Emergency Management

Research in the Field of Emergency Management

Researcher and Compiler: Dariush Panjeh Ali

Date of Preparation: Winter 1400

Foreword

Given that emergency management, which has only completed a hospital management course, works alongside the emergency clinical staff and does not have the right to interfere in the field of treatment and clinical measures, it is necessary to be at least familiar with the tools, equipment, and general principles in the emergency department, which in this study is only a general introduction to emergency management, hemostasis, and trauma. Anyone who is interested in management in this field should be familiar with all hospital and prehospital emergency topics, have seen the work in those places up close, and be fully familiar with the procedures and be able to explain all topics in a concise, useful, and practical manner, and in addition, use educational films for teaching according to teaching methods.

Abstract

Emergency management refers to a set of actions that a person, acting solely as a manager (without involvement in medical and clinical affairs), who has completed a course in hospital management or nursing or management related to health and treatment, carries out guidance and management in the best possible way with the available facilities, equipment and human resources, so that he can provide services in this field in the shortest possible time and with the best quality.

Management-Guidance-Emergency

Notes and Warnings

Note 1: This work is solely my personal understanding and research in the field of emergency management and is not intended as a guide in any way.

Note 2: This work is solely a research work for the emergency management course and is intended to be presented to the Avicenna International University of Georgia and is not and will not be an interference in hospital, emergency, medical, and treatment matters in any way.

Note 3: This work is solely a research work and is not and will not be an interference in hospital, emergency, medical, and treatment matters in any way. If any person uses it in any way, he or she must be accountable for his or her actions. The producer of this research work, Dariush Panjeh Ali, does not and will not have any customary, religious, or legal responsibility.

Note and warning 4: This work is purely a research work and is not and does not mean economic or commercial productivity in any way. Note and warning 5: This work has been carried out based on personal information, resources, and research and does not in any way imply its implementation or use, even in emergency management.

Table of contents

page	Title
1	Cover
2	In the name of God
3	Foreword
4	Abstract
5	Warnings and Alerts
6	List
7	Emergency Management
14	Types of Bleeding, Hemostasis, and Dressings
18	Trauma
20	Introduction to Diagnostic Techniques in the Emergency Department
23	Introduction to the Operating Room
27	Resources

Management: It refers to the set of actions that are taken with the available facilities, equipment, and human resources to achieve the required goal of that institution or organization at the most appropriate cost and time.

Hospital emergency: It refers to a place inside the hospital where vital emergency services are provided to patients as soon as possible.

Emergency management: It refers to a set of measures taken by a person known as the emergency manager, with the available facilities, equipment, and human resources, to provide emergency medical services to patients and the injured in the shortest possible time.

Generally, medical emergencies are divided into 2 parts.

In-hospital emergency: It refers to rapid medical measures taken to save the lives of patients inside the hospital.

Out-of-hospital emergency: It refers to the rapid medical measures taken to save the life of patients outside the hospital until the patient is transported to the hospital. (Also called pre-hospital emergency.) The set of factors and forces of an emergency: Out-of-hospital emergency: *Emergency medical technician *Driver who has completed the emergency rescue course and, in addition to driving the ambulance, assists the technician in emergency work. *Ambulance transporting patient *The location of the out-of-hospital emergency personnel, which is also called the pre-hospital emergency base or center. In-hospital emergency: *Patient carrier: Carries out the patient's transportation in accordance with standards under the supervision of the nursing staff.

*Nursing Assistant: Assists in nursing matters without interfering in treatment matters.

*Physician: Which is not new to the profession, but has been around for a while and to some extent performs the work of a nurse with less responsibility under the supervision of a nurse or doctor.

*Nursing Assistant: A person who has completed a nursing course and participates in the care and treatment under the supervision of a nurse or doctor, depending on the type of patient's condition.

*Emergency Medical Technician: A person who has completed an emergency medical technician course, such as a nurse, who serves mostly in emergency medical matters.

*Nurses, including emergency, operating room, and hospital: A person who has completed a nursing course and serves under the supervision of a doctor.

*General Practitioner: A person who, after completing a general medical education course, diagnoses and treats patients as a general practitioner.

* Emergency medicine specialist: A specialty whose scope of activities is in the field of patients who require urgent medical measures and must be treated as soon as possible, beyond general medicine.

* General surgeon specialist: A surgeon approved by the Ministry of Health and licensed to practice surgery.

* Assistant surgeon, also called a surgical resident: Someone who completes the final years of a general surgery residency and serves alongside the general surgeon in accordance with the rules.

* Supervisor: A nurse who is present on every shift and is responsible for supervising all personnel and their activities.

