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: 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

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

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

ORGANIZATION: Triage area TARGETS: 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

ORGANISATION: Triage area Routine triage : 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

ROUTINE: SYNDROMIC APPROACH

ROUTINE: VITAL SIGNS APPROACH

Mass casualties incident

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

EMERGENCY ROOMS Long process ! Very long! Achieved: 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

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

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

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?

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 !

TARGETS IN THE FUTURE : SEVERE TRAUMA WILL NEED 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, ...)

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