Emergency room

Today we will talk about the creation of a cabinet for emergency medical care in a polyclinic, its equipment standards, tasks, functions, schedule of its work, consider an exemplary sample of documentation: the order of a medical organization for its creation and approval of the emergency room cabinet. The main information for the writing of this article was the publication from the site of the Unified State Library of Ukraine "Nechaevskaya CRH".

Some statistics

Every year, the ambulance service for Nekhaevsky districtis executed from three and a half thousand trips and more. And the practice shows that often people without good reason to go to the emergency department. Its free basis and accessibility for the population led to the fact that people are typing "03" for any reason from a minor cut to a simple cold. And the expensive resources of ambulances, specialist brigades are spent on cases without a real threat to human life.

And therefore there was a need for the regional polyclinic to organize an emergency medical care room. Now, when a telephone call arrives to the ambulance at 03, 5-15-33, 033, 112 on the cellular telephone 033, 112 the paramedic( ambulance dispatcher) on receiving emergency calls distributes calls according to severity and urgency.

Principle of operation of the

cabinet When there is no immediate threat to the life and health of the patient, urgent hospitalization is not required, and this is a call for acute illnesses or exacerbation of chronic ones. They are transferred to the emergency room and qualified help is provided by the doctor's assistant in patient treatment regimens. For these purposes, there are appropriate medications( in accordance with the list of essential and essential drugs approved in the established order, which is also included in the first-aid kit in the treatment room) and equipment. A sanitary car is attached to the office.

Emergency medical care in the office The Nechaevskaya CRH is immediately and at home, processed within no more than two hours after the registration of the call. In cases where the paramedic of the emergency care unit finds out that the patient's condition is more serious than previously thought, in the absence of the effect of medical care, worsening of the patient's condition and the emergence of life-threatening conditions, he organizes a call of an ambulance team, or transports the patient for hospitalizationin the hospital alone. After the provision of emergency care, information about the medical care provided to the patient is passed on to the district doctor for a follow-up visit to monitor the condition, the course of the disease and timely assignment( correction) of the necessary examination and( or) treatment( active visit) during the day.

When an ambulance is needed

An ambulance leaves when a person's life is in danger and emergency medical care is required.

All calls from the public about an accident, injury, electric injury, poisoning, indomitable vomiting, an intractable attack of bronchial asthma, acute abdominal pain, chest pain, alcohol abstinence syndrome of severe severity, as well as calls from the street, public places, medical facilities, pre-school and school institutions, regardless of the reason for the challenge, are carried out by the ambulance department and are part of the doctor's duties.

Emergency room operation mode

The emergency room is located in the polyclinic on the first floor, opposite the registry. Office hours coincide with the mode of the clinic: from 8.00-16.00( Tuesday-Friday), on Monday from 8.00-17.00, except on Saturday and Sunday and public holidays. In the office, a paramedic is working: they will alternately provide assistance at home and directly in the office. During non-working hours( when the polyclinic does not work) urgent calls, as before, will be served by an ambulance. The emergency room began its work in full since 01.12.2014.

Equipment

Premises of the emergency room include: an outpatient clinic and treatment room, are provided with telephone communication, ambulance transport.

The control over the activity of the emergency room is carried out by the responsible ambulance doctor Mihailychenko E. V. and the chief doctor of the HBUZ "Nechaevskaya CRH" Ryabtseva O.G.

Emergency medical care is provided at the outpatient clinic for treatment, at home at the exit - only in the village of Nekhaevskaya, in the region emergency nurse, paramedic assistant and feldsher-midwife stations( FAP) and medical outpatient clinics( VA), district hospitals( UB), in their absence the ambulance crew leaves.

Who can contact

Patients who came to the clinic for treatment may turn to the office, and they become ill( pain, temperature, pressure and other symptoms that do not endanger life).Also here you can measure the pressure, consult, if the patient does not know to which specialist he should apply.

• The Emergency Room of the Nekhaevsky Central District Hospital is organized by the

emergency room. The paramedic assigned to the office is Yuri Tarantsev, contact phone: 8( 84443) 5-15-33.

Sample-example of the order on the creation and organization of the work of the cabinet

Order on the establishment No. 199 of 19.11.2014 "On the organization of the emergency room for the adult population of the polyclinic of the Nekhaevsky Central District Hospital."

In accordance with the order of the Ministry of Health of the Volgograd region of September 11, 2014 № 2334 "On the organization of the work of the emergency medical care unit in the public health institutions of the Volgograd region, providing medical care in outpatient conditions", in accordance with the order of the Ministry of Health and Social DevelopmentRussia from 15.05.2012 № 542n "On approval of the Regulation on the organization of primary health care for the adult population"

ORDER:

1. From 01.12.2014 Oranizovat work emergency adult population cabinet clinic GBUZ "Nehaevskaya CRH."

2. To approve:

• Regulations on the emergency room of the polyclinic.(Annex 1).
• List of outfitting emergency medical team.(Annex 2).
• The list of reasons for calling the paramedic of the emergency room for the adult population.(Annex 3).

