Emergency medical aid, promotion tools &planning

in hospitals

Presented by- dr.priyanka

EMSEmergency medical services (EMS) are a type of emergency service dedicated to 

providing acute medical care and/or transport to definitive care, to patients with illnesses and injuries, which the patient or the medical practitioner, believes constitutes a medical emergency. 

• Emergency medical services may also be locally known as: first aid squad emergency squad, rescue squad, ambulance squad, ambulance service, ambulance corps or life squad.

• The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, 

The key services in the emergency medical services system include:• emergency medical dispatch;• emergency medical response and medical care;• emergency medical transport; and • inter-facility medical transportation

CASUALTY• Casualty Department is a medical treatment facility, specializing in acute care of patients who present without prior appointment, either by their own means or by ambulance. The emergency department is usually found in a hospital or other primary care center.

OBJECTIVESThe province is committed to ensuring emergency medical service systems 

deliver pre-hospital care within the following guiding principles:• Emergency medical services are safe and effective.• There will be a base level standard of pre-hospital care across the 

province.• When there is a medical emergency, the ambulance response and 

transport will be as timely as possible.• Emergency medical services are a part of the broader health system to 

ensure access.• Emergency medical services will be sustainable over time.• EMS will have the opportunity to work with their regional health 

authority and be involved in the planning process for emergency medical service delivery.

PurposeEmergency medical services exists to fulfill the basic principles of first aid, which are to 

Preserve Life, Prevent Further Injury, and Promote Recovery.This common theme in medicine is demonstrated by the "star of life". The Star of Life

 showed here, where each of the 'arms' to the star represents one of the 6 points. These 6 points are used to represent the six stages of high quality pre-hospital care, which are_

• Early detection - Members of the public, or another agency, find the incident and understand the problem

• Early reporting - The first persons on scene make a call to the emergency medical services and provide details to enable a response to be mounted

• Early response - The first professional (EMS) rescuers arrive on scene as quickly as possible, enabling care to begin

• Good on-scene care- The emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident

• Care in transit- the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey

• Transfer to definitive care - the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians

Levels of careA category of emergency medical service which is known as 'medical retrieval' • The levels of service available will fall into one of three categories; Basic Life Support (BLS), 

Advanced Life Support (ALS), and care by traditional healthcare professionals, meaning nurses and/or physicians working in the pre-hospital setting and even on ambulances.

1)Basic life support• First responder A first responder is a person who arrives first at the scene of an incident• Ambulance driver• Ambulance care assistant (ACA)• Emergency medical technician (EMT) • Emergency medical dispatcher (EMD) 2)Advanced life support (ALS)• Paramedic (EMT-P)• Critical care paramedic (CCEMTP)• Paramedic practitioner / Emergency care practitioner3)Traditional healthcare professionals• Registered nurse (RN)• Physician

Critical conditions handled

HEAD INJURY CHEST PAIN COPD ASTHMA BROUGHT DEAD UNCONCIOUS PATIENTS GYNAC. PATIENTS CLW SUTURING PAEDIATRIC PATIENTS FRACTURE PATIENTS UNKNOWN RTA PATIENTS

CRITICAL CONDITIONS HANDLED

1)Anaphylaxis

Severe, life- threatening allergic reaction Occurs as reaction to an allergen  

Causes• Food like nuts, milk, eggs, fish• Insects• Vaccines• Medications like antibiotics, anesthetics• Some tropical insects, plants, animals• Unknown causes

Symptoms• Tingling / warm sensation• Itchiness / Rash• Swelling of areas around mouth / throat • Restricted air-ways• Reduced oxygen level in brain• Signs of asthma• Vomiting• Diarrhea• Low blood pressure• Palpitations / feeling faint• Loss of consciousness