*Matron or Director of Nursing Services: A nurse who is more senior and more active during office hours in the management of nurses and the organization of other related personnel, and in other words, is a liaison between the medical personnel and the hospital director or president.

*Nursing management: refers to the set of necessary management measures that are aimed at organizing nurses to provide the most service to patients in the shortest time according to the rules and regulations of medical and medical institutions.

*Admission and department secretary: Responsible for guiding and accepting patients according to their conditions, preparing files, and calculating treatment costs.

*Service and cleaning forces: Responsible for cleaning, washing, disinfection, and disinfection services.

*Pharmacy: A place where medicine is stored and distributed.

*Pharmacy technician: A person who is responsible for preparing and delivering medicine to the patient according to the doctor's prescription.

*Emergency laboratories: Responsible for testing samples sent from the emergency department and responding quickly to the emergency department.

*Emergency and portable radiology: Responsible for performing radiography and imaging of emergency patients.

*Dialysis: A part of the hospital that is used for medical support for kidney patients, which is also used in emergency situations.

An emergency department within a hospital includes the following parts:

*Emergency entrance: This is the part of the emergency department where the ambulance enters and is used until the patient is delivered to the triage room,

which has an emergency sign and the Latin word EMERGENCY installed above it.

*Triage room: This is a place where patients enter upon entering the emergency department, where they are prioritized according to the type of illness and injury, and treated.

*Emergency room: A place where very ill patients are given immediate initial treatment, such as shortness of breath, who are immediately admitted to the emergency room after triage and treated according to the doctor's orders.

*Emergency room under observation: A place where patients in a more favorable but still urgent condition are maintained and cared for, such as patients with high blood pressure but which can be corrected.

*CPR room: A place where patients who have had a cardiac arrest and are not breathing are transported directly from the emergency room entrance to receive cardiopulmonary resuscitation (CPR) according to the doctor's order.

*Outpatient operating room in the hospital emergency room: A place where patients with injuries who are diagnosed by the surgeon are treated there and do not need to be transferred to the surgical ward.

*Emergency intensive care room: For patients in very bad condition who require serious follow-up and if necessary, they are kept and cared for there, such as patients with heart problems.

*Relaxation room: Where personnel rest during non-working hours but during rotating shifts.

*Ambulance station: A place where an ambulance is stationed for patient dispatch and transportation and where the patient is stationed again after dispatch.

*Consumable equipment warehouse: A place for storing consumable equipment.

Notes Note:

*An emergency manager should always consider and follow up on the following issues and cases:

1- Always study the personnel file and, considering the documents, records, and physical and mental conditions of each person, place him in the appropriate position for service.

2- Always hold technical and legal meetings with the personnel and explain the duties and limitations of each job position by a legal expert, and prevent incidents that lead to follow-up

It is legal to provide training.

3-Personnel liability insurance should be prioritized and it should be followed up to see if personnel liability insurance has been taken out

and if not, follow up and ensure that it has been taken out.

4-The mental and physical health of personnel should always be monitored by a relevant expert and referred for treatment if necessary.

5-The safety of personnel's workplace should be reviewed in every aspect and corrected if necessary.

6-Always anticipate and prepare replacement personnel for critical situations, and their list and phone number should be made available to the shift manager.

7-Always check the inventory of consumables and equipment needed and always store twice the amount needed as backup.

8-An emergency manager should be fully familiar with emergency medications and equipment.

9-An emergency manager should complete a first aid and advanced first aid course and, if possible, a basic medical emergency course.

10- An emergency manager must be familiar with all hospital and ambulance departments and equipment

and know how to use each in emergency situations.

11- An emergency manager must have a Level 2 motorcycle and ambulance driver's license.

12- Complete supervision of hospital departments and regular monitoring of department personnel and managers, and if necessary, transfer and select a more qualified person to be responsible for the department.

13- Complete follow-up of instructions in the field of hospital and department management and preparation of reports to the superior on a weekly basis.

14- Holding regular and continuous meetings to identify challenges of personnel and departments and follow up to resolve them, taking into account legal considerations.

15- Passing a course in personality psychology and how to deal with clients and personnel.

16- If an issue is followed up and not resolved, seek help from the hospital director in writing to resolve and refer that issue.

17- First aid courses must be provided for all administrative and non-medical personnel such as services, administration, and drivers.

18- An emergency manager must take courses, however short, in educational management, human resources management, crisis management, disaster and risk management in the health sector, and an English conversation course.

It is worth noting that the management of each institution or emergency center can vary depending on its conditions and laws, of course, according to the laws of each region.