3. Control over the execution of the order is entrusted to the district therapist Mikhailichenko E.V.

Chief Physician OG Ryabtseva

Appendix 1 to the order of the Chief Physician No. 199 dated 11/19/2014.

Regulation on the work of the emergency room of the polyclinic

1. General provisions of

• The emergency medical care cabinet is a structural unit of the polyclinic and is organized to provide medical care for sudden acute illnesses, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care( hereinafter - emergency conditions).Provision of emergency medical care to persons who have treated with signs of emergency conditions can be carried out in an outpatient setting or at home when called by a medical professional.
• Emergency medical assistance can be provided as a primary first aid for paramedics by paramedics, also as primary medical care by medical specialists.
• The headcount of the medical emergency room is established by the head of the medical organization in whose structure he is a member. Medical assistance in the emergency room can be provided by medical personnel of the emergency medical office or medical personnel of other departments of the organization in accordance with the schedule of the duty approved by its leader.
• Emergency medical care for people who have turned to a medical organization with signs of emergency conditions, is on the direction of the registrar without delay.
• Emergency medical assistance at home is carried out within no more than 2 hours after receipt of the treatment of the patient or another person about the provision of emergency medical care at home.
• In the absence of the effect of medical care, the deterioration of the patient's condition and the emergence of life-threatening conditions, health care workers take measures to eliminate them using fixed or portable emergency medical care and arrange a call of an emergency medical care team or transport the patient to a medical organization that provides specializedmedical assistance, accompanied by a medical professional.
• After providing emergency medical care to the patient and eliminating or reducing the manifestations of an emergency condition, the patient is referred to the doctor or the local doctor receives information about the patient to visit the patient to monitor his condition, the course of the disease and timely assignment( correction) of the necessary examination and( or)treatment( active visit) during the day.
• The district therapist supervises the work of the cabinet and direct management of the cabinet.
• The main functional unit of the cabinet is the paramedic visiting brigade.
• Brigades are created in accordance with staff standards with the expectation of ensuring an approved operating mode.
• Cabinet activity is performed by the medical staff of the institution in accordance with the schedule of call service, approved by the head physician of the health care institution.

2. The main tasks of the cabinet

• The organization and provision of emergency medical care to the adult population in accordance with the approved list of reasons for calling the department doctor.
• Carrying out systematic work to improve professional knowledge. Practical skills of medical personnel.
• Development and improvement of organizational forms and methods of providing emergency medical care, introduction of modern technologies, improving the quality of medical personnel.

3. Basic functions and organization of work

• Reception of calls from the population of a fixed service area( by phone and at direct request), registration of calls in the call reception log and transferring them for execution to personnel is performed by the registry medical officer, as well as by the dispatcher of the emergency room.
• Emergency medical care for patients at home.
• Organization, if necessary, of emergency hospitalization of patients through the emergency room( hereinafter referred to as SME).In case of patient's refusal from hospitalization, the medical worker's refusal to admit hospitalization with indication of possible consequences, with the corresponding entry in the medical documentation and the signature of the patient or his legal representative and medical worker providing medical care at home.
• Statement of death by an employee of the Cabinet in accordance with the procedure established by law.
• Organization of interaction with district doctors and doctors - specialists of this outpatient clinic.
• Advising relatives on the care of patients in case of need.
• Compliance with norms and rules of sanitary and hygienic and anti-epidemic regimes.
• Maintaining the necessary medical records( emergency medical aid team call card, emergency medical aid call log from the public).
• Participation in conferences, discussions, consultations held in an outpatient clinic, which includes an emergency room at home for adults and other institutions( by order of senior officials), in accordance with the established procedure.
• Compliance with the requirements for the protection and safety of labor, the rules of internal labor regulations of the outpatient clinic.
• In the case of temporary incapacity for work of the patient, the paramedic of the emergency room gives him a compulsory emergency call( which reflects health status, diagnosis), as well as the conclusion about the need for temporary release from work.

Appendix No. 2 to the order of the chief physician № 199 from 11/19/2014.

List of equipment for the emergency medical team:

Apparatus:

1. Electrocardiograph.
2. Oxygen inhaler.
3. Bag of amber.
4. Glucometer( in the set - 10 strips).
5. Tonometer.
6. Phonendoscope.

Medical drawer:

1. Medical scissors 1 pc. Spatula disposable 10 pcs. Urinary catheter disposable 2 pcs.
2. Haemostatic forceps 1 pc.
3. Medical thermometer in a case 2 pcs.
4. Harness for intravenous injection 1 pc.
5. Sterile disposable tweezers 1 pc.
6. Syringes with needle disposable sterile 2ml, 5 ml, 10 ml, 20 ml( 5 pieces each)
7. Disposable sterile system for infusion of infusion solutions 5 pcs.
8. Plaster for fixation to / in catheters 1 pc.
9. Medical disposable mask 10 pcs. Shoe covers disposable 10 pcs.
10. Container with disinfectant for use of needles( needle striker) 1 pc. Gloves rubber non-sterile, non-sterile 10 pairs.

