OVE VERVI VIEW EW Emer ergen gency cy and T d Trauma Care S - - PowerPoint PPT Presentation

OVE VERVI VIEW EW

• Emer

ergen gency cy and T d Trauma Care S e System ems

• The

e DCP em emer erge gency ncy compon ponen ents ts of es essen entia ial pa package ges

• WH

WHO Emer ergency gency Care e System em Framewor

• rk
• Emer

ergenc gency Car are e System em Asses essm smen ent t Tool

PREVENTION REHABILITATION

EMERGENCY CARE SYSTEMS

PREHOSPITAL & TRANSPORT FACILITY-BASED CRITICAL CARE

TRAUMA SYSTEMS

Of 45 m million llion ann nnua ual l deaths ths in n LMICs, Cs,

54% 54%

are due to condit itions ions addres essable sable by prehospi hospital tal and emerge ergency y care. .

1,0 1,023 23 mi million lion DALYs Ys, , 932 932 mi million lion yea ears s of life e lost st

to premature emature mortality tality.

Emergenci gencies es occur ur everywher where, e, and each h day they y consume sume resour urces ces regardl dless ess of whet ether her there re are re system ems s capable ble of achievin ing g good d outcomes comes. Kobusi usingy ngye, Bulletin tin of WHO

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Essential packages at each level of the health system include emergency components.

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)* )* Initiat iate e magnesi esium m sulphat hate Det etec ection tion of sepsis sis First st Level el Hospital ital Managem agement t of labour bour and deliv liver ery in high risk sk wo women men Caesa esarean an Vac acuum m extractio ion/f /for

• rceps

s deliv livery Ectopic

• pic preg

egnancy ancy Vac acuum aspir iratio ion and dilatation latation and cure rette Hyster erectom

• my for uterine

ine rupture e or intrac actable table post-par artum m haemor emorrhag hage Anten enatal atal steroids* ids* Magnesium ium sulphat ate Treatmen eatment of sepsis sis Induction tion of labo bour post-ter erm Ectopic

• pic preg

egnancy ancy case se managem agemen ent* Det etec ection ion and d mana nage gemen ment of feta fetal l gro rowt wth h restr tric iction tion*

* Denotes that the intervention effect was included in the Lives Saved Tool (LiST).

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)* )* Initiat iate e magnesi esium m sulphat hate Det etec ection tion of sepsis sis First st Level el Hospital ital Managem agement t of labour bour and deliv liver ery in high risk sk wo women men Caesa esarean an Vac acuum m extractio ion/f /for

• rceps

s deliv livery Ectopic

• pic preg

egnancy ancy Vac acuum aspir iratio ion and dilatation latation and cure rette Hyster erectom

• my for uterine

ine rupture e or intrac actable table post-par artum m haemor emorrhag hage

Child and Newbor

• rn

n Health th

Community Facility Detect and refer severe acute malnutrition Detect and treat serious infections without danger signs Thermal care for preterm newborn Neonatal resuscitation Oral antibiotics for pneumonia Primary Health Centre Treat severe acute malnutrition Detect and treat serious infections with danger signs* Kangaroo mother care Injectable and oral antibiotics for sepsis, pneumonia and meningitis Jaundice management First Level Hospital Treat severe acute malnutrition associated with serious infection* Detect and treat serious infections with danger signs with full supportive care* Full supportive care for preterm newborn* Treatment of newborn complications, meningitis and other very serious infections*

* Denotes that the intervention effect was included in the Lives Saved Tool (LiST).

