ACCIDENT AND EMERGENCY

ASSOCIATED HOSPITAL

GOVERNMENT MEDICAL COLLEGE KATHUA

SOP FOR ACCIDENT AND EMERGENCY SERVICES

Doc. No. 03

GOVT. MEDICAL COLLEGE, Issue Date 22-06-2020

KATHUA
Revision Date 22-12-2020
JAMMU AND KASHMIR
Revision No.

Next Review 22-06-2021

Page No. 08

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 ACCIDENT AND EMERGENCY

List of contributors

S.no Name Designation

1 Dr.Yangchen Dolma Assistant Professor

2 Aditya Bhanotra Record Clerk

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 ACCIDENT AND EMERGENCY

S.NO INDEX PAGE NO.

1. About the Department

3
2. Quality Policy
3
3. Quality Objectives
3
4. Receiving Patient in Emergency
4
5. Patient Assessment & Admission in ward
5
6. Managing Patients during non-availability of beds
6
7. Initial Assessment and Reassessment of Patients
7
8. Taking Consent
8
9. Handling MLC Cases
9
10. Handling Death in Casualty
10
11. Handling Brought-in Dead case
11
12. Death on Arrival
12
13. Referral of Patients
13
14. Disaster Management
14
15. Maintaining records in Emergency
17
16. Storage and replenishing of medicines in emergency
18

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 ACCIDENT AND EMERGENCY

1. About the Department:

Scope of services
It ranges from providing episodic, primary, acute (comprehensive) care to referrals.

Timings

Round the Clock 24*7

Types of patients served:

All patients arriving the hospital with Emergency.

2. Quality Policy
Associated Hospital is committed to provide service excellence in an equitable way with
best practices in Medicare and maintaining highest standards of quality with assurance to
treat patient with due respect, compassion and dignity in a safe environment.It is also
committed to provide Healthcare par excellence. This would be achieved through:

i. To Place at the core of service Delivery.

ii. To encourage attainment of best practice.
iii. To promote a patient centric service delivery.
iv. To ensure patient, visitors and employees safety.
v. To work towards a continuous improvement of heath indicators.
vi. Universal access to integrated and compressive primary and secondary
health care services

3. Quality Objectives
i. To focus on quality of patient care.
ii. To improve the performance of all professional.
iii. To involve all employees to participate in Quality improve.
iv. To monitor, measure and improve performance and to enhance patients satisfaction.
v. To guard, measure and improve patient/employees safety.
vi. To search for patient of Non- Compliance with goals, objectives and standard though.
(A) Problem Identification.
(B) Problem Assessment.
(C) Finding the Root cause
(D) Solution Generation
(E) Plan for Solution Implementation
(F) Implementation of correction action and monitoring

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 ACCIDENT AND EMERGENCY

4. Receiving Patient in Emergency

S. Activity Responsibility Record
No
1. The hospital shall have a separate dedicated entrance for Hospital Available
the emergency department management

2. The emergency department shall have a trolley bay with Emergency Available
wheelchair and stretcher readily available to receive the department
patients.
3. Upon arrival of patient the security guard posted at the Security guard Available
entrance of the emergency department shall immediately
inform the nursing station at emergency to send a ward
boy/nursing orderly to come and receive the patient.
4. On arrival of the patient inside the emergency room, the CMO, staff Initial
casualty medical officer & staff nurse shall initiate physical nurse Assessment
form –
assessment and treatment of the patient and guide the
Emergency
patient attendant/relative towards the registration counter
to get the registration formalities done. For a MLC case
also, treatment should be initiated first and later
registration can be carried out.
5. No patient shall be denied treatment, first aid shall be Emergency Referral form
department
provided to all patients to ensure they are stabilized and
then they can be referred.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

