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11
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27
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 PARAMETERS
There should be written policies and procedures document which is updated reflecting policies and
procedures to be followed in the department and its relationship with other departments in the
hospital.
2. The department should have a full time Administrative Incharge and the staffed 24 hours daily by
qualified emergency medicine specialist.
The department should be accessible to ground transportation in all kinds of weather. If possible
arrangements should be made to receive and despatch patients by way of air transportation, if
possible, in areas of remote inaccessible areas.
Round the clock availability of laboratory personnel capable of performing immediate analysis of blood
gas pH, serum electrolytes and other body fluids.
The department should be equipped with basic minimum facilities like ventilator, cardiac monitor,
defibrillator, pace maker, apparatus to establish central venous pressure, sterile surgical sets, gastric
lavage equipments, intravenous fluids and devices to administer the same and life saving drugs.
Radiological investigation services should be within or easily accessible to emergency department.
There should be a predetermined plan for the diagnosis and treatment of alcoholic or drug abuse
patients.
8. Operation Theatre (OT) should be within or easily accessible to the Accident and Emergency
Department with availability of operating room personnel within a reasonable period of time.
Blood bank or blood storage facilities should be easily acessible to Accident and Emergency
Department.
10. Special training in life saving procedures should be provided to all categories of staff.
11. There should be a continuing medical education (CME) programme for all category of personnel.
12. A list of on call specialists, with their availability, location and telephone number should be maintained
and easily accessible in Accident and Emergency Department.
13. There should be availability of emergency care reference material such as for tetanus, burns and
poisioning and emergency medical identification and treatment manuals and text books.
14. There should be adequate patient/visitor waiting area, separate from the emergency treatment area.
15. There should be an isolation area/ward for patients suffering from diseases like rabies, tetanus and
burns.
16. Medical records should be reviewed regularly by Emergency department Medical staff.
17. There should be a periodic and comprehensive review of services jointly by the emergency
department staff and ambulance personnel who are catering to the hospital, so as to assess the need
and improve the performance.
18. Communication equipments for intra-hospital coordination should be available, either for immediate
medical consultation with a specialist to assist in resuscitation or referral to other appropriate hospital.
19. Public information services should include sign posting on the hospital indicating to the general public
the scope of emergency medical services available.
20. A disaster plan should be prepared, and updated regularly and well rehearsed in order to deal with
mass casualties at short notice.
Emergency care is not simply pre-hospital transport and hospital based facility. Rather it is a complex
responsibility involving many other agencies like police, rescue agencies like fire services, social organisation,
communication departments so planning of the services have to be multi-discplinary and incorporate inter-
sectoral coordination.
Admission in Private Ward/Paying Ward/Nursing house in the hospital: When a patient attending emergency
room and requires admission if he/she wants private ward or nursing home bed, he can be admitted after
depositing necessary advance payment (money at admission office) but precaution should always be taken
that prior information be given to keep the available bed ready to receive the patient and CMO should also
ensure that patient is fit enough to be treated there and that the concerned clinical unit is ready to manage the
case in the private ward room.
Patient Needing admission and in need of Surgical Intervention:Those patients who require immediate
admission and surgery should be formally admitted in the hospital as per the hospital procedure and are to be
prepared for operation as per the preoperative instructions. The following steps are also essential:
a) Taking history and physical examination, investigations be conducted as per the clinical protocol.
b) Arrangement for blood if required are to be made.
c) OT/anaesthesist be informed in advance so that OT can make arrangement to receive the patient.
d) All Patients will be prepared for operation after obtaining the necessary informed consent in writting
from the patient (when possible) or else the need of kin (if the patient is not in a fit condition).
e) Necessary premedication sould start as soon as possible.
f) After operation patients are shifted to a ward as usual.
MEDICO-LEGAL CASE
A medico-legal situation can be defined as one where there is an allegation, confession or situation of causes
attributing to body injury or danger of life. Further any case of road side accident should also be treated as
medico-legal case.
a) All medico-legal cases should be stamped MLC. on the face sheet itself on capital letter. All such
cases be thoroughly examined and investigated.
b) Prompt medical aid should be provided.
c) In all such cases care for record keeping must be taken apart from patient prescription and card for
record keeping, it should also enter all relevant information into a separate medico-legal register.
Filling of medico-legal register are to be in duplicate, so that one copy can be given to police/court
and one can remain in medical record which are to be used at later date as an evidence/exhibit in
court during the legal process. Medico-legal register is therefore an important document of hospital
emergency service.
d) All X-ray, and investigation forms should be clearly marked as an MLC case and it can be done by
stamping M.L.C. - and kept in one composite document (case-sheet).
e) All samples and exhibits of the medico legal case are important from the court procedures purpose so
that items like gastric lavage in case of poisioning, blood stained cloth or bullet removed from body,
arms used in case of fire or semain stained cloth in case of rape, should be sealed and kept under
lock and key till they are delivered to the police and signature of the police should be obtained in the
receipt book.
INSTRUCTION REGARDING PATIENTS WHO ARE DEAD ON ARRIVAL
a) All cases of “Brought in Dead”, where the actual cause of death is not known, should be handed over
to the Police for suitable action.
b) The name of such cases should be entered in the Casualty attendance register along with all the
possible details about the dead person obtained from the accopanying relatives and their names and
addresses should also be noted and recorded in the remark column of the attendance register.
c) Where death has occured due to natural causes and there is no suspicion of any foul play, the dead
bodies may be handed over to the relatives on their request and this must be recorded with signatures
of relatives/ attendants.
d) All other cases where death has occured due to accident, assault, burns, suicide, poision, rape or any
other causes where it is suspected that death has not been due to natural causes, must be registered
as MLC and the police authorities should be informed accordingly.
b) The checklist should include the functional status of the the following special equipments:
i) Suction machine
ii) Blood pressure instrument
iii) Laryngoscope with blades of different size and with battery cells
iv) Defibrillator
v) Ambu-bag
vi) ECG machine
vii) Disposable syringes and needles
viii) Infusion bottles
ix) Oxygen cylinders
x) Emergency drug tray
YES NO REMARKS