EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS - PowerPoint PPT Presentation

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EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS

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EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS EMERGENCY ROOMS ORGANISATION: Medical care area ER = severe patients management (trauma++) ER = ADAPTED ... – PowerPoint PPT presentation

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Title: EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS


1
EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF
SETTINGS
2
EMERGENCY ROOMS
  • No emergency medical care referent in MSF F
    before September 2010.
  • We are now 1 year and 2 months old!
  • Lets see what we have done or not done yet.

3
EMERGENCY ROOMS
  • MSF emergency rooms in regular missions
  • Drouillard hospital / HAITI --- 300/sem
  • Teme Hospital / NIGERIA --- 150/sem
  • Hangu Hospital / PAKISTAN --- 400/sem
  • Rutshuru Hospital / CONGO DR --- 275/sem
  • /- Khameer Althal Hospitals / YEMEN
  • Mullaitivu Hospital / SRI LANKA --- 50/sem
  • Awil Hospital / SOUTH SUDAN
  • Pawa Hospital / CAR

4
EMERGENCY ROOMS
  • MSF ER in emergency missions
  • Ivory Coast
  • Libya
  • Syria
  • Egypt?
  • Yemen?

5
EMERGENCY ROOMS
  • Common strategy for
  • Organization
  • Protocols
  • Medical material and drugs
  • Human resources

6
EMERGENCY ROOMS
  • ORGANIZATION Triage area
  • TARGETS
  • To attend in priority patients with
    life-threatening conditions or higher risk of
    complication.
  • To improve medical care.
  • To manage patients flow and decrease
    overcrowding.
  • To improve patient satisfaction and decrease
    overall length of stay.
  • ESSENTIAL IN ANY EMERGENCY ROOM

7
EMERGENCY ROOMS
  • ORGANISATION Triage area
  • Routine triage
  • syndromic approach or vital signs approach
    (depends of skills, patients flow, material)
  • Triage area at ER entrance
  • Massive influx
  • Large area prepared at ER entrance (empty and
    closed in routine activity)
  • Mass casualty incident guide line

8
ROUTINE SYNDROMIC APPROACH
9
ROUTINE VITAL SIGNS APPROACH
10
Mass casualties incident
11
EMERGENCY ROOMS
  • ORGANISATION Medical care area
  • ER severe patients management (trauma)
  • ER ADAPTED RESOURCES NEEDED
  • ( considering good quality of surgery /
    anaesthesia)
  • Resuscitation zone / red zone
  • Specific material automatic BP, vacuum,
    electrical syringe driver
  • Resuscitation material and drugs
  • Dedicated HR?
  • Yellow zone acute patients / no needs of
    resuscitation
  • Green zone non seriously sick patients
  • Plaster and suture dedicated room or trolley.
  • Isolation room?
  • Link with OT, radiology, ICU, lab, wards
    central position
  • ORGANISATION Observation room

12
EMERGENCY ROOMS
MEDICAL PROTOCOLS
  • Long process ! Very long!
  • Evidence based protocols
  • Problem validation and implementation
    (training)
  • TARGET same severe patients management in all
    MSF settings.
  • Problem different levels in terms of material,
    skills, logistics
  • Achieved
  • Triage in routine
  • Triage in mass casualty incident
  • Intra-osseous catheter
  • Almost achieved or in process
  • Trauma
  • Shocks
  • Asthma
  • Convulsions

ADULT AND PAEDIATRICS
13
EMERGENCY ROOMS
  • EQUIPMENTS
  • MONITORS / AUTO BP no unstable patient
    management without adapted tools !
  • SYRINGES DRIVERS essential for dopamine,
    adrenaline
  • FAST echo EXCELLENT ALTERNATIVE / scanner dream
  • INTRA OSSEOUS KT / ELECTRICAL DEVICE central IV
    dangerous and difficult / excellent alternative
    urgent IV access
  • ECG pb for ECG diagnosis AND pb for treatment
    even if diagnosis is well done
  • gt ADAPTATION to new tools TRAININGS

14
EMERGENCY ROOMS
  • DRUGS / MEDICATIONS
  • Implementing new protocols (evidence based),
    well have to implement new drugs
  • Worldwilde health changes (thanks to
    mondialisation). We have to face more and more
    western pathologies
  • Diabetes
  • Cardiac and vascular
  • Old and multi pathologies patients
  • gt ADAPTATION to new health problems and
    new treatments

15
EMERGENCY ROOMS
  • HUMAN RESOURCES
  • TRAININGS how to train our national staff to
    EM?
  • Most countries no concept of emergency med
    speciality.
  • Most expat volunteers different back-grounds in
    EM.
  • SOLUTIONS / ISSUES?
  • ATLS
  • FAST ECHO
  • BASIC
  • ACLS? PALS, ASLO?
  • MSF made trainings?
  • Qualified Expat emergency doctor senior doctor.

Impact? Value? Certification?
16
EMERGENCY ROOMS
  • REAL CHALLENGE TO HAVE EFFICIENT EMERGENCY ROOMS
  • TRAININGS
  • NEW MATERIAL
  • NEW ADAPTED PROTOCOLS AND DRUGS
  • EXPAT EMERGENCY DOCTORS / SENIORS
  • ..
  • Step by step we achieve interesting progresses !

17
EMERGENCY ROOMS
  • TARGETS IN THE FUTURE SEVERE TRAUMA WILL NEED
  • surgeon anaesthetist/intensivist ER
    physicians commitment
  • Patient pathways
  • Development of technologies as we began
    (Ultrasound, Intra osseous cath.)
  • Training in specific fields ultrasound, trauma
    management (ATLS, BASIC)
  • Dedicated protocols (hemodynamic and fluids
    management, ...)

18
EMERGENCY ROOMS
  • HAITI / Hôpital Drouillard
  • ? Implementation of FAST Echo in emergency Room
  • ? Experienced and qualified EM doctor expat, for
    6 months ( 3 months)
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