The evolving role of Emergency Department in Nagaland hospitals

“Expect the best, plan for the worst, and prepare to be surprised” - Denis Waitley

The Emergency Department (ED) is a very stressful and critical area of a hospital. The area has a significant impact on saving lives. Emergency Medicine (EM) is a new emerging medical specialty mainly in the North-East India with a challenging role for all the doctors and staffs working in the ED. It is dedicated to the diagnosis and treatment of unforeseen illness or injury. The practice of Emergency Medicine includes the initial evaluation, diagnosis, treatment, and coordination of care among multiple providers for the coordinated care of any patient requiring expeditious medical, surgical, or psychiatric care.

The ED of CIHSR Hospital has been functioning 24/7 since the very inception of the hospital and has grown at a steady pace. It caters to the need of individuals walking, wheeled or carried inside the department irrespective of age or gender or race, without discrimination. The team is led by staffs that have undergone specialized training and courses in Emergency and Trauma Management. The department is staffed with nurses, hospital assistants, Postgraduates and Medical officers, and manned round the clock by an Emergency Medicine consultant.

The Emergency cases:
Dimapur has a mixed population with multi-racial distribution. Patients present to our ED with all various kinds of medical emergencies. 

From all regions of Nagaland and neighboring Assam, patients present with problems ranging from minor conditions like “I can’t sleep” to acutely serious cases of “stroke and heart attack.” 

Accidents and trauma cases, animal bites and stings, gynecology and pregnancy related cases, surgical emergencies, acute airway obstructions, addictions and poly substance abuse, alcoholic intoxications, Medico-Legal Cases (MLC) with legal implications like rape, suicidal and poisonings, acute psychiatric illness and pediatrics emergencies are frequently seen in the ED. Lifesaving procedures like intubation, intercostal drainage, CPR, and occasionally pericardiocentesis and tracheostomy are performed at the ED. 

We are also responsible for the management of Mass Casualty Incidents and disaster situations in and outside the hospital.

Importance of ED:
For many hospitals, the ED is the point for patient entry. ED professionals provide valuable clinical, administrative, and leadership services to the hospital and other sectors of the health care system. 

With limited resources, hospitals must get the right attention to the right people at the right time. Considering the masses ofpatients coming through the ED yearly, serving everyone promptly becomes a challenging task. A properly trained ED staff and their effective management is crucial. Proper ED management ensures that the right resources are in place to help patients on time. Management is often a balancing act. The balance between juggling with limited beds, equipments, and staff shortages while managing patient’s expectations becomesvery critical. More often than not, particularly in small and rural hospitals, there are insufficient resources to deal with all patients’ needs. Emergency management is vital in making sure patients do not feel the impact of what’s going on behind the scenes. 

ED services use the system of “triaging the patients” (Categorizing patients in order of their priority of illnesses) and the general public need to be sensitized towards the functioning of ED by cooperating with the health care personnel as and when they are requested to follow certain protocols laid by the institution.

According to a famous research study done in America by RAND Cooperation. the following points are to be noted:
1.     EDs account for nearly all of the recent growth in hospital admissions.

2.     Increasingly, EDs are support primary care practices by performing complex diagnostic workups and handling after-hours demand for care.

3.     As a result of these shifts in practice, ED physicians have become the major decision makers for approximately half of all hospital admissions.

4.    Although hospital EDs and the doctors who staff them represent a small part of the health care system, they have a disproportionate impact on patient care

5.     Most patients who seek ED treatment on a walk-in basis do so because they lacked an alternative or were sent to the ED by a health care provider.

6.     Although hospital admissions from EDs are increasing overall, EDs appear to be playing a constructive role in limiting preventable hospital admissions.

7.     The ED always operates at the Interface of Inpatient and Outpatients Care.

Awareness of Emergency Medical Service to public:
Awareness of the available Emergency Medical Services (EMS) and preparedness are mandatory among the general public for the success of an emergency service. It is termed as ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that typify the importance of EMS all over the world. It is a well-accepted fact that a patient who receives basic care from trained ED professionals and is transported to the nearest healthcare facility within 15-20 minutes of emergency care has the greatest chance of survival. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately.

The following are very important for hospital in Nagaland that runs the ED:
1. A good pre-hospital care system with ambulance co-ordination system

2. Trained emergency technicians/paramedics/nurse

3. Trained and experienced full time post graduate emergency doctor(s)

4. A well- equipped ED with all the basic resuscitation materials

5. A good inter-hospital communication for referrals and transfer of emergency patients

6. Consultation room/Emergency OPD with proper triaging area

7. Observation area and patient waiting area

8. Attached Minor/Major OT

Much has been done to upgrade the quality of ED services in our state. While appreciating the efforts of the Hospitals of our state in providing better healthcare facilities, there is a lot of room for improvement. The ED in several Hospitals including the far flung peripheral areas are ill-equipped and need immense improvement in meeting the requirements for providing proper emergency medical service to needy patients. Established hospitals in the growing sector need to equip themselves with updated facilities as almost all the lifesaving procedures take place in the ED. 

We need to push ourselves to a great extent to really give satisfactory assistance to our people and this can only be possible when all the personnel working in ED are highly committed to the point of walking the extra mile.

A great amount of focus needs to be directed towards strengthening this very vital area of health care.

(Article contributed by Dr Krosakhol Pucho and Dr Tsarangpi Sangtam, CIHSR ED Consultants)

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