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)* )* Initiat iate e magnesi esium m sulphat hate Det etec ection tion of sepsis sis First st Level el Hospital ital Managem agement t of labour bour and deliv liver ery in high risk sk wo women men Caesa esarean an Vac acuum m extractio ion/f /for

• rceps

s deliv livery Ectopic

• pic preg

egnancy ancy

Child and Newbor

• rn

n Health th

Community Facility Detect and refer severe acute malnutrition Detect and treat serious infections without danger signs Thermal care for preterm newborn Neonatal resuscitation Oral antibiotics for pneumonia Primary Health Centre Treat severe acute malnutrition Detect and treat serious infections with danger signs* Kangaroo mother care Injectable and oral antibiotics for sepsis, pneumonia and meningitis Jaundice management First

Injur ury

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Resuscitation with BLS measures Suturing laceration Management of non- displaced fractures First st Level el Hospital ital Resuscitation with advanced life support measures, including surgical airway Tube thoracostomy (chest drain) Trauma laparotomy Fracture reduction Irrigation and debridement of open fractures Placement of external fixator; use of traction Escharotomy/fasciotomy (cutting of constricting tissue to relieve pressure from swelling) Trauma-related amputations Burr hole

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)* )* Initiat iate e magnesi esium m sulphat hate Det etec ection tion of sepsis sis First st Level el Hospital ital Managem agement t of labour bour and deliv liver ery in high risk sk wo women men Caesa esarean an

Child and Newbor

• rn

n Health th

Community Facility Detect and refer severe acute malnutrition Detect and treat serious infections without danger signs Thermal care for preterm newborn Neonatal resuscitation Oral antibiotics for pneumonia Primary Health Centre Treat severe acute malnutrition Detect and treat serious infections with danger signs* Kangaroo mother care Injectable and oral antibiotics for sepsis, pneumonia and meningitis Jaundice management First Level Hospital Treat severe acute malnutrition associated with serious infection*

Injur ury

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Resuscitation with BLS measures Suturing laceration Management of non- displaced fractures First st Level el Hospital ital Resuscitation with advanced life support measures, including surgical airway Tube thoracostomy (chest drain) Trauma laparotomy Fracture reduction Irrigation and debridement of open fractures Placement of external fixator; use of traction Escharotomy/fasciotomy (cutting of constricting tissue to relieve pressure from swelling) Trauma-related amputations

Genera eral Surgical cal

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Drainage of superficial abscess Drainage of septic arthritis Debridement of osteomyelitis First st Level el Hospital ital Repair of perforations: for example, perforated peptic ulcer, typhoid ileal perforation Appendectomy Bowel obstruction Colostomy Gallbladder disease, including emergency surgery Hernia, including incarceration Relief of urinary obstruction: catheterization or suprapubic cystostomy

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)* )* Initiat iate e magnesi esium m sulphat hate Det etec ection tion of sepsis sis First st Level el Hospital ital

Child and Newborn Health

Community Facility Detect and refer severe acute malnutrition Detect and treat serious infections without danger signs Thermal care for preterm newborn Neonatal resuscitation Oral antibiotics for pneumonia Primary Health Centre Treat severe acute malnutrition Detect and treat serious infections with danger signs* Kangaroo mother care

Injur ury

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Resuscitation with BLS measures Suturing laceration Management of non- displaced fractures First st Level el Hospital ital Resuscitation with advanced life support measures, including surgical airway Tube thoracostomy (chest drain) Trauma laparotomy

Genera eral Surgical cal

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Drainage of superficial abscess Drainage of septic arthritis Debridement of osteomyelitis First st Level el Hospital ital Repair of perforations: for example, perforated peptic ulcer, typhoid ileal perforation Appendectomy

Menta tal, Neurol

• logical
• gical, and Substan

stance ce Ab Abuse use Disor

• rder

ders

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Management of prolonged seizures or status epilepticus (neurological disorders) Emergency management of poisoning (suicide and self-harm) First st Level el Hospital ital Diagnosis and management of acute psychoses (mental health disorders) Management of severe dependence and withdrawal (alcohol and illicit drug use) Spec ecia ialised lised Car are Electroconvulsive therapy for severe or refractory depression (mental health disorders)

EMERGENCY COMPONENTS OF ESSENTIAL PACKAGES

Obst stetric, tric, Gynecolo cologic, gic, Reproducti ductive e Health h and Family Plannin ing

