EMERGENCY MEDICINE DEPARTMENT (EMD)

A: INTRODUCTION:

The emergency medicine department (EMD) at MNH-Mloganzila acts as the interface between the hospital and the population that it serves. It is the receiving department for all emergency referrals and cases at Muhimbili National Hospital-Mloganzila campus. The department was opened in September 2017. It is among the very few full capacity EMDs in Tanzania having emergency physicians available in the department for 24-hours every day including weekends and holidays. The Emergency Medicine Department (EMD) is equipped with advanced life support machines and Point-Of-Care investigations that help to provide specialized and quality emergency interventions to all patients, adult and pediatric presenting to MNH-Mloganzila campus with undifferentiated medical, surgical and trauma illnesses at different levels of acuity. The Department also coordinates the Ambulance Unit, which is used to transfer patients between MNH main campus and Mloganzila campus when such need arises, but also some dedicated services upon request of patients/ relatives. The EMD in collaboration with other stakeholders serves as the commanding and tertiary receiving center for mass causality incidents around Dar es salaam and Tanzania at large.

B: AIM

Emergence Medicine Department (EMD provides services for acutely ill patients with potential life-threatening conditions and the aim is to stabilize and manage them for a maximum of 24 hours before referral to an inpatient ward, intensive care unit, outpatient clinic or medical evacuation if possible for further diagnostic and treatment.

C: EMD STRATEGIES AND ACTIVITIES:

• Strategies:

1. Maintain the EMD mortality rate below one percent

2. Reduce the patient turnaround time at the EMD for queue category of patients

3. Reduce the lag time to definitive treatment of EMD patients by early consultations

4. Maintain workers morale, customer care and work ethics at all times

• Activities:

1. Treating and stabilizing critically ill patients
2. Conducting basic and advanced life support training for all doctors and nurses working in EMD. The courses are internationally certified for emergency providers, they include
   • Basic life support (BLS)
   • Advanced cardiac life support (ACLS)
   • Paediatric Advanced Life Support (PALS)
   • Primary Trauma Care (PTC)
   • BAP- Basic Ambulance Provider
   • BEC-Basic Emergency Care

3. Conducting Weekly CME for all providers to keep them updated with current evidence-based emergency medicine and familiarize with departmental clinical protocols
4. Conducting research in emergency medicine
5. Training emergency care providers (Specialist Doctors and Nurses) for the country in collaboration with MUHAS and MNH-Upanga
6. In collaboration with MNH-Upanga responds to mass causality incidents around Dar es Salaam and Tanzania.

(Currently, EMD has training programs for all staff and visiting Emergency providers from USA, Australia, Canada and South Africa act as mentors and faculty in the department)

C: ORGANIZATION

The EMD is divided into 6 sections for the purpose of providing organized high quality care to patients. These include,

1. Triangle area
2. Resuscitation area (Wing A)
3. Adult treatment area (Wing B)
4. Pediatrics treatment area (Wing C)
5. Isolation (2 Negative pressure rooms)
6. Emergency Pharmacy

C: EMD SERVICE PROFILE

1. Triage area:
   1. To receive referral and emergency cases.
   2. To collect data and rapidly assess patient condition in order to prioritize and initiate appropriate care.
   3. Transfer patients to the appropriate EMD area, treatment or resuscitation.
   4. In non-emergency cases, send patients to the cold casualty or Out-patient department.
   5. Screen for diseases of public importance so as to initiate early isolation

2. Resuscitation area (Wing A):
   1. To treat emergency patients with immediate life-threatening conditions.
   2. Patients receive a doctor consultation and nursing care and interventions immediately upon arrival.
   3. Additional investigations may be ordered and initiated.
   4. In addition to Specialized Emergency care, definitive care specialist consultations may be called at EMD depending on patient condition.
   5. Patients’ transferred to operating theater, admitted to appropriate ward/ICU or discharged with follow-up instructions according to their condition

3. Adult treatment area (Wing B)

1. To treat priority and queue patients; patients with conditions that are not life threatening but must be attended within 24hours.
2. Patients will receive a doctor consultation, nursing care and interventions according to priority.
3. Additional investigations may be ordered and initiated.
4. In addition to Specialized Emergency care, definitive care specialist consultations may be called at EMD depending on patient condition.
5. Patients’ admitted to appropriate ward or discharged with follow-up instructions according to their condition.

4. Pediatrics treatment area (Wing C)

1. Equivalent to Adult treatment area but specialized to attend priority and que pediatric patients, designated to be friendly to children and equipped with pediatric size consumables and treatment gadgets.

5. Isolation

1. Negative pressure rooms for containment of infectious conditions
2. Help for easy separation of care of patients who need isolation

6. Emergency Pharmacy

1. Dedicated pharmacy, which is inside the emergency department, its easily accessible and staffed 24/7 with pharmacist. Its equipped with all the essential life saving medications required at the emergency department.
2. Easy consultation to pharmacists in all issues concerning medications given to emergency patients