In the news again, now almost daily…
Referring to the Short English Oxford Dictionary
Accident is defined as “An event that is without apparent cause, or unexpected; an unfortunate event
Emergency is defined as “A situation, especially of danger or conflict, that arises unexpectedly and requires urgent action”
As a medical student it was an invaluable part of our training to spend time in the department to learn skills such as giving injections,dressings and sutures aswell as being accustomed with medical emergencies and accidents. I can remember a patient walking into ‘Casualty’ as we referred to it with an arrow through his head ! – both an accident and an emergency!
0n one occasion I attempted to administer my first tetanus injection to a miner (skin black with coal dust) and when I swabbed his skin clean he looked down at the white patch and then took flight down the corridor leaving me standing with needle and syringe. I sutured international rugby players with various lacerations.
Cardiff Royal Infirmary on a Saturday afternoon /evening was the ideal place to become skilled in dealing with accidents and emergencies. The reception desk was manned by stern middle aged women who vetted each person as they arrived and if they thought it was not an accident or emergency they were sent home and firmly reminded that their attendance was inappropriate.
This a far cry from my experience of Hillingdon A&E where I work from time to time. The receptionists at the desk book the patients in but can only mutter under their breath when they book in inappropriate attendees, the worried well, the pitifully minor injuries only needing an Elastoplast, the numerous patients who arrive with a history of having vomited 20- 30 minutes ago or on one occasion an ‘intelligent’ parent bringing a child who had developed abdominal pain following drinking cold milk out of the fridge. Also the repeated attendances of those who have had a condition for weeks or even months who seemingly on a whim appear in A&E .
There have been many changes.
Serious trauma or medical cases brought in by ambulance enter by a separate entrance and taken straight to majors. Those with chest pain entering via A&E reception are sent for triaging to majors clutching a red cardboard heart. People who are seen at reception are sent for triage with the A&E nurses and others are sent to the Urgent Care Centre where they are seen by a GP or Nurse Practitioner. There is also a clinic (Primary Care Clinic) which is run by GP’s and they are people that have phoned 111 and have been given a specific appointment.
For the most part this works well and people with significant problems are seen quickly and efficiently seen but inevitably on a Bank Holiday this may not be the case. Also the advent of the 111, which has been in operation in Hillingdon as a pilot for longer than the recent national launch , has unfortunately had its teething problems. In Hillingdon patients and doctors feedback is taken seriously and adjustments or protocols are introduced to adapt to a change in situation ( eg regarding management of vomiting when there is an outbreak of gastroenteritis) Also, there is cooperation between all areas so that patients can be transferred to an appropriate clinician if necessary.
The Faculty of Emergency Medicine only started in 1991 and was was defined by the International Federation for Emergency Medicine as:
“A field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”
This also means that doctors and nurse who work in these departments have had specific training in Emergency Medicine.
The specialty of Emergency Medicine aims to provide an around the clock care to patients who present with symptoms of acute illness and injury, across the whole age spectrum. In the UK , Emergency Medicine as a specialty is constantly adapting and developing. This has been in response to external pressures, for example the multiplicity of changes in the provision of out of hours and acute care, changes in the expectations of patients, changes in medical practice, government targets such as the “4 hour target,” as well as discussion and internal debate around the future direction of emergency and urgent care.
As I alluded to the specialty is quite different now compared to the first “casualty surgeons” in the 60’s and 70’s. The emphasis has developed beyond simply treating traumatic injury, to encompass critical and acute care for a much wider range of problems.
Most Emergency Departments are open 24 hours a day, 7 days a week. All will have resuscitation facilities for the critically ill, cubicles to see other sorts of patients, and access to investigations (such as blood tests and X-rays) to help make diagnoses.
Patients with acute illness or injury can present at any time, with a wide range of problems. Patients often have “undifferentiated” presentations (i.e. they don’t come in with a known diagnosis), with little initial information available apart from that obtained by talking to the patient; the history, examination and bedside investigations. There is a great challenge in providing rapid and appropriate treatment in the first hours, but effective early diagnosis and treatment has been shown to make big differences for short and longer term outcome in many conditions.
It is not possible or practical to have an experienced representative from every hospital sub-specialty standing by in the Emergency Department at all times. Emergency Medicine evolved because emergencies can occur in any age group, at any time, in one or many body systems, and emergency physicians developed expertise as specialised generalists. This enables them to make working diagnoses, start appropriate treatment, and if the problem can’t be completely fixed at the time refer on to other appropriate specialists.
Not all acute problems need to be dealt with in Emergency Departments, and there are now a number of different ways in which patients can access help. If you want to know where your nearest service is there is website which should be able to help at:
Where I work in Hillingdon Hospital the walk in clinic and Primary Care Clinic are located in the hospital but there others located in other venues listed on our website.
WHAT TO DO IN AN EMERGENCY?
In the case of a life threatening accident or emergency always call 999
For illnesses that are not life threatening you should first contact your GP surgery. Outside of normal surgery hours you can still phone your GP, but you will usually be directed to an out-of-hours service. The out-of-hours period is from 6.30pm to 8am on weekdays, and all day at weekends and on bank holidays.
During out-of-hours periods you can also call NHS 111
NHS 111 is the new three-digit telephone service has been introduced to improve access to NHS urgent care services. Patients can use this number when they need medical help or advice and it’s not urgent enough to call 999. NHS 111 operates 24/7, 365 days per year and is free to use from a landline and a mobile. The website has useful guidance when to call their number.
Do you want to learn more about first aid and what you can do in an emergency?
We are hoping to offer this to anyone who would like to do this . I thoroughly recommend this to anyone, as it involves how to deal with common accidents and emergencies aswell as Basic Life Support training in adults and children. The 3 hour session will be held at the surgery in groups of 8 people. I am afraid there will be a fee as the professionals teaching this are highly trained.
All practise staff including doctors have to undertake this regularly and everyone has found it very useful and informative
If you interested please contact our practise manager by email or give your details to one of the receptionists and we will contact you regarding dates and times.
In the news again, now almost daily… Referring