❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
Introduction to pre hospital care and in
1. Introduction to emergency
PRE-HOSPITAL &
in-hospital care
Dr Ismail Mohd Saiboon
Emergency Department HUKM
Assoc Prof Dr Ismail Mohd Saiboon
Emergency Department
UKMMC
2. What is Pre-Hospital Care?
• Giving medical care to patients beyond the wall of
Hospital (emergency dpt.)
• Wide range of activities
- ground ambulance service
- battlefield medicine
- medical cover of gatherings
- sports event- motor- cross, Rallies,
F-1, soccer etc
- disaster relief efforts
- first responder/ first aider
3. Pre-hospital care
• Aim: reduce morbidity and mortality in those seriously
injured or in dangerously ill patients outside hospital
• *39% - 47%** of pre-hospital fatalities are
preventable
• Involve - rapid attendance (ambulance personnel)
- performed life-saving@ limb saving
(basic @ advance) procedures
- stabilized patients condition, prevent
deterioration, maximized chances of
good definitive care.
4. Immediate care
• Provision of skilled medial help
• At scene and
• During transport
• By doctors or paramedic that have receive
special training, use specific equipment
• Adapted to PHC situation
6. How does it started?
• Evolves from warfare
• Early organized civilian PHC group
JF Pantridge – Ireland ( Ambulance Coronary Care Unit)
UK – BASIC
US- DOT (1960’s)- EMS
Germany – Notrazt
Now, Faculty of Pre- Hospital Care, RCS Edinburgh)
• Dip. IMC
• FIMC
7. The philosophy
“ appropriate intervention at appropriate time”
“ short and safe, never be prolonged”
Aim of treatment: produce neurologically intact
survivor & reasonable quality of life
Need careful judgment of when to intervene and
when not to.
8. The practice of Pre-Hospital Care
• Uncomfortable
• Less ideal
• Any weather- bad weather
• ?Safety – depends on working
together effectively
with other emergency
service agencies.
9. Pre-Hospital Care: How does it
start?
History
• During Battles of Uhud and Hunain,
Arabian Peninsula (> 14 centuries ago)
• Sir Robert Jones, Manchester-Liverpool
canal, UK (1888)
• More organised system, US & Ireland
(1960s)
10. Who is involve?
• Doctors – General Physician
-- E Ps
-- Surgeons
-- Anesthetic
• Paramedic – MAs, S/Ns
• Uniform bodies- BOMBA, JPA3, Police, Army
• NGO- PBSM, St John, Mercy others
• Volunteers
Undergone basic training
14. TRAUMA IN MALAYSIA
• Trauma is the 2nd cause of mortality in
Malaysia
• Road injury is a leading cause of premature
death of age group 12 – 45 (young adult:
31.2%, adolescents: 21.5%)
• Road injury causes 25 to 30 deaths per 100
000 population, 6000 deaths per annum, 15
deaths/day
• Pre Festival week: 15 to 20 deaths per day
Epidemiology of injury in M’sia, Dec 1997
15. 10 Principal causes of deaths in
MOH hospitals, Malaysia 2001
1. Heart Diseases & Diseases of
Pulmonary Circulation 15.99 %
2. Septicaemia 14.51 %
3. Malignant Neoplasm 9.16 %
4. Cerebrovascular Diseases 4.48 %
5. Accident 6.76 %
6. Conditions Originating In The Perinatal Period 5.56 %
7. Pneumonia 4.98 %
8. Diseases of the Digestive System 4.38 %
9. Nephritis, Nephrotic, Syndrome and Nephrosis 3.72 %
10.Ill-defined conditions 2.74 %
16. 10 principal causes of hospitalization in M0H
hospitals, Malaysia 2001
1. Normal Delivery 18.91
%
2. Complications of Pregnancy 11.84 %
3. Accident 9.16 %
4. Diseases of the Circulatory System 6.94 %
5. Diseases of the Respiratory System 6.61 %
6. Conditions Ori. In The Perinatal Period 5.62 %
7. Diseases of the Digestive System 4.87 %
8. Ill-defined conditions 3.57 %
9. Diseases of the Urinary System 3.49
%
10.Malignant Neoplasms 2.62 %
17. “Transportation of critically ill
patients to EDHKL does not
follow a standard guideline”
(inadequate communication, ineffective liaison,
