Consider the examples of clinical emergencies below:
A) A patient comes to ER with an ongoing heart attack (Myocardial Infarction). Can the hospital arrange a PAMI (Primary Angioplasty in Myocardial Infarction) at midnight?
B) A patient comes with an Intracranial bleed (requiring Neurosurgical intervention), with high BP (requiring a Physician or a Neurologist), and urgent imaging (CT or MRI) with reporting by a qualified Radiologist. Can the hospital arrange all this at odd hours?
C) A young man sustains multiple injuries in a road accident, including severe head injury, injuries to the liver and spleen, and major fractures in lower limbs. He is in hypovolemic shock. Can the hospital arrange resuscitation and emergency surgeries involving at least three different specialties?
All emergencies require significant coordination between different departments and Consultants. On reaching a hospital, a patient with a life-threatening or critical limb injury is taken to the Emergency Room (ER). Most tertiary care hospitals have an Emergency Medicine qualified Dr on duty: but only during 'working hours' and on 'working days'. This translates to (8 x 6 or 48 hours) a week. So for most of the time, i.e., 120 hours a week, there is no Emergency Medicine specialist. Some hospitals address this by requiring Emergency Med specialists to be 'on call' 24/7. In reality, they manage critical emergencies offsite!
Other hospitals make arrangements as follows:
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