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Emergency Medicine: Triage & Protocols

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Triage categories and emergency response protocols.

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Emergency medicine

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  1. 1Emergency medicine
    The medical specialty concerned with care of illnesses or injuries requiring immediate medical attention, specializing in unscheduled and undifferentiated patients of all ages
  2. 2Emergency physicians responsible for
    Initiating resuscitation, stabilization, and early interventions during the acute phase of a medical condition, in coordination with emergency medical services
  3. 3Where do emergency physicians generally practice?
    Hospital emergency departments, pre-hospital settings via EMS, intensive care units, and primary care settings like urgent care clinics
  4. 4Some sub-specialties of emergency medicine
    Disaster medicine, medical toxicology, point-of-care ultrasonography, critical care medicine, EMS, hyperbaric medicine, sports medicine, palliative care, aerospace medicine
  5. 5Anglo-American model of emergency medicine
    Emergency medicine as a recognized specialty with dedicated training programs, where emergency physicians manage patients in the ED
  6. 6Franco-German model of emergency medicine
    Emergency care provided directly by specialists (anesthesiologists, surgeons, internists) as appropriate, rather than by dedicated emergency medicine specialists
  7. 7Significant diseases treated in emergency medicine
    Trauma, sepsis, burns, acute coronary syndrome, poisoning, stroke, cardiac arrest, psychiatric crisis, and unconsciousness
  8. 8Significant tests used in emergency medicine
    Primary survey (ABCDE), blood tests, blood gas, ECG, ultrasound, X-rays, and CT scans
  9. 9Primary survey (ABCDE) in emergency medicine
    A systematic approach to assess: Airway, Breathing, Circulation, Disability (neurological status), and Exposure/Environment
  10. 10Why is Dominique Jean Larrey sometimes called the Father of Emergency Medicine?
    For his strategies of using ambulances with trained crews to transport wounded to centralized field hospitals during French wars
  11. 11'Alexandria Plan'
    The first 24/7 year-round emergency care established in 1961 by Dr. James DeWitt Mills and associates at Alexandria Hospital in Virginia
  12. 12Royal College of Emergency Medicine
    UK organization (formed 2005) that conducts membership and fellowship examinations and publishes guidelines and standards for emergency medicine practice
  13. 13EMTALA
    Emergency Medical Treatment and Active Labor Act, enacted by US Congress in 1986 to curtail 'patient dumping' by requiring EDs to provide care regardless of ability to pay
  14. 14What does EMTALA require of emergency departments?
    Hospitals must provide medical screening and stabilize emergency medical conditions of anyone presenting at an ED with patient capacity, regardless of ability to pay
  15. 15Penalty for EMTALA violations
    Civil penalties of up to $50,000 for both hospitals and responsible ED physicians
  16. 16Goal of EMTALA
    To prevent 'patient dumping' - the practice of refusing medical care for economic or other non-medical reasons
  17. 17How much did ED visits increase after EMTALA's enactment?
    One study showed a 26% rise in visits (more than double the population increase over the same period)
  18. 18Can on-call physicians be held liable under EMTALA?
    Yes, liability extends to on-call physicians that fail to respond to ED requests to come to the hospital to provide service
  19. 19'patient dumping'
    The practice of refusing medical care to patients for economic or other non-medical reasons
  20. 20Triage in emergency medicine
    The process of determining the priority of patients' treatments based on the severity of their condition when resources are insufficient for all
  21. 21Medical abandonment in emergency medicine
    Termination of the patient-provider relationship prior to stabilization or without handoff to another qualified provider
  22. 22What must a physician verify before initiating an outside transfer?
    That the next hospital can provide a similar or higher level of care, and that the transfer won't aggravate the patient's condition
  23. 23Five essential tasks for patient-physician communication in emergency medicine
    Establishing rapport, gathering information, giving information, providing comfort, and collaboration
  24. 24Why is emergency medicine particularly susceptible to medical error?
    Regular transfer of patients, crowded/noisy/chaotic ED environments, frequent interruptions, and high patient turnover
  25. 25What error rate was identified in one academic ED study?
    18 errors per 100 registered patients
  26. 26HEEAL mnemonic for medical error disclosure
    Honesty, Explanation, Empathy, Apology, and Lessen the chance of future errors
  27. 27What teamwork failures contribute to ED medical errors?
    Poor communication, lack of team structure, and lack of cross-monitoring (averaging 8.8 teamwork failures per case)
  28. 28What percentage of emergency care in the US is uncompensated?
    Approximately 55% of all quantifiable emergency care is uncompensated
  29. 29ED overuse estimated to cost annually
    $38 billion in spending each year (care delivery failures, over-treatment, administrative complexity, pricing failures, fraud)
  30. 30Typical shift lengths for emergency physicians
    8-12 hour shifts; they do not tend to work on-call

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