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Managem agement t of labour bour and deliv liver ery including ding initia ial l treatme eatment t of complic lications tions Post-GB GBV car are e (preven entio ion of STI/ TI/HI HIV, , emer ergen ency con

• ntr

tracep eptio ion, , suppor

• rt/c

t/counseli

• unseling)

Managem agement t of uninten ende ded d pregnancy ancy Managem agement t of miscarriage iage/i /incom

• mple

lete e abor bortion tion and post abor bortio tion car are* e* Antib ibio iotics tics for pPRoM

• M

Tetan etanus toxoi

• id*

Scree eening ing for com

• mplica

licatio ions s of pregnancy ancy Initiat iate e anten enatal atal ster eroi

• ids (as long as clin

inical ical crit iter eria ia and d standa dards s are e met et)*

Child and Newborn Health

Community Facility Detect and refer severe acute malnutrition Detect and treat serious infections without danger signs Thermal care for preterm newborn Neonatal resuscitation Oral antibiotics for pneumonia Primary Health Centre Treat severe acute malnutrition

Injur ury

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Resuscitation with BLS measures Suturing laceration

Genera eral Surgical cal Menta tal, Neurol

• logical
• gical, and Substan

stance ce Ab Abuse use Disor

• rder

ders

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre

Cancer cer Care

Comm mmunity ity Facili ility and d Prima mary Healt alth h Centr tre Hep B vaccination (including birth dose) First st Level el Hospital ital Emergency surgery for obstruction

WHO EMERGENCY CARE SYSTEM FRAMEWORK

EMERGENCY CARE SYSTEM FRAMEWORK

• Document of consensus-based essential

components of emergency care systems.

• Designed for ministries, policy makers, health

system administrators, and general advocacy

• Facilitates the identification of system gaps to aid in

priority setting.

WHO EMERGENCY CARE SYSTEM FRAMEWORK

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Scene Transfer Facility

Bystander Response Patient Transport Inpatient Care Provider Response Dispatch Transport Care Emergency Unit Care Disposition Reception

WHO EMERGENCY CARE SYSTEM FRAMEWORK

SCENE

Bystander Response

Primary Functions Components Site

System Activation Bystander Care

WHO EMERGENCY CARE SYSTEM FRAMEWORK

SCENE

Bystander Response

Primary Functions

Dispatch

Components Site

System Activation Bystander Care Dispatch of Personnel Instructions to Bystanders

WHO EMERGENCY CARE SYSTEM FRAMEWORK

SCENE

Bystander Response

Primary Functions

Provider Response Dispatch

Components Site

System Activation Bystander Care Dispatch of Personnel Instructions to Bystanders Scene Control Scene Care Field to Facility Communication Destination Triage

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Site

TRANSFER

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Site

TRANSFER

Patient Transport

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Site

TRANSFER

Patient Transport Transport Care

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Components Site

FACILITY

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Components Site

FACILITY

Reception

Registration Screening Triage Handover

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Components Site

FACILITY

Reception Emergency Unit Care

Registration Screening Triage Handover Initial Assessment & Resuscitation Monitoring and Revaluation Detailed Assessment Diagnostic Studies Additional Therapeutics Establishing Diagnoses

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Components Site

FACILITY

Reception Emergency Unit Care Disposition

Registration Screening Triage Handover Communication System with Protocols Initial Assessment & Resuscitation Monitoring and Revaluation Detailed Assessment Diagnostic Studies Additional Therapeutics Establishing Diagnoses

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Primary Functions Components Site

FACILITY

Reception Emergency Unit Care Disposition Inpatient Care

Registration Screening Triage Handover Communication System with Protocols Early Operative Care Early Critical Care Initial Assessment & Resuscitation Monitoring and Revaluation Detailed Assessment Diagnostic Studies Additional Therapeutics Establishing Diagnoses

WHO EMERGENCY CARE SYSTEM FRAMEWORK

Scene Transfer Facility

Bystander Response Patient Transport Inpatient Care Provider Response Dispatch Transport Care Emergency Unit Care Disposition Reception

WHO EMERGENCY CARE SYSTEM FRAMEWORK

EMERGENCY CARE SYSTEM ASSESSMENT TOOL

EMERGENCY CARE SYSTEM ASSESSMENT TOOL

• An instrument for internal or external assessment of

national or sub-national emergency care systems.