    Treatment• If nauseated, lie down on the side• If feeling faint, lie down, legs raised• In case of breathing difficulty, sit up• First time patients should be hospital treated • Epinephrine injections – effective treatment • Continuous monitoring mandatory• Severity/ response / prior episodes determine

treatment

   Prevention• Avoid allergens as far as possible• Those at risk should carry adrenalin auto-injector• Inform school authorities, if children at risk• Children should wear food allergy badges• Emergency protocols necessary in schools/ work

place• Educating the public is vital

Animal breaksSymptoms• Skin break • Bruise / puncture• Cuts,Bleeding• Swelling and redness of the area• Oozing of fluid Treatment• Calm the affected person• Wash hands before attending to wound• Wash wound with soap & running water• Apply antibiotic ointment • Dress using sterile bandage• After first aid, medical treatment must be sought quickly• Suturing may be required• Tetanus booster / antibiotics required• Treatment depends on type / location of wound• Prevention• Avoid keeping wild animals as pets • Choose a pet that is friendly to children• Train the pet to obey commands• Vaccinate your pet

ASTHAMA• It is a chronic lung disease• It creates narrowing of  air passagesof the lung Produces 

difficulty in breathing.  Symptoms• Wheezing• Cough and cold• Tightness in the chest• Disturbed sleep• Breathlessness  Asthma Triggering Factors  • Colds and viruses• Irritants like Cigarette smoke, scent, pollution • Cold air or change in weather• Physical exertion • Allergens like dust, mite, pollen, furs• Some medications• Infections• Stress Treatment• Anti-inflammatory drugs include:

a. Steroid Inhalersb. Sodium Chromoglycate Inhalers / Capsules

• Treatment –Bronchodilators• Common bronchodilators include:

a. Salbutamol Inhalersb. Terbutaline Tabs

• Consult your Pulmonologist

BURNS• Injuries due to heat/ chemicals/ electricity/ radiation • Common heat injuries due to fire, hot liquids, steam

Burns due to heat / chemicals – through skin contact 

• Severe burns affect muscles, fat and bones• Older people/ children - particularly vulnerable

   Categories of burns

First-degree burns• Injuries are superficial / mild• Swelling & redness of the injured area • Pain develops• No blisters seen• Burned area becomes white on touch• Takes 3-6 days to heal

  Treatment• Remove patient from heat source• Remove the burnt clothing• Run cool water over burnt area• Gently clean the injured area• Gently dry • Apply anti biotic such as Silver Sulphadiazine• Use a sterile bandage to cover burns• Take tetanus vaccination.   

 Second-degree burns• Burns extends to middle skin layer, dermis • Swelling, redness and pain observed• Burnt area may turn white on touch• Blisters develop, that ooze a clear fluid • Scars may develop• Restricts movement, if injury occurs at joint• Dehydration may occur• Healing time varies, depends on extent of injury

    Treatment• Clean the affected area thoroughly• Gently dry• Apply antibiotic cream over affected area• Skin graft may be required• Hospitalization is essential

 Third-degree burns • Damage occurs to all 3 skin layers• Destroys adjacent hair follicles, sweatglands, nerve

endings • Scars develop • Dehydration occurs resulting in shock • Symptoms may worsen with time • 90% body surface injury results in death • 60% injury in elderly, fatal •     Treatment • Requires immediate hospital care • Dehydration treated through intravenous fluid

supply • Oxygen is administered • Periodically run clean cool water over burns 

CHOCKING Overview• Occurs when foreign object is lodged in windpipe• This blocks oxygen supply to brain • Choking could be fatal, if first aid not given

    Causes• Swallowing a large piece of food• Swallowing food that is not well chewed• Eating food quickly• Eating and talking• Consuming alcohol before a meal• Wearing dentures

    Symptoms• Hands will grasp throat• Breathlessness• Noisy breathing• Inability to cough• Skin, nails and lips may turn blue• Loss of consciousness          

Treatment• Heimlich maneuver and CPR –2 techniques

Heimlich maneuver - an emergency procedure to help someone who is choking because food is lodged in the trachea

Heimlich manoeuvere

 If person is unable to talk, try Heimlich maneuver Forces the diaphragm up to the lungs  Creates an artificial cough

•    Heimlich Maneuver on a standing    person• Stand behind the person• Form a fist with one hand• Place fist below ribcage, thumb inward• Hold the fist with other hand• Keep arms off ribcage• Give four inward and upward thrust• Repeat till the object is ejected• Same method is used for a child too

   Heimlich maneuver On an Unconscious Person• If person is lying down, straddle the person with

your knees• Place heel of one hand above waistline• Place other hand over the first• Give four inward and upward thrust• Repeat till object is coughed out