Types of bleeding, hemostasis, types of dressings:

Types of Bleeding

*Internal Bleeding

*External Bleeding

There are 3 types of external bleeding:

*Arterial: Bright red and pus-filled.

*Venous: Light dark and swollen.

*Capillary: Under the skin

A wound is any damage to the skin, whether partial or total, that leads to the disruption of skin tissue

and damage.

Types of Skin Damage (Wounds)

*Abrasions or abrasions

*Cleft wounds or cuts

*Ruptures

*Penetrating wounds: such as knife wounds

*Perforations caused by the bite of an animal infected with or suspected of having rabies

*Amputation: The loss of a limb for any reason, such as the loss of a finger due to an impact.

Types of wounds in terms of degree of contamination:

*Clean wounds: (These are non-infected surgical wounds that do not have inflammation and

do not open into the respiratory, digestive, genital, or non-infected urinary tracts.

* Clean Wounds Contaminated – Clean: Surgical wounds that have been exposed to the respiratory, digestive, genital, or non-infectious urinary tracts under controlled conditions but are not abnormally contaminated. * Contaminated Wounds: Includes fresh, open surgical wounds and surgical procedures involving major disruptions in sterile technique or the release of significant amounts of bowel contents. Incisions in areas with acute inflammation and no infection are also classified as contaminated. * Infected and Dirty Wounds: Wounds that are caused by organisms that were present in the surgical field before the operation. Traumatic wounds that have necrotic tissue remaining in them and wounds that have been caused in areas with clinical infection or with visceral rupture are considered dirty or infected wounds. Bleeding control: This refers to Hemostasis is also said to be different from pre-hospital and hospital emergencies.

Why is hemostasis performed: To help stop bleeding and prevent further damage to the bleeding patient

Ultimately, to save the injured person's life.

There are several methods of hemostasis:

Automatic or automatic hemostasis type 1: Which is controlled by the body itself (blood platelets) and by blood clotting at the site of bleeding in a kind of bleeding.

Automatic or automatic hemostasis type 2: Which is reinforced by the body itself (blood platelets) at the site where the blood clot has already formed and the bleeding is controlled more completely.

It is worth noting that if bleeding is not controlled automatically, it is controlled by factors outside the body, which is called hemostasis by the surgeon, which is done in the operating room, such as vascular rupture, which is controlled by the surgeon, which is called hemostasis surgical procedures. Types of dressings: Traditional dressings Absorbent dressings Moisturizing dressings Modern or semi-permeable dressings Foams Hydrocolloids Transparent films or dressings.

Trauma:

Trauma: Any injury to the body caused by external factors such as impact or accident or incident.

Types of trauma are generally divided into 2 types including penetrating and non-penetrating trauma.

Penetrating trauma: A type of trauma in which a foreign object enters the body and causes visible damage

Such as an accident in which glass fragments enter the body's skin due to a broken car window and cause bleeding

Non-penetrating trauma: A type of trauma in which a foreign object does not enter the body but due to excessive pressure

and beyond the body's tolerance, it leads to invisible but serious and dangerous injuries, such as someone who has an accident and receives a very severe blow to his abdomen and side and has no visible damage, but has internal bleeding, but the symptoms indicate serious damage.

Types of trauma according to damage to body parts and organs:

Compound trauma: This is when a person has multiple traumatic injuries together, such as a person who has an accident and has injuries to the head, eyes, and abdomen along with fractures.

Traumas according to damage to body organs:

Trauma to the brain - eyes - ears - nose - throat - jaw - chest - heart - abdomen and internal organs - neck - spinal cord - kidneys and urinary tract -

Very important point: In hospital emergencies, there are also hospitals that specialize in dealing with traumatic injuries, which also vary according to the facilities and equipment and the type of use of that center, and the classification is categorized according to the specialized services provided.

Familiarity with diagnostic methods in the emergency room

Diagnostic methods in the emergency room that are used in all hospital emergencies.

Blood tests are generally as follows:

Persian abbreviation for "exam"	Latin abbreviation for test
It includes counting blood cells, including white blood cells, red blood cells, platelets, and other blood cells.	CBC
White blood cells	WBC
Red blood cells	RBC
Hematocrit	HCT
Platelet	PLT
Hemoglobin	H Gb
Fasting blood sugar	FBS
Non-fasting blood sugar in normal condition	BS
Generally indicates blood clotting time	PT-PTT
Urine tests	UA-UC
Triglycerides	TGs
Blood cholesterol	cholesterol
Blood uric acid	Uric asic

Non-laboratory diagnostic methods in the emergency room:

* Simple imaging: by a radiology machine and by a radiology technician according to the rules.