untrained & inexperienced staff)
Ridzuan Isa. A study on inter hospital ambulance transportation of
critically ill patients to GHKL, May 2003
21. Malaysian ‘EMS’
Available service
C MOH hospitals
C University hospitals
C St. John Ambulance of Malaysia
C Malaysian Red Crescent Society
C JPA 3
C Private ambulance services
22. Malaysian PHC
Providers
C Assistant Medical Officer
C EMTs
C JPAM
C NGOs- First Aider (SJAM, PBSM)
23. PRINCIPLE OF PRE
HOSPITAL TRAUMA CARE
~ Deciding the best option for the
patient on the field requires knowledge
of the potential detriments and the
means to correct the situation in the
right time frame ~
24. Key element in administering a PHC
system
1) Lead by a national agency (MOH, MOT)
- govern the system
- legislative & regulatory oversight
- organization
- financing
6) Regional or local support – member of
community
7) Local administration
8) Medical direction –education, training, quality
improvement
9) Political support
25. System of PHC
• National systems
• Local or regional systems
• Private systems
• Hospital based systems
• Volunteer system
• Hybrid system
27. Key aspects in PHC systems
• Personnel
• Training
• Communication systems
• Transportation
• Receiving facilities
• Documentation of care
• Legislation & regulation
28. Personnel
“Quality of a PHC is determine by the ability and
attitudes of provider couple with knowledge and
skills required”
• Come from different walks of life
• Full-time or part-time
• Paid or volunteer
• Different level of knowledge and care
• Need good coordination and understanding
• Good command and control
29. Training
Interested physician need to be involve in training
• FRLS/ FALS- Fire & Rescue, Police, ? Tow-Truck
driver
• EMT-B / Post basic - Paramedic.
• Dip. IMC
• Degree Emerg. Paramedic
• FIMC
Other courses they should undergone
BLS, BTLS/BTC, ATLS (MTLS, ATRC), ACLS, MIMMS
30. Communication
• Emergency number: 991, 911, 999, 000, 994 ???
• Cellular phones: 121, 112, 122, 999???
• We need to know and same goes with the public?
• Communication Center
• Able to communicate among all PHC providers
• Priority dispatch / pre-arrival instruction/ phone triaging
• Able to communicate with hosp. of destination
31. Transportation
• Air ambulance – helicopter, fixed wing
• Ground ambulance- type 1, 2, 3
• Sea ambulance
Simple transport vehicle Sophisticated-
specialized-efficient mobile
patient care unit
32.
33. Able to provide lifesaving maneuvers
Design: Ambulance personnel must be able to
provide airway & ventilatory support while
transporting
BLS- equipped
ALS- equipped
35. Facilities
• Transport to the closest appropriate
hospital.
• Specific dedicated hospitals for the special
conditions.
• Patient demand?? To consider or not.
• In life-threatening condition- NOT
36. Critical care unit
• Must identify the hospital that have tertiary care
facilities
i.e. Trauma
NICU
High risk Obstetric
Burns
Spine unit
Neurosurgery
Cardiac care
Do NOT load one hospital with everything unless
there is only one
38. Consumer participation
• Lay person
• Political
• Consumer association
• Need their support and corporation in order
to have successful PHC service
manpower/ financial/ legislative
39. Access to care
• Ensure public have access to emergency care
• Must develop system that discourage public from
accessing the PHC system for wrong reason or
perceived emergency.
• Political back-up and their understanding of the
system
• Principle: all individual deserve timely access to
the emergency PHC system.
40.
41. SCOPE OF PRE HOSPITAL
TRAUMA CARE
• Scene size up
• Triage, treatment (ABC I)
• En route management
• Patient’s Transportation
• Communication and Dispatching
• Pathway of care; sending and receiving
protocol.