Bandages:

1. Sterile bandages of various sizes 10 pcs.
2. Bactericidal plaster 1 pack( 20 pcs.)
3. Hemostatic sponge small 5 pcs.
4. Hemostatic sponge large 5 pcs.
5. Bandage mesh, tubular( shin, hip, forearm) 5 pcs.

Medicines:

Drugs: first-aid kit in the cabinet, its composition:

1. Aminophilin( euphyllin) 2.4% - 10 ml / 1 ampoule
2. Ammonia 10% - 40 ml / 1 bottle
3. Analgin 50% - 2.0 ml / 3 ampoules
4. Anaprilin 0.04 g / 1 package
5. Atropine sulfate 0, 1% - 1 ml / 3 ampoules
6. Acetylsalicylic acid( aspirin) 1 package
7. Betadin 10%( iodine) - 30 ml / 1 bottle
8. Baralgin 5.0 ml / 2 ampoules
9. Verapamil( isoptin) 2.0 ml / 2 ampoules
10. Glycine 0.1g / 20 tablets
11. Calcium glucon 10% - 10.0 ml / 2 ampoules
12. Dexamethasone 4mg / 1mg / 2 ampoules
13. Dextran( Polyglucin) 400/1 vial
14. Dextrose( Glucose) 40% - 10 ml / 4 ampoules
15. Digoxin 0, 025% -1 ml( Korglikon 0.06% -1.0 ml) / 2 ampoules
16. Droperidol 0.25% - 2 ml / 1 ampoule
17. Drotaverine( no-spike) 40 mg / 2ml / 3 ampoules
18. Dimedrol 1% -1.0 ml / 2 ampoules
19. Diclofenac 25 mg / 3.0 ml / 3 ampoules
20. Isosorbide - dinitrate( isotetic spray), nitromint spray / 1 bottle
21. Potassium magnesium asparaginate( panangin) 5ml / 2 ampoules
22. CaptoprilKapoten) 25 mg No. 10/1 plate
23. Ketorolac( Ketorol) 30 ml / 2 bottles
24. Clemastine( Tavegil) 2mg / 2ml / 2 ampoules
25. Corvalol 25 ml / 1 bottle
26. Sodium caffeine sodium benzoate 20% - 1 ml / 1 ampoule
27. Magnesium sulfate 25% - 10 ml / 4 ampoules
28. Vaseline oil 25 ml / 1 bottle
29. Metoclopramide( Cerucal) 10 mg / 2 ml / 2 ampoules
30. Sodium chloride 0,9% - 10 ml / 4 ampoules
31. Sodium chloride 0,9% - 500 ml / 1 bottle
32. Nitroglycerin 0,0005 No. 40/1 package
33. Nifedipine( Corinfar) 1 mg No. 100/1 package
34. Novocaine amide 10% - 10.0 ml / 2 ampoules
35. Hydrogen peroxide 3% - 40 ml / 1 bottle
36. Papaverine hydrochloride 2% - 2 ml /2 ampoules
37. Platifillinahydrotartrate 0.2% - 1ml / 1 ampoule
38. Prednisolone 30mg / ml - 1ml / 4 ampoules
39. Alcohol wipes 10 pieces
40. Activated charcoal 0,25 # 10/5 packs
41. Lafrin( mezaton) 1% - 1 ml / 2 ampoules
42. Furosemide( Lasix) 20mg / 2ml / 5 ampoules
43. Chloropyramine( Suprastin) 2% - 1 ml / 2 ampoules
44. Epinephrine( Adrenaline) 0.1% - 1ml / 5 ampoules

Appendix # 3 to the order of the chief physician № 199 from 11/19/2014

List of reasons for calling the paramedic of the emergency room for the adult population

1. Headache in the background of blood pressure( without pronounced blood pressure from the usual figures and other symptoms indicative of the presence of a hypertensive crisis);
2. Habitual headache with migraine;
3. A non-intense headache in the face of increased fever;
4. Joint pain syndrome;
5. Phantom pain;
6. Pain under the cast;
7. Pain in the spine( with a preliminary examination of the doctor);
8. Pain syndrome after trauma;
9. Pain syndrome in cancer patients;
10. Pain on the background of trophic ulcers and pressure sores;
11. Abdominal pain on the background of the established diagnosis of chronic gastritis, gastric ulcer and 12 duodenum( without symptoms of perforation and bleeding);
12. Pain in the throat, ear, toothache( if there is a preliminary examination of the doctor);
13. Temperature for oncological diseases;
14. Temperature for ARVI( in the absence of pain and symptoms of dyspnea);
15. Temperature with established diagnosis of sinusitis;
16. Temperature after subcooling;
17. Rashes on the skin without difficulty breathing;
18. Dyspeptic disorders in the background of chronic gastrointestinal diseases;
19. Violation of urination( except acute urinary retention).