5. Patient Assessment & Admission in ward

S No Activity Responsibility Record

1. All details of the patient like name, age, sex, address etc Casualty Medical Emergency
are entered in the Emergency register. officer, Sister- Register
Incharge
2. The records present complaint, history of the disease and Casualty Medical Patient case
vital status of the patient and writes prescription and officer, Sister- sheet
advice for admission if needed. Incharge
3. The Casualty Medical officer prioritizes cases and informs Casualty Medical Nil
the concerned specialist doctor if required. officer
4. In case of emergencies requiring specialist care, Casualty Casualty Medical Nil
Medical officer contacts the concerned specialists over officer
telephone immediately and a call book is sent. However
initial resuscitation is provided to patient, if need arises.
5. In case of Medico Legal Case/Road Traffic Accident case, Casualty Medical MLC Register
the details of the patient and nature of injury shall be officer
written in the MLC Register.
6. If admission is required in ward for further care, then the Casualty Medical Patient case
concerned ward shall be informed over phone and officer sheet
arrangement for patient transfer shall be carried out.
7. If the admission is of Medico Legal Case patient, then the Casualty Medical MLC Register,
IP case paper is stamped with ‘Medico Legal Case’ stamp. officer Patient case
sheet

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

6. Managing Patients during non-availability of beds

S No Activity Responsibility Record

1. In case beds are not available in the emergency, initial Casualty Medical Patient case
first aid shall be provided in Recovery ward to be kept officer sheet
under observation for few hours before discharge.
2. The staff nurse at the respective ward shall be instructed Casualty Medical Patient case
to ensure timely observation of patient. officer sheet
3. The Casualty Medical officer shall carry a thorough re- Casualty Medical Patient case
assessment of the patient to ensure his stable condition officer sheet
prior to ordering for discharge.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

7. Initial Assessment and Reassessment of Patients

SNo Activity Responsibility Record

4. Initial assessment shall be conducted immediately by the Casualty Medical Initial

Medical officer on arrival of the patient. Officer assessment
form
5. Use of standard criteria of assessment like Glasgow Casualty Medical Initial
comma scale, Poly trauma, MI, burn patient, paediatric Officer assessment
patient, pain assessment criteria can be used as tools for form
initial assessment.
6. Initial assessment done shall be documented preferably Casualty Medical Initial
within Officer assessment
2 hours. form
7. For patient under observation in the casualty, the Medical Casualty Medical Patient case
officer shall conduct reassessment of the patient’s Officer sheet
condition in every
2 hours.
8. The reassessments done shall be documented in the Casualty Medical Patient case
patient case sheet. Officer sheet

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

8. Taking Consent

S No Activity Responsibility Record

1. If the patient is required to undergo any invasive Casualty Medical Informed consent
Officer form
procedure then consent of the patient (if
conscious)/next of kin/nearest blood relation
shall be taken.
2. Consent shall be taken for blood transfusion or Casualty Medical Informed consent
Officer form /
any minor/major invasive procedure under
blood transfusion
emergency condition if required. consent form
3. In case of an unidentified patient/unconscious Casualty Medical Informed consent
Officer form / blood
patient and non availibilty of family members,
transfusion consent
then the Casualty medical officer’s signature on form
the consent form shall be taken for the
treatment/procedure required.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

9. Handling MLC Cases

S No Activity Responsibility Record

1. The MLC patient shall be brought to the casualty Casualty Medical MLC register,
officer , staff nurse patient case sheet
department and treatment initiated; Police shall be
informed immediately, however patient shall be
offered treatment as required even if there is
delay in arrival of police.
2. The nature of the case with details shall be Casualty Medical MLC register
officer/staff nurse
recorded in the MLC register and information sent
to the nearest police station.
3. All medico-legal case sheets shall be stamped Casualty Medical Patient case sheet
officer/staff nurse
‘MLC’ on the case file and all necessary entries
shall be made in the MLC Register.
4. Two copies of the injury report shall be prepared. Casualty Medical Injury Report
officer
Original copy shall be handed over to the
concerned police officer and the duplicate copy
shall remain in the Police Information Register.
5. The medical officer who first examines the patient Casualty Medical Injury Report
officer
shall write the report. He/she shall write their
name, designation and date on the report and also
sign it.
6. The medical officer who first examines the case Casualty Medical Injury Report
officer
shall be responsible for the completion and
handing over the injury report to the police within
24 hours of the arrival of the patient.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