Cardiac Arrest• Often caused by abnormal heart rhythm• This aberrant rhythm is ventricular fibrillation(VF)• During VF heartstops pumping blood• Patient may stop breathing • No pulse may be detected• A shock to the heart, called defibrillation, required

Defibrillation stops VF, restores heart function

   What is CPR?• Emergency life-saving measure• Combination of rescue breathing &

chest compressions • Done on unconscious/ non-breathing patient • Done on persons suffering cardiac arrest• Also for near-drowning/ asphyxiation/ trauma cases• CPR conducts defibrillation• Supports heart pumping for short duration• Allows oxygen to reach brain• Buys time till help arrives• More effective when done as early as possible

 Caution• Ribs/heart/lungs/ liver may be injured• After CPR, medical attention should be given

 THE VITAL STEPS Clear the airway• Assess if the person is conscious / breathing• Lay the person on his back on a hard surface• Using a head tilt -chin lift open his airway• Check for breathing sound• If not breathing, start mouth-to-mouth breathing

   Mouth- to-mouth breathing• Pinch the person's nostril shut• Seal his mouth with your own• Give the first breath, lasting one second• Watch if chest rises• If it rises, give second rescue breath• If it does not rise, give a head tilt- chin lift• Now give second rescue breath

  Restore circulation through compression• Place heel of your palm on patient's chest• Place your other hand above first

Keep elbows straight• Push down using upper body weight (compress)• Push hard and fast• After 30 compressions, clear airway• Give two rescue breaths • This is one cycle• Give 100 compressions /minute• Continue CPR till medical help arrives

      

• Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. In 2010, the American Heart Association updated its guidelines to recommend that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions.

• Here's advice from the American Heart Association:• Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of about

100 a minute until paramedics arrive (described in more detail below). You don't need to try rescue breathing.• Trained, and ready to go. If you're well trained and confident in your ability, begin with chest compressions instead of first

checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.

• Trained, but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of about 100 a minute.

• The above advice applies to adults, children and infants needing CPR, but not newborns.• CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore

a normal heart rhythm.• When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. A person

may die within eight to 10 minutes.• To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external

defibrillator (AED).• Before you begin 

Before starting CPR, check:• Is the person conscious or unconscious?• If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"• If the person doesn't respond and two people are available, one should begin CPR.— unless you think the person has become

unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute & call local emergency number.

• If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

• Remember to spell C-A-B• In 2010, the American Heart Association changed its long-held acronym of ABC to CAB — circulation, airway, breathing

— to help people remember the order to perform the steps of CPR.

Circulation: Restore blood circulation with chest compressions• Put the person on his or her back on a firm surface.• Kneel next to the person's neck and shoulders.• Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of

the first hand. Keep your elbows straight and position your shoulders directly above your hands.• Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches

(approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.• If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency

medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway• If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-

lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

• Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and continue chest compressions.

Breathing: Breathe for the personRescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

• With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

• Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.

• Resume chest compressions to restore circulation.• If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is

available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED. Do not use an AED for babies younger than age 1.Continue CPR until there are signs of movement or emergency medical personnel take over.

Electric shock Injuries caused when electric current passes through 

body Source may be natural or man-made     What happens during electric shock?• Makes you fall down• Muscle contraction• Seizures• Dehydration• Burns • Fractures• Clotting of blood• Tissue death (narcosis)• Respiratory/Heart/Kidney failure Steps to follow• Do not attempt to move the victim from current 

source• First step is to switch off the current source• Otherwise, move the source using a wooden stick  

Attend to the victim• Check for breathing No breathing, do

Cardio pulmonary resuscitation (CPR)• Call emergency medical aid• If breathing, do a physical examination • Treat for minor burns• Re-establish vital functions• Excessive burns may require hospitalization/ 

surgery &Supportive care must be provided

fractures   Types• Open fracture: Skin breaks causing open wound• Closed fracture: Skin not broken • Complicated fractures: Damage of adjacent organs• Stress fracture: Hairline crack due to repeated

stress• Greenstick fracture: In children's flexible bones

   Symptoms• Severe pain • Difficulty in movement• Swelling/ bruising / bleeding • Deformity / abnormal twist of limb• Tenderness on applying pressure

