Casualty and Emergency Services
Assessment of Facilities at Casulty and Emergency Services in Hospitals at Bangalore
Introduction
Bangalore is one of the fastest growing cities in India. It is located in Karnataka state and has a population of 4.5 million (1991 census). The population is increasing at a rapid rate and the resources are not sufficient to keep pace with the increasing demand. Bangalore has a large number of hospitals and nursing homes in public and private sectors and, inspite of these, people are not satisfied with the quality of care provided in the casualty and emergency departments.
Casualty and emergency services are expected to provide immediate therapeutic and diagnostic care on emergency basis round the clock. Any delay may mean loss of life or prolonged morbidity. Hospital managers face a challenge to provide quick and competent care which can lives and also reduce severity and duration of illness.
The need for evaluation of casualty services in Bangalore has been felt. A study of the available facilities may be starting point in order to identify strategies to improve the services. This study has been taken up in order to achieve the following objectives.
Objectives
1. To assess the available facilities in casualty and emergency departments of major hospitals in Bangalore.
2. To identify those components of casualty services which require improvement.
Methodology
At the beginning, a list of 25 major hospitals was drawn up and incidentally, these hospitals are participating in a major study on Road accidents in Bangalore. A questionnaire covering various aspects of casualty services like manpower, equipment, building, protocol, demand on the services, procedures followed, etc., was developed,. Suitable changes were made after the original version. The questionnaire was mailed to Medical Superintendents of all the 25 major hospitals in Bangalore and they were requested to fill in the questionnaire. Responses thus obtained have been analyzed to identify the current state-of-the-art of emergency care services.
Result
The city of Bangalore has a wide range of hospitals extending form public sector and private hospitals along with medical college hospitals and Nursing Homes. The study centres had an appropriate mix of these hospitals. 2 of the hospitals have been functioning for more than 100 years and only 2 of the hospitals were started beyond 1994. The total bed strength of the hospitals varied from 50-1000 and casualty bed strength from 2-43. The average number of patients seen in the Casualty varied from 8-150.
Nearly 70% of the hospitals reported that facilities like waiting room, treatment room, observation or holding room, emergency laboratory, isolation beds, etc., were available. Other basic amenities like drinking water, toilets, canteen were present in 80-90% of the hospitals. The total staff strength in terms of doctors, specialists, trainees, nurses, medico social workers, technicians and group ‘D’ staff varied from hospital to hospital.
In majority of the hospitals, immediate care for patients was provided by non—specialists duty doctors (Casualty medical officers). The specialists services were available in 92% of the hospitals mainly by on call basis. Only 50% of the hospitals reported that their staff were sent for periodic training in emergency care.
In terms of the available facilities a Central Oxygen facility, ECG machine, and stand-by generators for meeting power failures were available in 80% of the hospitals. Ventilators were available in only 8 of the 23 hospitals. Communication facilities in terms of free telephone for patients was provided in 50% of the hospitals. Intercoms and paging services were available in only private hospitals. Computerisation of hospital services was undertaken in only 4 of the 23 hospitals.
Ambulance services were available in 85% of the hospitals which were available round the clock. 30% of the hospitals had more than 3 ambulances. However, the internal facilities like resuscitation availability of paramedics and communication equipment was available in only 50% of the ambulances. Nearly, 90% of the hospitals also charge a considerable fee for providing ambulance services.
Blood bank facility within the hospitals was available in 60% of the hospitals. A list of voluntary blood donors was available in 50% of the hospitals. With recent mandatory instructions for screening of HIV/ Hepatitis B, all blood banks were routinely screening the patients.
Co-ordination between different units of the hospitals was present in 85% of the hospitals with related units of Bio-chemistry, Microbiology, Radiology and other services. All the hospitals reported the presence of operation theatres, intensive care units and wards for immediate admission of patients. Nearly 58% of the hospitals reported considerable delays in co-ordinating services due to lack of facilities.
In terms of the various protocols of admissions, medico legal issues, investigations and treatment, handling disaster and managing patients without identity, all the hospitals reported presence of these protocols. However, the details in terms of the exact standards or guidelines were not specified.
None of the hospitals except 2% had any ongoing research activities.
Conclusions
It is obvious from the present survey that there is an immediate need for identifying the current status of emergency care services in developing cities of India. The survey has identified the obvious lack of facilities in terms of staff availability, facilities for patients, lack of co-ordination between different units in the hospitals was very evident. The inadequate. The lack of clear guidelines of various aspects of functioning within the casualty services needs further investigation.
Based on these findings, there is an immediate need to strengthen casualty services with more trained man power and facilities, extending ambulance services, communication networking and developing protocols. Establishing referral systems for early and appropriate care will be vital for saving lives.
V.L. Satesh1, G. Gururaj1
1Department of Epidemiology, National Institute of Mental Health and Neuro Sciences Bangalore-29, India
