EMP Guidance

 National Emergency Medicine Report

Understanding Emergency Care

Emergency medicine is a medical specialty — a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”

International Federation for Emergency Medicine definition of Emergency Medicine.

An Emergency Department (ED) is a dedicated area in a hospital that is organised and administered to provide continuous access to Emergency Medicine (EM) services for patients and communities.
  • EDs provide 24/7 access for undifferentiated emergency and urgent presentations across the entire spectrum of medical, surgical, trauma and behavioural conditions.
  • Eds operate under the clinical governance of Consultants in EM. They are staffed by appropriately trained doctors, nurses and multidisciplinary healthcare provider teams.
  • EDs require the on-site presence of core supporting specialties and services and must have seamless access to regional medical and surgical specialties and more complex diagnostic imaging facilities within an Emergency Care Network (ECN).

For more information on EDs and ECNs see Chapter 2, EMP Report 2012.

Injury units provide unscheduled emergency care for patients with non-life threatening or limb threatening injuries as conveniently as possible, while ensuring patient safety and equitable standards of care. These units treat conditions such as broken bones, dislocations, sprains, strains, wounds, scalds and minor burns that are unlikely to need admission to hospital (criteria list). Staff in Injury Units perform x-rays, reduce joint dislocations, apply plaster casts and treat wounds by stitches or other means.

Patients can go directly to the Injury Unit or be referred by a GP. Injury Units do not treat children under the age of five, serious head injuries, abdominal (stomach) pain, medical illnesses or mental health problems.  Please note some Injury Units currently have higher age limits for the treatment of children. Please check here for further details. Despite the fact that these units see undifferentiated patients, nine of the Injury Units are located in Model-2 hospitals and two operate as  stand-alone units. This requires strict adherence to the patient inclusion/exclusion criteria.

Each Injury Unit is linked to a Hub Emergency Department in an acute hospital. If a patient in an Injury Unit needs to be admitted to hospital they will be referred directly to linked hospital, in exactly the same way as if they had attended the Hub Emergency Department.

Emergency Care Networks, ECNs, are collaborating groups of Emergency Departments (EDs) and Local Injury Units (LIUs) organised to deliver safe, high quality emergency care for local populations and communities.

The aim of ECNs is to provide functional system networks that provide emergency care across the entire spectrum from high-acuity medical and surgical presentations, to complex psychosocial emergencies and non-life or limb threatening injuries. ECNs align the work of Pre-hospital and hospital-based emergency care services.

Core Emergency Medicine activities:
• The prioritised evaluation and treatment of patients with time-critical and emergency health care needs;
• The prioritised evaluation and treatment of patients with problems that are not immediately life-threatening or limb-threatening but which require emergency care to protect or restore the patient’s wellbeing or to prevent avoidable disability;
• Essential supporting activities for clinical care and governance in EM;
• Education, training and continuing professional development in EM;
• Major Emergency planning.

Valuable non-core Emergency Medicine activities:
• Clinical Decision Unit – an inpatient facility adjacent to the ED managed by Consultants in Emergency Medicine;
• Review clinic work;
• Contributing to National Agencies and organisations relating to EM Service Development and Training.

Important Emergency Medicine activities facilitated through specialist centres:
• Research;
• Medical Support for Pre-hospital Care.

Model of Care Guidance

Paediatric Emergency Care

Click here for information on the Paediatric emergency medicines key principles.

The triage of children in Emergency Departments is an established standard of care in international and national practice. However the triage of children can be difficult compared to adults and additional triage parameters are recommended to reflect age-related physiological differences, children’s presenting signs and symptoms, significant paediatric co-morbidities and common Paediatric Emergency Medicine diagnoses.

 

The development of the Irish Children’s Triage System (ICTS) was prompted by the triage experiences of front-line ED nurses caring for children. The development and testing of the ICTS has been conducted under the guidance of a Steering Group composed of stakeholders from within Emergency Medicine and senior clinicians across a number of hospitals. This group collaboratively produced the national Irish Children’s Triage System, based largely on the pre-existing tool in use in OLCHC and TSCUH.

The ICTS was successfully piloted and evaluated in the following six EDs across the country in 2013:

  • Cork University Hospital
  • Galway University Hospital
  • National Children’s Hospital, Tallaght
  • Our Lady of Lourdes Hospital, Drogheda
  • Our Lady’s Children’s Hospital, Crumlin
  • Temple Street Children’s University Hospital

 

Implementation of ICTS contributes significantly to paediatric patient care in our Emergency Departments and will promote safety, quality of care, improved access and patient experience in emergency care in Ireland.

Pre-Hospital Emergency Care

Pre-hospital Care (PHC)

incorporates the primary response to injury and sudden illness, patient retrieval services, inter-hospital patient transfer, aspects of telemedicine and Major Emergency management and response. The delivery of PHC in Ireland is primarily the responsibility of the NATIONAL AMBULANCE SERVICE. DUBLIN FIRE BRIGADE provides an ambulance service in the Dublin area by agreement with the HSE NAS. The PRE-HOSPITAL EMERGENCY CARE COUNCIL is the statutory regulator for pre-hospital healthcare professionals. For further information on the role of Pre-hospital care in Emergency Care Networks please see CHAPTER 6 OF THE EMP REPORT 2012.

CLICK HERE for information on the national protocol for the handover of care of patients transported by ambulance to EDs.

Trauma Care

Trauma care involves Emergency Medicine, pre-hospital care, multiple medical and surgical specialties, healthcare organisations and other agencies and all have a contribution to make to the future development of trauma systems in Ireland. Trauma management involves all stages of the patient journey from pre-hospital care to rehabilitation and injury prevention. International research, education, audit and the development of trauma systems has resulted in improved outcomes for injured patients and has transformed the delivery of modern trauma care. The National Emergency Medicine Programme will work towards the establishment of Trauma Networks in conjunction with future acute hospital groups, Major Trauma Audit and a Trauma Registry in Ireland.

The EMP has played a lead role in the development of the National Major Trauma Audit in the National Office for Clinical Audit.

Please see Chapter 7 of the EMP Report 2012 for recommendations on the Organisation of Trauma Care in Ireland.

 

Major Emergency Planning

EMP is collaborating with the HSE to develop a template to guide Acute Hospitals Emergency Planning.