Handling the emergency wards

Health is everything. All the healthcare institutions, from sub-centres of primary healthcare to tertiary institutions, are important. People come there with the hope of returning cured and cared. Primary healthcare centre is the basic structural and functional unit of health services, mostly in rural and far-flung areas followed by secondary level which includes community health centres, sub-district and district hospitals. Then there are tertiary sector hospitals with a highly specialised medical care at divisional and state level. Quaternary hospital is a rare care as an extension of tertiary care at advanced level of medicines not widely accessed, and offered in a very limited number of national or international centres.

All these act as referral units also for one another. At secondary level, healthcare institutions have IPDs and OPDs which attend to indoor and outdoor patients. With relaxed public finance in social sector the department of health services has witnessed a tremendous innovation and expansion in having machinery, equipment, infrastructure and human resource development with the objective of having a wider, quick and effectively efficient service outreach.

In this field SMHS and SKIMS are our AIIMS, managing huge influx of patients in IPDs and OPDs. But in case of handling of emergency wards the situation is somewhat chaotic after 4 pm when these crucial wards are looked after by junior doctors or interns. Emergencies are emergencies; be they related to flood, fire, earthquake or medical. They are inexorable and ruthless to accommodate delayed and slow action or wrong and insufficient treatment. Medical emergency is a sudden and urgent situation that requires immediate and correct action.

It is a treatment facility specialising in emergency medicine to cure the acute conditions of patients who present without appointment either by themselves or by supporters. The junior doctors who have little practical experience and the interns who are inexperienced struggle to respond to emergencies in absence of senior doctors in the ward. Whether they are on duty as per roaster or not, physically they are not seen to guide the junior doctors in the process of diagnosis, prescribing medicines and follow-up action.

An attendant narrated his tale by saying that, “he brought his mother to the emergency ward of the SMHS hospital Srinagar on 26.9.2023 at 8.30 pm. She had a chronic stomach ailment. Instantly she was semi-conscious as she had some bleeding problem. After getting the admission ticket we were guided to medicine side. What followed thereafter begs description? There was a huge rush of people running helter-skelter. Some patients were lying on stretchers, some on beds, some on wheel chairs, some sitting on the floor, downcast with their attendants around.

Some four junior doctors seen there were dazed to figure out what to do and whom to attend first. Sometimes sitting in their chairs and sometimes standing they were consulting one another to confirm their diagnosis for further action. Some was taking the stethoscope from other to use it himself and someone dragging the BP apparatus from other’s side for checking BP. Some doctor using oximeter the other waiting for the same. The doctors asked us questions, individually as well as collectively, about the case history of the patient. It seemed that junior doctors, in absence of any senior guidance, felt somewhat uncertain to conclude the diagnosis though striving their best. Then we were asked to consult surgical side for their findings & opinion.

There too were some three-four doctors surrounded by a large number of patients and attendants desperately jostling with one another to be first attended to. This exercise also took us about 20 minutes before we were referred back to medicine side. The doctors went through the surgical opinion and gave us short stay admission. It took more than an hour before the patient was administered a first glucose drip and other subsequent actions. Short stay section was also handled by the junior doctors and Para-medics and situation found them short and overburdened.

One doctor kept the flow of glucose slow. We asked him that it was very slow and he answered that was right. Meanwhile came another junior doctor who changed to a faster pace justifying that patient was in dire need of it immediately. It appeared latter doctor was correct”. The attendant, however, elaborated that, “all junior doctors and paramedical staff were humane and had every sympathy with the patients to revive and recover soon but for the matching staff, space and devices that made a grim picture”.

It is only after surviving the brunt of emergency situation the patients are either discharged or advised to attend OPD or admitted as indoor patients for further treatment. Emergency is more than a casualty. This defines the extra significance of the emergency ward which needs to be manned by sufficient personnel duly guided and supervised 24X7 physically by senior faculty one each in medicine, surgical and short stay section.

During daytime between 10 am and 2 pm in OPD patients with minor ailments who deserve indoor treatment get admission in IPD where they are treated by a team of doctors under the supervision of a senior doctor. In case of IPD patients surgeries may even be deferred and medicinal treatment prolonged, after seeking advice of the senior faculty unlike in emergency cases where decision making has to be quick.

Emergency is a matter of life and any delay can cost lives. As in medical lexicon patient survival and pace of recovery depends on the timely treatment after correct diagnosis, it is indispensable to have senior faculty physically present in the emergency wards.
The author is a former Sr. Audit Officer and Consultant of A.G’s Office Srinagar.