   First-aid• Depends on type & location of fracture

For open fractures• Control bleeding before treatment• Rinse and dress the wound• For open / closed fractures• Check the breathing • Calm the person • Examine for other injuries• Immobilize the broken wound • Apply ice to reduce pain / swelling• Consult a doctor •    DO NOT• Massage the affected area• Straighten the broken bone • Move without support to broken bone• Move joints above / below the fracture

GastroenteritisOverview• Gastroenteritis is inflammation of stomach and

intestines• Can affect- any one, any age, any time• Symptoms prominent in children• Depending on cause, it may last for a day or a

week • Use of drugs like aspirin can increase the risk•    Causes• Bacteria contaminated food / water• Viral infection• Stress• Irregular/ improper diet• Reaction to a new food• Reaction to medication•    Symptoms• Vomiting• Nausea• Diarrhea• Cramps/Abdominal pain• Dehydration• Weakness• Fever/Chills, occasionally•  

 Treatment• Adequate rest is advised• Drink plenty of fluids to

prevent dehydration• Gradually eat easy -to-digest food• Avoid eating if nauseated• Do not give water to a child with

gastroenteritis• Give other prescribed rehydration

liquids• Or give a mixture of salt and

glucose in water• Avoid aspirin

Head InjuryHead trauma is an injury that affects the brain / skull• Head injury may be 'closed' or 'penetrating'

   Causes• Road traffic accidents• Accidents at home / work• Assault• Fall• Sports•    Symptoms• Loss of consciousness- for short or long duration• Bleeding• Vomiting• Fluid discharge from nose• Loss of hearing, vision, taste, smell• Speech-related problems• Irregular heart beat• Seizures• Paralysis• Coma• Change in personality• Mental health-related problems   

Treatment For mild injury-• Apply ice to injured area to minimize swelling• The size of the bump is not related to the severity of

injury• Observe the patient carefully for signs of bleeding

For moderate to severe injury-• Check the patient's breathing pattern• If necessary do   

Cardio Pulmonary Resuscitation (CPR)• In case of bleeding, press area with a clean cloth• If the cloth soaks, place a fresh cloth over the first one• Do not remove debris from the wound• If person is vomiting turn on the side and lower the

head• To minimize spine injury- hold head, neck and body in

one line • Immobilize the patient• If unconscious, treat it like a spinal injury• Keep the head in alignment with spine• Get immediate medical help

 Consult a DoctorWhen the following occur seek medical help-Bleeding

• Fluid discharge from nose, mouth, ears,Vomiting• Loss of consciousness• Confusion / Restlessness / Irritability Slurred speech /

Convulsion ,Blurred Vision,Low breathing• Fracture/ Stiff neck• Loss of sensory abilitiesInability to move one or more

limbs

   

Poisoning   Causes

• Medications • Drug overdose • Occupational exposure • Cleaning detergents/paints • Carbon mono oxide gas from furnace, heaters • Insecticides • Certain cosmetics • Certain household plants, animals • Food poisoning (Botulism) 

   Symptoms• Blue lips • Skin Rashes • Difficulty in breathing • Diarrhea • Vomiting/Nausea • Head ache • Giddiness/drowsiness • Double vision • Abdominal/chest pain • Palpitations/Irritability • Loss of appetite/bladder control • Numbness • Muscle twitching • Seizures • Weakness • Loss of consciousness 

Treatment• Seek immediate medical help• Check for signs like burns around mouth,

breathing difficulty or vomiting • Induce vomiting if poison swallowed • In case of convulsions, protect the person from self

injury • Position the victim on the left till medical help

arrives 

For inhalation poisoning• Seek immediate emergency help • Hold a wet cloth to cover your nose and mouth • Open all the doors and windows • Take deep breaths before you begin the rescue • Avoid lighting a match • Check the patient's breathing • Do a CPR, if necessary • If the patient vomits, take steps to prevent choking 

   Steps to Avoid• Avoid giving an unconscious victim anything orally • Do not induce vomiting unless told by a medical

personnel • Do not give any medication to the victim unless

directed by a doctor • Do not neutralize the poison with limejuice/honey

Shock Shock is a life-threatening condition .When vital organs

fail to get enough blood, shock results•    Causes• Severe infections• Allergic reactions• Heat Stroke• Trauma• Poisoning• Injury•    Symptoms• Cool, clammy skin  ,Dilated pupils • Vomiting/nausea • Feeling weak  ,Confusion • Excitement • Anxiety • Shallow/ slow breathingor rapid/ deep breathing 

Weak and rapid pulse•    Treatment Get emergency medical help.

