Professional Documents
Culture Documents
PURPOSE:
To guide staff members regarding protocols and policies to be adhered to ensure prompt
and error free management of Emergency patients.
To guide staff members to adhere to hospital policies to comply the national and hospital
safety policies to ensure zero errors as well as to abate any sort of safety risk and
emergencies
To guide staff members to follow policies and protocols to monitor, manage and handle
all equipments in a safe and effective manner.
To ensure adherence to Infection control protocols and practices and enable speedy
recovery of all emergency patients.
The Department of Emergency Medicine is functioning 24 hours a day and caters to all
types of emergencies.
Scope of services includes but not limited to:
All Trauma and Polytrauma cases
Road Traffic Accidents
Stroke, Cardiac arrest, respiratory arrest etc.
Burns
Poisoning and Snake bite
High Risk pregnancy
All Type of medico legal cases
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
MANAGING DIRECTOR
MEDICAL ADMINISTRATOR
ER PHYSICIAN
ER NURSING INCHARGE
Assess patient medical condition and initiate immediate care to the patient.
Obtain patient's' histories and gather medical information from electronic records, patient
interviews, dictated reports, or by communicating with patient bystanders.
Supervise and conduct all relevant documentation pertaining to patient care given at ER.
Request relevant diagnostic investigations as deemed necessary to assess patient’s
medical condition and ensure immediate conduction of the same.
Perform, interpret and document the outcomes of diagnostic investigations and supervise
appropriate clinical interventions including life saving measures.
Communicate examination results or diagnostic information to referring physicians,
patients, or families.
Communicate detailed medical information to patients or family members.
Communicate test or assessment results to medical professionals.
Evaluate medical information to determine patients' risk factors, such as allergies to
contrast agents, or to make decisions regarding the appropriateness of procedures.
Analyze patient data to determine patient needs or treatment goals.
Train and supervise Medical officers as well as nursing staff assigned to ER and conduct
periodic performance evaluation.
Coordinate inhouse skill acquisition programmes to enable others to acquire skill and
knowledge.
Ensure adequate staffing pattern is ensured in each shift including those of medical
officers to maintain staff patient ratio as per guidelines.
Conduct periodic departmental training for existing staff and orientation training for new
staff members.
Ensure adequate staffing pattern to meet the patient flow and as per the ER guidelines.
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
Improves quality results by evaluating accuracy and quality of images; providing technical
assistance; implementing new techniques, equipment and procedures.
Provides statistical reports by controlling the collection of treatment and clinical data.
Act as liaison between department and administrative office to ensure smooth functioning of
the department.
Allocate staff responsibilities and train them on inventory management, equipment control,
Ambulance medicine and equipment maintenance etc.
Ensure adherence to hospital infection prevention and control protocols and environment
surveillance protocols.
Equip and observe readiness to meet any community emergency, internal and external
disasters, mass casualty etc.
Supervise during maintenance and test procedures on systems and components or in areas
where radiation safety may be affected or where service/maintenance personnel may need to
be given special protection.
Developing suitable emergency response plans to deal with accidents and maintaining
emergency preparedness.
In case of any untoward incident in the department, initiate an incident report timely.
Adhere to NABH standards, Quality and Infection control practices and take part in
Quality improvement activities.
CROWD MANAGEMENT IN ER
TRIAGING
Triage is a process of prioritizing patient based on the severity of their condition so as to treat
as many as possible when resources are insufficient for all to be treated immediately.
i. Triage is done by trained staff in the department Emergency and Accident care.
ii. Repeat training is being ensured by the involvement of specialist doctor through
supervision in most of the cases as a daily routine.
a. Number of patients does not exceed the resources available in the department.
b. In case of multiple casualties, most life threatening cases are attended first.
a. Number of patients exceeds the resources available in the department. Cases like
Natural calamities, bomb blast and epidemics
Triaging protocol
i.When call or information regarding any mass casualty is received a fully equipped
ambulance with drugs and sufficient staffs including doctors are sent to the spot
immediately.
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
ii.All beds in the Accident and Emergency Medicine are made vacant to the best extent
possible to accommodate the patients. If possible a general ward is also vacated to the
extent possible to accommodate mass casualty.
iii.Patients in the emergency area are shifted to ICU, ward or OP depending on the patient
condition and accommodation available.
v.Emergency department is prepared with crash cart, drugs and equipments to receive the
patients.
vi.Tagging of patients with colour coded tag is done in ambulance itself. A person should be
in charge for this. Tag consists of patient’s name, address and phone number in case of
stable patients.
viii. In case of unstable or passing out patients numbers are given in the tag for
identification.
ix. Patients’ ornaments, clothes etc. are collected in a sealed bag and stored with patient
details or number.
Triaging Process
(1)Most urgent
i.First priority patients.
ii.Triage area denoted by Red colour
iii.Life threatening shock or hypoxia and needs resuscitation.
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
All requests for Radiology investigations are sent to the lab / radiology department in a
standardized requisition format for each investigation as X-ray, Ultrasound, CT etc.