10. Handling Death in Casualty

S No Activity Responsibility Record

1. Death of a patient shall be handled carefully in Casualty Medical Nil
Officer
casualty.
2. If requested by the patient party then Casualty Medical Nil
Officer
transportation of the patient body can be arranged
by the hospital.
3. The dead body shall be released as soon as Casualty Medical Nil
Officer
possible to the next of kin or to person of nearest
blood relation on producing their identification
proof and after completion of all formalities.
4. Acknowledgement for receipt of the body and the Casualty Medical Death certificate
Officer
death certification can be obtained from next of
kin/legal representative.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

11. Handling Brought-in Dead cases

S No Activity Responsibility Record

1. Take past history of the patient and events leading Casualty Nil
Medical officer
to death.
2. Look for / Ask about any suspicious signs: Casualty Patient case sheet
Medical officer
- Poisoning – Smell
- Strangulation – Ligature mark around neck
/ abnormal signs
- Any external injuries
- Expose the body completely and look for any
signs
- Palpate the head and look for any hematoma,
etc which may be missed
- If a female, ask history of married life and if it
is less than 7 years register it as MLC, this is
mandatory
3. Register all brought dead cases as medico-legal Casualty Brought dead
Medical officer register
case if death has occurred unexpectedly or from
an unexplained cause.
4. After complete examination and confirmation by Casualty Brought Dead
Medical officer Certificate
clinical evaluation death& is confirmed, the
individual are declared as Brought in Dead (BID)
and the accompanying relatives/friends must be
explained and informed about the probable cause
of death and they are given only a “Brought Dead
Certificate” until the cause of death is confirmed.
5. The local police shall be informed immediately in Casualty Nil
Medical officer
case of suspicion or foul play. The orders of police
shall be further considered for further disposal of
the dead body. The Casualty Medical officer shall
render necessary assistance for the purpose.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

12. Death on Arrival

S No Activity Responsibility Record

1. If a patient has sudden Cardio-Respiratory Arrest on Casualty Nil
arrival at the Emergency Room, the patient is Medical officer
resuscitated. Once death is confirmed the case is
treated as death on arrival, and necessary
documentation is done.
2. CMO should go into the detailed history of the patient Casualty Nil
and arrive at the probable cause of death. On the basis Medical officer
of this, death certificate is issued and arrangements
for release of the body are made.
3. After examining the patient, the Casualty Medical Casualty Nil
officer goes into the history in detail and looks for Medical officer
signs of homicide, suicide, violence, external injuries to
rule out any suspicious cause for the death
4. After complete examination and clinical evaluation Casualty Nil
when death is confirmed, the individual is declared as Medical officer
Brought in Dead (BID) and the accompanying
relatives/friends must be explained and informed
about the probable cause of death and they are not
given a Brought Dead Certificate until the cause of
death is confirmed.
5. The local police is informed immediately in case of Casualty Nil
suspicion or foul play. The police will do the further Medical officer
disposal of the dead body after inquest. The Casualty
Medical officer will render necessary assistance.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

13. Referral of Patients

S No Activity Responsibility Record

1. In case of any certain service/ speciality care Casualty Medical Referral Register
Officer
required for the patient that is not available in the
hospital then patient shall be referred to a higher
facility.
2. However Basic first aid or stabilization of the Casualty Medical Nil
Officer, Casualty
patient shall be done prior to referral.
Incharge
3. The CMO (Casualty Medical Officer) shall fill the Casualty Medical Referral form
Officer, Casualty
referral form, indicating patient details, reason for
Incharge
referral and course of treatment provided.
4. The Casualty Incharge / Paramedical Staff on duty Casualty Medical Refer In-Out register
Officer, Staff Nurse
shall document the referral details in the Refer In-
Out register and coordinate for the referral
process.
5. An advance telephonic communication with the Casualty Medical Refer In-Out register
Officer, Staff Nurse
referral centre shall be done to ensure the
required service is available and intimate the staff
of the higher centre about the referral.
6. Ambulance service for the patients is charged for Casualty Medical Refer In-Out register
the transfer as per norms of the RKS except BPL Officer, Casualty
Incharge
Patient.
7. JSSK patients and 108 patients are not charged. Casualty Medical Nil
Officer
8. Patient along with the referral form and case sheet Casualty Medical Referral form
Officer
shall be referred to the higher centre.
9. The Incharge staff on duty shall also contact the Casualty Medical Refer In-Out register
referral centre and follow up about the condition Officer
of the patient post referral.

