Medical emergency

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A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified person, as some of these emergencies, such as cardiovascular (heart), respiratory, and gastrointestinal cannot be dealt with by the victim themselves. [1] Dependent on the severity of the emergency, and the quality of any treatment given, it may require the involvement of multiple levels of care, from first aiders through emergency medical technicians, paramedics, emergency physicians and anesthesiologists.

Contents

Any response to an emergency medical situation will depend strongly on the situation, the patient involved, and availability of resources to help them. It will also vary depending on whether the emergency occurs whilst in hospital under medical care, or outside medical care (for instance, in the street or alone at home).

Response

Summoning emergency services

Implementation of the two ITU approved emergency telephone numbers in the world:
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112
911
112 and 911
Other number, no redirection or redirection for mobile phones only Emergency telephone numbers in the world.svg
Implementation of the two ITU approved emergency telephone numbers in the world:
  112
  911
  112 and 911
  Other number, no redirection or redirection for mobile phones only

For emergencies starting outside medical care, a key component of providing proper care is to summon the emergency medical services (usually an ambulance), by calling for help using the appropriate local emergency telephone number, such as 999, 911, 111, 112 or 000. After determining that the incident is a medical emergency (as opposed to, for example, a police call), the emergency dispatchers will generally run through a questioning system such as AMPDS in order to assess the priority level of the call, along with the caller's name and location.

First aid and assisting emergency services

Those who are trained to perform first aid can act within the bounds of the knowledge they have, whilst awaiting the next level of definitive care.

Those who are not able to perform first aid can also assist by remaining calm and staying with the injured or ill person. A common complaint of emergency service personnel is the propensity of people to crowd around the scene of a victim, as it is generally unhelpful, making the patient more stressed, and obstructing the smooth working of the emergency services. If possible, first responders should designate a specific person to ensure that the emergency services are called. Another bystander should be sent to wait for their arrival and direct them to the proper location. Additional bystanders can be helpful in ensuring that crowds are moved away from the ill or injured patient, allowing the responder adequate space to work.

To prevent the delay of life-saving aid from bystanders, many states of the USA have "Good Samaritan laws" which protect civilian responders who choose to assist in an emergency. In many situations, the general public may delay giving care due to fear of liability should they accidentally cause harm. Good Samaritan laws often protect responders who act within the scope of their knowledge and training, as a "reasonable person" in the same situation would act.

The concept of implied consent can protect first responders in emergency situations. A first responder may not legally touch a patient without the patient's consent. However, consent may be either expressed or implied: [3]

Usually, once care has begun, a first responder or first aid provider may not leave the patient or terminate care until a responder of equal or higher training (such as an emergency medical technician) assumes care. This can constitute abandonment of the patient and may subject the responder to legal liability. Care must be continued until the patient is transferred to a higher level of care; the situation becomes too unsafe to continue; or the responder is physically unable to continue due to exhaustion or hazards.

Unless the situation is particularly hazardous and is likely to further endanger the patient, evacuating an injured victim requires special skills, and should be left to the professionals of the emergency medical and fire service.

The chain of survival

The principles of the chain of survival apply to medical emergencies where the patient is not breathing and has no pulse. This involves four stages:

  1. Early access
  2. Early cardiopulmonary resuscitation (CPR)
  3. Early defibrillation
  4. Early advanced life support (ALS)

Clinical response

Within hospital settings, an adequate staff is generally present to deal with the average emergency situation. Emergency medicine physicians and anaesthesiologists have training to deal with most medical emergencies, and maintain CPR and Advanced Cardiac Life Support (ACLS) certifications. In disasters or complex emergencies, most hospitals have protocols to summon on-site and off-site staff rapidly.

Both emergency department and inpatient medical emergencies follow the basic protocol of Advanced Cardiac Life Support. Irrespective of the nature of the emergency, adequate blood pressure and oxygenation are required before the cause of the emergency can be eliminated. Possible exceptions include the clamping of arteries in severe hemorrhage.[ citation needed ]

Non-trauma emergencies

While the golden hour is a trauma treatment concept, two emergency medical conditions have well-documented time-critical treatment considerations: stroke and myocardial infarction (heart attack). In the case of stroke, there is a window of three hours within which the benefit of thrombolytic drugs outweighs the risk of major bleeding. In the case of a heart attack, rapid stabilization of fatal arrhythmias can prevent sudden cardiac arrest. In addition, there is a direct relationship between time-to-treatment and the success of reperfusion (restoration of blood flow to the heart), including a time-dependent reduction in the mortality and morbidity.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">First aid</span> Emergency first response medical treatment

First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health, while psychological first aid is used as early treatment of people who are at risk for developing PTSD. Conflict First Aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in Canada.