The referring doctor ensures that patient details in the requisition form along with
provisional diagnosis are entered. The details required include:
o Patient Name
o MRD Number
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
o Age/ sex
o Date and time of reporting
o Name and signature of requesting doctor with seal
o Investigation to be performed with specifications on view of the image
o Part to be investigated with side / views, directional specifications etc.
In case of Outpatients and patients from emergency department, the request form is sent
to concerned department via patient / bystander / hospital patient relations staff /
secretaries of OPD.
ER Patients reporting at CT/MRI whether stable or unstable, is given priority for
scanning irrespective of token number of other waiting patients.
Patient identity is duly confirmed and taken for scanning upon registering and
entry in daily register maintained.
Stable patients if vulnerable the following shall be followed;
They shall be transported in a wheel chair / bed with belt fastened.
It shall be ensured that no body parts are projecting outside liable for hit and
causing injury.
Transport shall be with bystander accompanying the patient.
If no patients from emergency department or priority notice for a patient waiting
for scan from their doctor, then vulnerable patients are given priority for
undergoing CT/MRI Scan.
Patients are visited by the specialist consultants under whom the patient will be
admitted or patient’s condition is discussed with the specialist by the Emergency
medical officer and lab / radiology investigations results are discussed.
Patient file is opened through registration process directing by-stander for the same or
ER nurse does the same if no by-stander is with the patient.
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
All entries by the Medical officer or junior doctors are countersigned by the primary
consultant within 24 hours of admission.
While handing over the patient from ER to ward, the patient is accompanied by an
ER nurse and hand over is given as per ISBAR tool and documentation of same is
done in patient medical record as well as patient hand over register maintained in
ward.
Those patients who do not match the hospitals scope or if the patient request shifting to
another hospital, the patient is referred to Medical college hospital or the hospital of
choice of patient and bystander as per hospitals Referral policy.
All referral cases are given Referral Note duly filled in and signed by the emergency
medical officer on duty.
Referral note comprise of the following details
Patient identification details
Date and time of presentation
Date and time of referral
Patient condition at admission and at time of referral
Co morbidities if any.
Treatment and medications given
Resuscitation / intubation status.
Reason for referral
Name, signature and seal with Register Number of doctor
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
DISCHARGE POLICY
All patients discharged from Emergency department are given Discharge summary note
which includes the following:
Patient name
Age / sex
MRD number
Date and time of presentation
Patient condition at admission, co-morbidities if any
Investigations done with result
Treatment given and medication administered
Procedures done
Patient condition at discharge
Advice on Review/ admission / consultation at OPD
How and when to obtain urgent care
Name and signature of doctor discharging the patient
Discharge to home/ other hospital
Discharge process is complied with as per IPD/OPD or transfer defined in the respective
processes
After all attempts have failed to revive the patient, then he/she is declared dead
(cardiopulmonary resuscitation should be tried for a period of 20 min).
ECG should be taken, preferably in the presence of the relative to assurance of death of
the person.
After death is confirmed, the doctor should inform the relatives compassionately
following the Effective Communication policy of the hospital.
TREATMENT PROTOCOLS
b. The defibrillator to remain plugged into an electrical outlet at all times, except
during battery testing.
c. To liaise with Biomedical Department when a defibrillator problem is detected to
get loaner defibrillator.
d. All external contents of cart are checked documented once every 24 hours.
e. Crash carts are used only for emergency purpose and not for routine use.
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
f. High risk medicines are not be stored in the crash cart as they are to be stored
under lock and key arrangements on identified locations.
g. No narcotic drugs or psychotropic substances are allowed to keep open in the cart
other than under lock and key complying to the protocol of narcotic/psychotropic
substance control.
Registers Maintained:
Sl.No. REGISTER
1. MASTER PATIENT REGISTER
2. TRIAGE REGISTER
3. INVENTORY REGISTER – EQUIPMENT
4. INVENTORY REGISTER – MEDICINE
5. NARCOTIC REGISTER
6. WOUND REGISTER
7. MEDICO LEGAL REGISTER
8. POLICE INTIMATION REGISTER
9. BROUGHT DEAD REGISTER
10. DEATH REGISTER
11. REFERRAL REGISTER
12. AMBULANCE INVENTORY REGISTER – EQUIPMENT
13. AMBULANCE INVENTORY REGISTER – MEDICINE
14. AMBULANCE DAILY CHECKLIST
15. AMBULANCE COMMUNICATION REGISTER
16. MINOR OT REGISTER
17. RESUSCITATION REGISTER
DISASTER MANAGEMENT /CODE ORANGE KIT INVENTORY
18. REGISTER
19. TT INJECTION REGISTER
20. VACCINATION REGISTER
NIMS LOGO
EMERGENCY SERVICES DATE OF ISSUE: 01.01.2017
MANUAL
DATE OF LAST UPDATION:
DOC. No.: NIMS/MAN/03 01.05.2021
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