42. EMERGENCY
INTERVENTION
• Airway maintenance/Cervical Spine
Control
• Breathing and ventilation
• Circulation with hemorrhage control
• I mmobilization
43. CARING FOR THE PATIENT WHILE
EN ROUTE TO THE HOSPITAL
3. Continue to provide emergency care
4. Continue monitoring vital signs
5. Communicate with ED personnel using two way radio
6. Give a description of what happened
7. Describe patient age, sex and his condition
8. What type of injury suspected
9. Patient vital signs
• Emergency care that has been provided
• Estimated time of arrival
45. Public Information & Education
• Public must be informed and educate regarding
good emergency PHC system.
• Public can contribute by
- understand how a good system can benefit
them.
- Prepare to give first aid care
- Know how and when to access the system
rapidly
46. Disaster Preparedness
• Any PHC system is an integral part to disaster
response effort.
• Need to be involve in planning & practice drill
47.
48. In-hospital emergency care
• Receive patients
• Triage
• Resuscitation and stabilization
• Registration
• Investigation
• Treatment – definitive care, observation
• Disposal
49. Bystander
interventions Early Definitive
Care/Trauma Center/ED
Emergency Service
Dispatch
Transportation
On scene
interventions
This is a picture of mass casualty accident. It involved multiple vehicles. 35 casualties with 5 deaths. Who is going to manage this type of scenario? How are we going to manage it if it occurs in KB? Do you think it is as easy as managing ICU patients or prof Jafri patients who are already on the OT table? Who is the expert here? Last year, during the fasting month, it was raining during time. There was an accident between the a car and a truck. I followed the ambulance to dispatch the victims. The area flooded by a villagers and other emergency service personnel (BOMBA/POLIS). There was also a reporter and photographer around, snapped the pictures at different angle. Nobody cares the trapped victims. The BOMBA busy cutting the roof of the car and they hold it for me and ask me to take the patient out. I did a quick triage & I found out only one survivors. The victim had respiratory distress and poor circulation. It was not easy to remove the patient. It was not easy to manage the patient at the field. I decided to practice scoop & run rather than scoop and play. Run and play… fuh!!! Don’t want to talk about it…
Questions? Why?
Most of Trauma strategy & management were started by the military/army. Their exposure & experiences managing trauma victims during war made them more concern & the needs of trauma care. They learn the through a hard way, hard time & do not imagine the prize they have to pay. This slide shows a relationship between evacuation time and mortality rate during the different type of war. Mortality rate goes down whenever the evacuation time is reduced. The reduction of time evacuation and mortality rate were bcoz the advancement of transportation at war. For ex – the usage of helicopter to bring soldier to the medical center diring the world war 11 7 orean war.
This is a chain of survival for trauma victim. It has 5 elements… All the component which represented by a ring are attach/link to the other in sequence & strongly connected to form a chain. The morbidity & mortality are depending on the strength of the chain not a single individual or ring. A strength of the chain as strong as the weakest link.
Prehospital management is not easy or simple. Everything is difference, inconvenience and non conducive. Hot. Noisy. Too many casualties. Everybody calls us for help. Everybody asking for help. At the same time we have to take care of own safety. Decision made is very difficult. Wrong decision may jeopardy patient’s life. Yet, our enemy is a time. We re fighting with the time. We are against the time. Delayed definitive management means death. Nowadays, too fast also not very good. Too fast may compromised our safety/victims’s safety – eg sept eleven, ambulance collision.
Trauma center and availability of trauma surgeon do improve the survival of trauma patients. Trauma center is just a name. We don’t have to create a trauma center if we can coordinate and communicate among ourself. It is about mobilization of resources.
This slide is to illustrated to you there was o major organization involved in management of trauma @ even medical patients. Both of them are equally important in order to save patient life.
In order patient life we required to strengthened above chain. It is a team expert not an individual expert. Everybody has a role.