<span class="mw-page-title-main">Emergency medical services</span> Services providing acute medical care

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

<span class="mw-page-title-main">Cardiac arrest</span> Sudden stop in effective blood flow due to the failure of the heart to beat

Cardiac arrest, also known as sudden cardiac arrest, is when the heart suddenly and unexpectedly stops beating. As a result blood will not be pumped around the body in normal circulation, consciousness will be rapidly lost, and breathing will be abnormal or absent. Without immediate intervention such as cardiopulmonary resuscitation (CPR), and possibly defibrillation, death will occur within minutes.

<span class="mw-page-title-main">Cardiopulmonary resuscitation</span> Emergency procedure for cardiac arrest

Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

<span class="mw-page-title-main">Good Samaritan law</span> Legal protection for rescuers

Good Samaritan laws offer legal protection to people who give reasonable assistance to those who are, or whom they believe to be injured, ill, in peril, or otherwise incapacitated. The protection is intended to reduce bystanders' hesitation to assist, for fear of being sued or prosecuted for unintentional injury or wrongful death. An example of such a law in common-law areas of Canada: a Good Samaritan doctrine is a legal principle that prevents a rescuer who has voluntarily helped a victim in distress from being successfully sued for wrongdoing. Its purpose is to keep people from being reluctant to help a stranger in need for fear of legal repercussions should they make some mistake in treatment. By contrast, a duty to rescue law requires people to offer assistance and holds those who fail to do so liable.

<span class="mw-page-title-main">Do not resuscitate</span> Legal order saying not to perform CPR if heart stops

A do-not-resuscitate order (DNR), also known as Do Not Attempt Resuscitation (DNAR), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), no code or allow natural death, is a medical order, written or oral depending on the jurisdiction, indicating that a person should not receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating. Sometimes these decisions and the relevant documents also encompass decisions around other critical or life-prolonging medical interventions. The legal status and processes surrounding DNR orders vary in different polities. Most commonly, the order is placed by a physician based on a combination of medical judgement and patient involvement.

<span class="mw-page-title-main">Choking</span> Mechanical obstruction of the flow of air from the environment into the lungs

Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen deprivation. Although oxygen stored in the blood and lungs can keep a person alive for several minutes after breathing stops, choking often leads to death.

<span class="mw-page-title-main">Life support</span> In medicine

Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival. Other types of basic life support include relief from choking, staunching of bleeding by direct compression and elevation above the heart, first aid, and the use of an automated external defibrillator.

<span class="mw-page-title-main">Automated external defibrillator</span> Portable electronic medical device

An automated external defibrillator or automatic electronic defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them through defibrillation, the application of electricity which stops the arrhythmia, allowing the heart to re-establish an effective rhythm.

<span class="mw-page-title-main">Certified first responder</span> Person who provides pre-hospital care for medical emergencies

A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.

Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers. It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">ABC (medicine)</span> Initialism mnemonics

ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.

The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early CPR, early defibrillation, early advanced cardiac life support, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately.

The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.

<span class="mw-page-title-main">Mass casualty incident</span> Incident which results in medical care systems becoming overwhelmed

A mass casualty incident describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, plane crashes, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995, the September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.

The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest. A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts".

<span class="mw-page-title-main">PHECC</span>

The Pre-Hospital Emergency Care Council (PHECC) is an independent statutory organisation responsible for implementing, monitoring and further developing the standards of care provided by all statutory, private and voluntary ambulance services in Ireland. It is also responsible for conducting examinations at six levels of pre-hospital care, the control of ambulance practitioner registration and the publication of clinical practice guidelines.

Slow code refers to the practice in a hospital or other medical centre to purposely respond slowly or incompletely to a patient in cardiac arrest, particularly in situations for which cardiopulmonary resuscitation (CPR) is thought to be of no medical benefit by the medical staff. The related term show code refers to the practice of a medical response that is medically futile, but is attempted for the benefit of the patient's family and loved ones. However, the terms are often used interchangeably.

References

  1. AAOS 10th Edition Orange Book
  2. "911 and 112 are the world's standard emergency numbers, ITU decides". The Verge. Retrieved 2018-07-26.
  3. Caroline, Nancy (2013). Emergency Care in the Streets (Seventh ed.). Jones and Bartlett Learning. pp. 96–97.