Meanwhile-• Make the person lie down on the back• Raise the legs above head level• If raising the legs is painful, keep the person still• Check for breathing If not breathing, do   

Cardio pulmonary Resuscitation (CPR)• Make the person comfortable by loosening tight

clothes• Cover the person with a blanket• If vomiting or bleeding from mouth -turn the patient

on the side• Do not feed the person orally  

Severe BleedingSevere bleeding involves loss of large amount of

blood .This may occur externally through natural openings, like mouth  A cut on the skin too can lead to bleeding  Internal bleeding occurs due to an injury to blood vessel 

   Causes• Accidents/Falls ,Blow to the head • Injuries, like scalp wounds • Certain medications • Illnesses like 

a. Hemophilia b. Scurvy c. Cancerd. Thrombocytopenia e. A plastic Anemiaf.  Leukemia g. Hemorrhageh. Peptic Ulcer i.  Platelet Disorderj.  Liver Disease k. Septicemia 

  Treatment• Wash hands well before administering to patient • Wear synthetic gloves • Make the victim lie down .Slightly elevate the legs • If possible keep the affected area elevated • Remove any obvious debris/particle • Apply direct pressure using clean cloth/bandage • Use hand if cloth is not available • Apply pressure continuously for at least 20 minutes • Hold the bandage in place using an adhesive tape • Apply direct pressure on the artery if necessary  • Squeeze the artery keeping finger flat • Continue applying pressure on the wound • Once bleeding stops immobilize the affected part • See a doctor 

Snake Bites

Thousands suffer from snake bites, globally, every year  People who live near wilderness/trekkers - more prone  Even bite from a harmless snake can cause allergic reaction 

   Symptoms• Fang marks • Swelling/severe pain at the site • Bloody discharge from wound • Burning • Diarrhea • Excessive sweating • Blurred vision • Numbness/tingling sensation • Increased thirst • Vomiting • Fever • Loss of muscle co-ordinations • Convulsions • Rapid pulse • Weakness/Dizziness/Fainting •   

 Treatment • a. Seek Medical help as soon as possible.  

Meanwhile -• Wash wound with soap/water • Immobilize the affected area • Keep area slightly elevated • Apply cool compress/wet cloth to affected part • Apply a firm bandage 2-4 inches above bite to

i. Prevent venom from spreadingii.Take care of any bleeding

• b. Monitor for pulse, respiration ,etc

  Prevention• Do not attempt to kill a snake. • If you spot a snake, leave it alone • While hiking or in the woods, stay out of tall grass • Do not put your hand into pits/crevices during treks • Exercise caution while climbing rocks 

PLANNING OF CASUALTYThe casualty has evolved into a self sufficient, well-equipped important area of the

hospital and is no longer just a two-room unit present in a remote corner of the hospital. It is called Accident and Emergency department (A & E) now and has gained recognition as a separate branch of medicine.

• . Casualty should be located on the ground floor and easily accessible both from inside as well as outside the hospital. It should have separate entry and exit points to minimize traffic congestion. The entry point should have a porch to protect the unloading of patient’s from rain and sun. All the doors should be wide, with two way swing to allow easy entry and exit.

• The casualty emergency department sign must be promptly displayed outside the facility. The corridors leading to the casualty should be wide enough to allow passage of trolleys and other mobile equipment. There should be a large waiting area for the relatives, trolley bay, canteen, police and security room and toilet facilities outside the casualty. Parking space for ambulance should also be earmarked. The area for medical disasters should be ear marked and can be either part of casualty or adjoining waiting area. The casualty complex should have separate examination, resuscitation & triage cubicles, ECG room, plaster, dressing and x-ray rooms.

