1. EMERGENCY MEDICAL CARE AND EMERGENCY ROOM IN MSF SETTINGS

2. EMERGENCY ROOMS
No emergency medical care referent in MSF F before September 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 /sem
Teme Hospital / NIGERIA /sem
Hangu Hospital / PAKISTAN /sem
Rutshuru Hospital / CONGO DR /sem
+/- Khameer & Althal Hospitals / YEMEN
Mullaitivu Hospital / SRI LANKA /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. 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

7. 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

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 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

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 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. 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. 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, ...)

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