• Survey structure in which answers represent

progressive stages of system development

• Creates roadmap functionality to guide priority

setting.

• Goal is to generate priority action plans

ECS ASSESSMENT TOOL

Emergency unit staffing in first-level referral facilities:

First-level referral facilities are the lowest level of facility that receives referrals. In many countries, these are district hospitals. An emergency unit is any dedicated intake area for acutely ill and injured patients. This may be referred to as the Emergency Department/Room/Ward, Accident and Emergency, Casualty, etc.

There are no dedicated emergency units or no providers with specific responsibility for emergency unit patients until they are admitted. 1 There are non-doctor staff that register and direct patients from the emergency unit to inpatient areas (the unit has a sorting function, but minimal care is provided). 2 Doctors from inpatient services have on-call responsibility to cover emergency unit patients, but are not assigned to be in the emergency unit. 3 Doctors from inpatient services are assigned to be in the emergency unit, rotating through for limited intervals (e.g. 1 month blocks). 4 There are non-rotating providers that permanently staff the emergency unit. 5 I don’t know. ☐ Cannot answer for another reason (explain): ☐

WHO EMERGENCY CARE SYSTEM FRAMEWORK

PREVENTION REHABILITATION

EMERGENCY CARE SYSTEMS

PREHOSPITAL & TRANSPORT FACILITY-BASED CRITICAL CARE

TRAUMA SYSTEMS

Mock et al. (2012) An Estimate of the Number of Lives that Could be Saved through Improvements in Trauma Care Globally. WJS

SDG 3.6 RTI fatality reduction target 625,000 RTI deaths

Mock et al. (2012) An Estimate of the Number of Lives that Could be Saved through Improvements in Trauma Care Globally. WJS

SDG 3.6 RTI fatality reduction target Lives potentially saved every year in LMIC by improvements in trauma care 562,000 RTI deaths 625K

Emergency Care and SDG Targets

3.1: Reduce by three quarters, between 2015 and 2030, the maternal mortality ratio Treatment for obstetric emergencies 3.2: Reduce by three quarters, between 2015 and 2030, the under-five mortality rate Treatment for diarrhea and pneumonia 3.3: Reverse the incidence of malaria and other major diseases and ensure that deaths caused by these diseases are reduced by a half in 2030 Treatment of acute infections and sepsis 3.4: By 2030, reduce by one-third premature mortality from NCDs Treatment of exacerbations of NCDs 3.5: Strengthen the treatment of substance abuse Emergency unit care and harm reduction interventions

3.6: Halve the burden due to global road traffic crashes by halving the number of fatalities and serious injuries by 2030 compared to 2010. Post-crash emergency care

3.8: Achieve universal health coverage including financial risk protection and access to quality essential healthcare services Emergency care is an essential component of health care 11.5: By 2030, significant reduce the number of deaths and people affected caused by disasters Disaster preparedness and response for resilient health systems

EMERGENCY CARE: DISEASE CONTROL PRIORITIES

The WHO Emergency Care System Framework and associated assessment tool are designed to characterize system gaps, set planning and funding priorities, and establish monitoring and evaluation strategies for system strengthening and development. Emergency care system strengthening will be essential for increasing global capacity for the emergency procedures DCP essential packages at each level of the health system include. Need to summarize and synthesize evidence of the effectiveness

• f emergency care interventions and provide comparative

economic evaluation of policies to implement those interventions.

PRE-HOSPITAL CARE