Cont….

It should be equipped with modern monitoring and therapeutic modalities, and manned round the clock by physicians and nurses familiar with emergency medical situations.

• Nursing staff is the backbone of the casualty and the department should have dedicated nurses. Senior nursing staff can look after the day-to-day running of the facility, accounting duties, supervision and implementation of disaster and waste management.

• The casualty should be provided with separate outcall and internal call facilities. It is a good idea to provide mobile telephone loaded with important telephone numbers to the CMO beside a paging system.

• The CMO should regularly participate in Advanced Cardiac Life Support and Advanced Trauma Life Support programmes and disaster drills conducted by the hospital from time to time. The hospital administration should have a dedicated person to look after the casualty.

• A round the clock receptionist is mandatory to make the casualty cards and interact with the patients, and should be provided with a computer connected to the hospital network for direct billing, data access, data retrieval and report generation. Involvement of medical social worker in the casualty provides help to the patients as well as the relatives.

• The casualty often encounters the problem of extra attendants, large crowds, with emotions and tempers running high. Good security arrangement must be provided to ensure the safety of the hospital staff and to prevent any disruption in work.

Basic Utilities 

Stretcher Trolley

Suction Machine

Hospital Wheelchair

OXYGEN CYLINDERSPO2 MONITOR

DEFIBRILLATOR

Casualty TrolleyDressing Trolley

Instrument Trolley

Monitor Trolley

MLC’sCases that are to be treated as medico-legal• 1. All cases of injuries and burns –the circumstances of which suggest 

commission of an offence by somebody.• 2. All vehicular, factory or other unnatural accident cases specially when there is 

a likelihood of patient’s death or grievous hurt.• 3. Cases of suspected or evident sexual assault.• 4. Cases of suspected or evident criminal abortion.• 5. Cases of unconsciousness where its cause is not natural or not clear.• 6. All cases of suspected or evident poisoning or intoxication.• 7. Cases referred from court or otherwise for age estimation.• 8. Cases brought dead with improper history creating suspicion of an offence.• 9. Cases of suspected self-infliction of injuries or attempted suicide.• 10. Any other case not falling under the above categories but has legal 

implications

PROMOTION TOOLSIn most places in the world, the EMS is summoned by members of the public via an 

emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation. 

Service providers -• Government Ambulance Service – Operating separately from the fire and police 

service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, almost all emergency ambulances are part of a national health system. 

• Fire or Police Linked Service – In countries such as the United States, Japan, France, and parts of India; ambulances can be operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truck.

• Volunteers Ambulance Service – Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. They may be linked to a voluntary fire service, with volunteers providing both services. There are charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service across the world on a volunteer basis. (and in others as a Private Ambulance Service),

• Private Ambulance Service – Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. non urgent), but in some places, they are contracted to provide emergency care, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. This system has the benefit of keeping emergency crews available all the time for genuine emergencies. These organizations may also provide services known as 'Stand-by' cover at industrial sites or at special events .

• Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.

• Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.

• Charity Ambulance – This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals

• Company Ambulance - Many large factories and other industrial centers, such as chemical plants, oil refineries, breweries and distilleries have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.

Improving health system preparedness for mass casualty events

A commitment from medicine, dentistry, nursing, emergency medical services, hospital systems and public health to improve health system preparedness for terrorism and mass casualty incidents .

We in the health professions pledge to make health system preparedness one of our highest priorities. Working with educators, social workers, firefighters, law enforcement, business, community groups, clergy and others, we will support national, state and local efforts to strengthen individual and community preparedness, response and resilience to terrorism and other catastrophic events.