* CT scan: by a CT scan machine and by experts in the CT scan department.

* MRI: by an MRI machine and by experts in the MRI department.

* Echocardiography: examination of cardiac output with an echo machine by a cardiologist.

* Electrocardiogram: examination of the heart's condition in terms of emergencies and diseases with an electrocardiogram, also known as an ECG.

Emergency tests: according to the doctor's order, the tests are performed by a laboratory technician after sampling.

Ultrasound: according to the doctor's order and the type of ultrasound, it plays a key role, especially in the diagnosis of trauma emergencies, and is performed by a sonographer.

Familiarization with the operating room:

Operating room: This is the place where surgery is performed by the surgical team using sterile techniques.

The operating room equipment and facilities are as follows:

Performance	Name of agent and personnel
Supervising the work of all personnel and coordinating, organizing, and resolving operating room and personnel issues.	Head or head of the operating room department
Surgery for patients	A surgeon specializing in general surgery and other surgical fields.
Surgical assistant, also called surgical resident: A person who completes the final years of general surgery residency and serves alongside the general surgeon in accordance with the regulations.	Surgeon's Assistant
Responsible for activities such as preparing operating room equipment and supplies, setting up the operating table, and the like.	Circular nurse
Activities such as assisting the surgeon and preparing for better visibility for the surgeon, counting gases and instruments, and transferring specimens to pathology.	Scrub nurse
An anesthesiologist is a physician who is responsible for procedures such as anesthesia, patient management and control during anesthesia during surgery, and the recovery of the patient after surgery.	Anesthesiologist
Collaborate with anesthesiologist for preparation and management	Anesthesia technician

She is responsible for controlling the patient in terms of anesthesia during surgery and taking the necessary measures to keep the patient awake after surgery until delivery to the recovery room.
Who is responsible for transferring the patient's file from the patient's delivery nurse, recording the actions taken for the patient by the surgical team, and controlling the patient's file until it is handed over to the nurse for delivery to the surgical ward.	Department Secretary
: A person who, or those under her supervision, dates the packaged sets and sterilizes each device in the machine according to her instructions, and then sends it to the operating room and delivery room.	CSR Manager (Sterilization of Surgical Instruments and Equipment)
A person who first decontaminates and then washes surgical instrument sets.
A person who sends surgical sets and instruments to the CSR department after washing, drying, and sterilizing them according to packaging instructions.
Measures such as general cleaning and disinfection of rooms and corridors are generally responsible for the physical space of the operating room.	Crew

Parts of the operating room: Operating room entrance - reception - hand washing room - sterile center (CSR) - (recovery room - dressing room - operating room - connecting corridors -

General sets in the emergency operating room, of course in general:

*Laparotomy set

* Chest tube set

* Cut-down set

* Tracheostomy set

* Orotracheal and nasotracheal set

* Sterile minor surgical set for hematoma control

* All resuscitation trolley ampoules

* Types of suture adhesives and suture thread

* Portable loop remover and cauterizer.

It is worth noting that there is a possibility of more or less equipment and supplies according to the rules of each institution or medical center

and it varies.

----------------------------------------------------------------------------------------

Sources:

*Nursing process of operative and surgical care. Author: Mary DiGuilio Donna) DiGuilio Mary.

JacksonDonna Jackson. Translators: Dr. Mohammad Zoul-Adl. Marwat Givi.2106 – McGraw-Hill

*Introduction to types of wounds and methods of dressing open wounds - Hazrat Vali Asr (aj) Medical Training Center, Zanjan, Nursing Office Training Unit - Nematollah Soleiman Nejad - Akram Khadiri 2019

* Principles of nursing care in the emergency room. Hazrat Vali Asr (aj) Medical Training Center, Zanjan, Nursing Office Training Unit. Nematollah Soleiman Nejad. 2019

* Handbook of laws and regulations of the surgical emergency department - Shahid Namazi Hospital, Shiraz.

* Nursing process of water and electrolyte disorders. Author: Mary DiGuilio Donna) DiGuilio Mary.

JacksonDonna Jackson. Translators: Dr. Mohammad Zoul-Adl. Marwat Givi.2106 – McGraw-Hill

*Research manuscripts, questions and answers, and interviews in the field of operating rooms and emergency rooms and their management with experts from 2013 to 2014 – Dariush Panjeh Ali

*Farsi Wikipedia 2017.

*Handwritten handouts in the pre-hospital first aid and rescue course – Dariush Panjeh Ali 2009.