Principles of Non-

Planned Emergency
Care.
HC2235
Aim

 Exploration of the non technical skills that influence the delivery of non-
planned/emergency surgical care.
Objectives

 To define surgical intervention

 Identify what constitutes an emergency (non-planned surgery)
 Identify what constitutes Trauma
 Identification of the non-technical skills that influence patient care delivery in
unplanned situations:
 Situational Awareness
 Teamwork
 Decision Making
 Leadership
 Communication.
Surgical Intervention

 As defined by the National Enquiry into Patient Outcome and Death

(NCEPOD,2004)
Surgical NCEPOD Classification of
intervention (2004)
Immediate Urgent Expedited Elective
1 2 3 4
Lifesaving Acute Stable requiring early Planned in advance of
A/Limb/organ Saving Onset/Deterioration intervention- not routine hospital
B Threatening Life/limb immediately admission.
life/limb/organ
threatening
Within minutes of Within Hours Within Days Planned
decision to operate

Resuscitation Usually following

Simultaneous with resuscitation
surgery
What Constitutes an emergency?

 https://www.ncepod.org.uk/classification.html

 https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-
prevention-and-control/covid-19-infection-prevention-and-control-guidance-low-
risk-pathway
What Constitutes Trauma?

 Trauma
“Trauma is a wound or injury, whether
physical or psychic inflicted on one’s person”
(Phippen &Wells.1994)
Trauma

Blunt: Road Traffic Collision (RTC), Falls,

Mechanism of Injury Sports Injuries

Intentional Consider:
Occult Injury
Unintentional Obvious Injury
Penetrating Trauma:
Ballistics
Specifically how energy Stabbing/Impalement

dissipated
How are your emergencies managed?

 Do you have:

 A designated emergency (CEPOD) and/or Trauma Theatre and team/s?

 Is this a 24hr provision?

 Will this influence patient care?

What does this mean to you?

 Consider how you manage the situation:

 Skill mix/teamwork

 Logistics/situational awareness

 Co-ordination/leadership/decision making

 COMMUNICATION
Situational Awareness

 Patient care requirements

 Logistical considerations:  Knowledge of their condition
 Equipment
 Facilities
 Other team/departmental involvement
 Theatre environment/availability
Team work

 Who might be involved in your patients  Skill requirement

care:
 Pre
 Intra
 Post
 Operatively?
Co-ordination

 Decision making:  Leadership:

 What determines the priority/order of  Who takes on the leadership role?
emergency care delivered?
COMMUNICATION!
Summary

 Find out how emergency (CEPOD) and Trauma theatre services are managed in
your respective hospitals- Theatre designation, availability, staffing.

 Communication is key to inform your patients care needs, to account for the
situation, team working, decision making and leadership required in non-planned
care.
References

Driscoll, J (ed) et al. 2000.ABC of Major Trauma. 3rd edition. London: BMJ Books
National Confidential Enquiry into Patient Outcome and Death (NCEPOD). 2004. Classification of Intervention
https://www.ncepod.org.uk/classification.html (Accessed 29/09/19)

National Health Service England. 2015.National Safety Standards for Invasive Procedures
(NatSSIPs)https://www.england.nhs.uk/wp-content/uploads/2015/09/natssips-safety-standards.pdf (Accessed
29/09/19)

Phippen, M and wells M et al. 2000.Patient care during operative and invasive procedures. (Ch. 33) 2nd edition.
USA :Saunders

Royal College of Anaesthetists. 2012. Raising the Standard: a compendium of audit recipes 3rd Edition
https://www.rcoa.ac.uk/system/files/CSQ-ARB2012-SEC4.pdf (Accessed 26/09/19)

University of Aberdeen. 2019.Scrub Practitioners' List of Intra-operative Non-Technical Skills (SPLINTS)

https://www.abdn.ac.uk/iprc/splints/(Accessed 29/09/19)
You have a patient with a Fractured Neck
of Femur….
 What do you need to know to care for this patient?
 Consider patient specific information
 Time of day
 Staff availability
 Logistics
……….and…