• Together, we will work to enable the public health and health care systems to become truly interoperable and integrated, with adequate resources, facilities and training to better coordinate their assigned tasks. As scientists, public servants and humanitarians, we will incorporate everything possible into our professional and advocacy efforts to protect public health and safety in a disaster. We resolve to:

• Provide leadership in national, state and local disaster planning and response efforts.• Put disaster preparedness into practice. • Educate ourselves about disaster preparedness and response.• Advocate for solutions based on sound science.To improve health system preparedness mass casualty events:• Collaboration, coordination and planning • Funding• Communications and information exchange  • Health system surge capacity• Disaster recovery and health systems • Legislation and regulation• Research

PLANNING IN HOSPITALSPlanning framework needed?• ensuring access to high quality pre-hospital care,• continuing to provide reliable emergency medical dispatch;• providing access to high quality and consistent patient triage and assessment;• maintaining qualified crews on ambulances;• maintaining well-equipped ambulances• locating emergency medical service stations in the right places to make sure 

they can respond to calls quickly and efficiently;• coordinating pre-hospital care with other services within the health care 

system;• ensuring efficient use of resources in the system;• responding to the needs of changing populations in the province;• implementing new technology and standards in emergency medical service 

delivery

PLANNING

INTERNALEXTERNAL

External Planning

A disaster plan encompassing both local and regional areas must focus on 3 possible scenarios:• The disaster occurs within the region and is confined and controlled with existing resources.• The disaster occurs in a neighboring region, and regional assets are requested through mutual

aid agreements.• The disaster area is the region and requires state or federal assistance for an effective response.

Incident command system• In the 1970s, the Fire Suppression Services developed the ICS concept to organize an effective

response to major disasters. The ICS structure includes 5 functional units: command, operations, logistics, planning, and finance. 

• Most disaster plans include similar organizational structures that are often modified depending on normal operations of the various agencies.

• In developing a disaster plan, leaders should remember that it is impossible to plan for all contingencies; therefore, plans must be relatively general and expandable. Most disasters that can be contained using local or regional resources have fewer than 100 fatalities and fewer than 500 major casualties. If plans are developed for larger-scale disasters, the plan should focus on the first 48 hours of the disaster until state and federal assistance teams can arrive and to address high initial fatality rates during the first 24 hours.

Internal Planning• Hospital disaster planners must take into account the scenarios including the possibility that the

disaster may involve the hospital. For such rare events, aspects of hospital involvement such as mass decontamination, multiple triage and staging areas within the confines of the hospital, recall of critical personnel, and provisioning of adequate supplies and resupply must be anticipated. The Joint Commission (formerly Joint Commission on Accreditation of Hospitals [JCAHO]) requires hospitals to exercise disaster plans periodically and to form disaster committees. These committees should comprise key departments within the hospital, including administration, nursing services, security, communications, laboratory, physician services (including, but not limited to, Emergency Medicine, General Surgery, and Radiology), medical records, and maintenance/engineering.

The hospital disaster plan should include protocols and policies that meet the following needs:• Recognition and notification• Assessment of hospital capabilities• Personnel recall• Establishment of a facility control center• Maintenance of accurate records• Public relations• Equipment resupply

PUBLIC HELPLINES MUMBAIPolice hotline 100Blood Banks 1910Ambulance Services 102General Complaints 1916Children Helpline 1098Mumbai Telephones Special immigrations 176Mumbai Telephones Assistance 199Mumbai Telephones Complaint 198Emergency Numbers:

Accident cases only: 102Heart Attack: 105

Mumbai Helplines | Emergency and Important Helplines For Mumbai

Ambulances Services – Mumbai | Emergency Ambulance Service Helplines In Mumbai• VITAL DIRECT AMBULANCE

SERVICE NUMBER :• Newly Launched, Dial 1298 for

Emergency Ambulance services in Mumbai.

• MUMBAI EMERGENCY AMBULANCE 102

• THANE EMERGENCY AMBULANCE 25331552

• NAVI MUMBAI EMERGENCY AMBULANCE 27572111

Police Station – Mumbai | Contact Numbers Of Mumbai Police Stations

MUMBAI POLICE VITAL DIRECT NUMBERS :

• Police Control Room:– City: 100– New Bombay: 757-4929

• Mumbai 22620111• Thane Police Station 25443535• Navi Mumbai Police Station 

27600101• (Crime Branch Mumbai) 103

Fire Brigades – Mumbai |Emergency Fire Stations and Fire Fighters Numbers

Emergency Control Room: 101 / 309-5991 / 309-5992 / 309-5993 / 309-5994

POWER SUPPLY• BEST 24-hour breakdown 

services– Fault Control (North): 414-

6683– Fault Control (South): 206-

6661

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