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EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS

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

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EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS

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  1. EMERGENCY MEDICAL CAREANDEMERGENCY ROOMIN 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! Let’s 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 • Achieved: • Triage in routine • Triage in mass casualty incident • Intra-osseous catheter • Almost achieved or in process: • Trauma • Shocks • Asthma • Convulsions… ADULT AND PAEDIATRICS • 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…

  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 • =====> ADAPTATION to new tools = TRAININGS

  14. EMERGENCY ROOMS DRUGS / MEDICATIONS: • Implementing new protocols (evidence based), we’ll 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 ====> ADAPTATION ++++ to new health problems and new treatments

  15. EMERGENCY ROOMS Impact? Value? Certification? 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.

  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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