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

14. Disaster Management

S No Activity Responsibility Record

1. Service Provision CMO Nil
To respond to both internal and external disaster
situations that affect patients, hospital staff,
visitors and the community.
2. Situation and Assumptions: Emergency Medical Nil
Several types of hazards pose a threat to the Officer
hospital:
 Internal disasters: Fire, Explosions and
Hazardous material spills or releases
 Minor external disasters: Incidents involving
a small number of casualties.
 Major external disasters: Incidents involving
a large number of casualties
 Disaster threats affecting the hospital or
community (large or nearby fires, impending
tornado, flooding, explosions, bomb threat etc)
3. Triage Emergency Medical Nil
The most severe patients are treated and Officer
transported first, while those with lesser injuries
are transported later.
The following “Sorting Scheme” is used for
prioritizing the patient’s according to the acuity of
the patient’s condition:
 Immediate: Those patients whose injuries are
critical but who will require minimal time or
equipment to manage and who have a good
progress for survival. E.g.:- patient with a
compromised airway or massive external

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 ACCIDENT AND EMERGENCY

haemorrhage.
 Delayed: Those patients whose injuries are
debilitating but who do not need immediate
management to salvage life or limb. E.g.:- Long
bone fracture.
 Expectant: Those patients whose injuries are
so severe that they have only a minimal chance
of survival. E.g.:- Patient with 90% full
thickness, burns and thermal pulmonary
injuries.
 Minimal: Those patients who have minor
injuries that can wait for treatment.
 Dead: Those patients who are unresponsive,
pulse less, breathless etc.
4. Management of casualties Disaster Nil
 Patients with hyper acute conditions shall be management team
sent for treatment to casualty.
 Seriously ill/injured patients requiring
surgery shall be directed towards Operation
Theatre by Medical Officer.
 Ambulatory care patients shall be sent to pre-
determined wards as advised by Medical
Officer.
5. External Disaster Plan Medical Nil
 The general directions for the Superintendent /
implementation of the External Disaster Plan Deputy Medical
shall be given by Medical Superintendent / Superintendent
Deputy Medical Superintendent / Staff
designated for this purpose.
Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

15. Maintaining records in Emergency

S No Activity

Registers
1. Casualty Register
2. MLC register
3. Police Intimation register
4. Referral register
5. Quality Indicator register
6. Training Log book

Checklist, forms & formats

7. Initial Assessment form
8. Case sheet
9. Referral form
10. Investigation requisition form
11. Blood requisition form
12. Consent forms (Informed consent form, Blood transfusion
consent form)

13. Crash cart checklist

14. Injury report

Reference Standard: ME G4.2

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 ACCIDENT AND EMERGENCY

16. Storage and replenishing of medicines in emergency

S No Activity Responsibility Record

1. The emergency department shall maintain a crash Casualty - Crash cart checklist
cart for storage of emergency medications. Incharge
2. The inventory in the crash cart shall be checked daily Staff nurse Drug inventory
and a register shall be maintained for the same. register
3. The Incharge or a designated staff nurse shall be Staff nurse Crash cart checklist
assigned the duty of daily checking of drug inventory
and the resuscitation equipments.
4. A daily checking checklist shall be displayed on the Staff nurse Crash cart checklist
crash cart.
5. Once used, the drugs shall be replenished immediately Staff nurse Drug inventory
and the drug inventory register shall be updated. register

Reference Standard: ME G4.2

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