Accident & EmergencyDepartment

Introduction

• EMS is an integral part of any hospital• Microcosm of the hospital as a whole• “Front door” of the hospital• Portal of entry that interacts with the highest volume of

patients requiring critical care

Definitions

• Emergency has been defined as a condition determined clinically or considered by the patient or his/her relatives as requiring urgent medical services, failing which, it could result in loss of life or limb……………WHO

• Medical emergency is a situation when patient requires urgent & high quality medical care to prevent loss of life or limb and/or to initiate action for the restoration of normal healthy life.

Importance

• Public perception & opinion of a hospital is often based on their visit to the accident & emergency department

• This facility, usually accounts for a significant number of all hospital admissions

• Effective functional operations in the department are important variables for staff, patient & visitors satisfaction

Functions

• Provision of immediate & correct life saving treatment at all times & for all situations

• Collection of casualties• Rapid institution of BLS to critically ill at site, en route

& in hospital• Information centre to render advice on telephone or

in person on simple medical queries• Capacity & capability to provide effective

management during disaster situations

Functions…..

• Liaison with courts & police in a medico-legal cases

• Provision of ambulance services• Act as information & communication center

especially during disasters• To provide education, training & research

Types of A & E Departments

• Type I : Large hospital with all specialists available round the clock

• Type II : Emergency room physician available round the clock where specialists on call

• Type III : Standby emergency facilities with physician & nurse on call

• Type IV : Referral emergency service where only nurse is available. First aid & refer

Planning

• Location– Should be loc on the ground floor– Direct access from the main road– Separate approach, other than OPD with a

spacious parking area– Loc adjacent to OPD– Well lighted & boldly sign posted both for day &

night– A helipad is required for major trauma centres,

hilly or unapproachable areas

Interrelationship

• Close relationship with:– OT– ICU– Blood bank– Laboratory– OPD– Mortuary– Some authorities recommend a close relationship with

CCU as well– Many sub-depts like OT, Diagnostics etc may be required

in the dept itself

Work & Traffic flow

Lay out

• Core type– Treatment spaces situated around a central point

in which emergency dept personnel work– Ideally, there should be a corridor outside the

treatment area through which the patients enter the cubicles

– Support rooms( plaster cast room, obstetrics & gynae room) are along the periphery of the corridor

– Greatest freedom of movements for emergency dept personnel

Core Design

Lay out….

• Arena type– Essentially a core plan design without the

periphery corridor– Provides a good view of all the cubicles from the

nursing & physician work areas– Less fatigue as distances are less– Best suited for emergency depts that are smaller

in size

Arena design

Lay out

• Corridor type–Many variants possible depending on the

size of the dept–Desirable plan for large emergency depts– Separate space is provided for each

specialty

Corridor plan

Entrance

• Separate from main hospital entrance• Separate entrance for ambulant & stretcher bound patients

coming by ambulance• Should be well marked & illuminated• It should open into spacious lobby• Porch outside the lobby to protect the unloading of the

patients from rain & sunlight• Approach to lobby should be in the form of ramp & steps• Approach & access should be appropriate to usage by the

disabled

Reception & information area• Entrance should open in to a large open space with reception

desk in front• Trolley, stretcher & wheel chair parking area• It should be adjacent to triage area• Should be close to waiting area• Should have communication links such as telephones• Worship room, grief room, flower, chemist & book shop• Space for medico-social worker, toilets, registration & records• BIS has recommended 1.75 sqm per hosp bed for the reception

area

Trolley bay

Reception and Information area

Waiting Area

• Should provide sufficient & comfortable space for waiting patients & relatives/escorts

• Area should be easily observed from reception & triage areas• Should be appropriately furnished with visual displays on

health education & hospital related information• Should cater for facilities such as drinking water, ladies &

gents toilets, television & channel music

Examination & Treatment Areas• Triage Area: A separate area or lobby may be used• Nursing Work Station– Centrally located to enable staff to monitor patient care

areas– Should preferably include central cardiac monitor station– Communication links to triage & resuscitation areas

• Doctors Work Area– Centrally loc for facilitating response to an emergency– Should provide privacy– Loc such that doctors & nurses able to view central cardiac monitoring

station

Examination & Treatment Area…

• Acute Treatment Area– Utilized for management of patients with acute illnesses– Should be able to fit a standard mobile bed with ample

storage & usage space– Area should include a service panel, examination light,

wall mounted sphygmomanometer, emergency call facilities

– 2.4m of clear floor space between beds– Each treatment area requires space of 15 sqm, doors at

least 1.3m wide

Acute patient care room

Resuscitation Room

• Should have space to accommodate specialized resuscitation bed, allow 360 degrees access to all parts of the patient for facilitating procedures & monitoring

• Imaging facilities should include:– Overhead X-ray– Lead lining of walls & partitions between beds– Radiolucent resuscitation trolley with cassette trays– X-ray viewing/digital electronic imaging system

• An OT light should be made available• All electric power should be on emergency stand-by circuits

Resuscitation Room…

• Ceiling arrangements needs to be carefully planned so that surgical lights, X-ray tracks, curtains & IV racks do not interfere with each other

• If room not directly visible from the work area, it should have alarm line to the nursing work area

• Storage cabinets should have glass panels to facilitate view of stored items & their retrieval as & when required

• Should have O2 & suction outlets• Patient’s privacy should be ensured• An area of about 30 sq m is suggested

Resuscitation Room

Observation ward

• Utilized for patients who have been evaluated & need extended treatment, observation, re-evaluation or time consuming procedures

• A 6 to 8 bedded ward is recommended

Special Treatment Rooms

• Obstetric roomS– Equipped for pelvic exam– Evaluation of patients in labour & emergency delivery

• Ophthalmology & ENT rooms– Equipped with slit lamp & other necessary eqpt

• Dental roomS– Should have a dental chair

• Decontamination room– Should have a flexible hose shower

Support Areas

• Radiology– Size & facility depend on relation & distance from main radiology dept– Unless the latter is just adjacent a satellite X-ray unit required– Besides a mandatory mobile unit 300-500Ma unit recommended for a

large A & E unit

• Laboratory– An emergency facility for performing routine blood, urine analysis,

bacterial smears & stains required– Advanced tests such as BGA, biochemistry may be done in main

laboratory

• ECG

Support Areas….

• Blood Bank– Closely related to or easy access to blood bank is recommended

• Duty room– A 9 sqm room with bed, chair, desk lockers, toilet,

telephone is required

• Storage area– An area/alcove for mobile eqpt; mobile X-ray, crash cart, ventilators

etc and for storing clean instruments, linen, drugs iv fluids

• Janitors closet

Administrative areas

• Office for director• Office for matron• Conference hall especially for teaching institute• Pantry: A 7 sqm pantry adequate for providing hot & cold

fluid/beverage• Communication room• Secretary’s office

Communication

• Two way radio communication with ambulances & inter communication between hospitals are required outside the hospital

• Intramural communication in the form of PA system, telephone (incl hot line), intercom, computer network etc

Engineering Services

• OT, ICU, main treatment area and resuscitation areas should be air conditioned

• 300 lux lighting is required for general area• 1100 lux for examination area• Stand by supply should be planned for

essential areas preferably for whole department & UPS for life saving equipment