joint visits with ASHA/ ANM/MPW-M,
as needed.
• Special focus on addressing prevalent taboos, myths and other
harmful superstitious practices.
• Organizing Focus Group Discussions (FGDs) involving Panchayati
Raj Institutions (PRIs), Self Help Groups, school teachers etc.
FILL IN THE BLANKS
• The group of conditions which need _______ medical care and intervention
are called as emergencies.
• Emergency conditions are _______ as well as _______ bound.
• _______ is one of the most common emergencies that occur in the community
and a major reason for morbidity and mortality in India.
• Most of the emergencies require intervention within _______ also called as the
_______ .
FILL IN THE BLANKS
• The group of conditions which need immediate medical care and
intervention are called as emergencies.
• Emergency conditions are non-discriminatory as well as time bound.
• Trauma is one of the most common emergencies that occur in the community
and a major reason for morbidity and mortality in India.
• Most of the emergencies require intervention within one hour also called as the
golden hour.
Thank You
