ED DOCS: Always on duty, No time to chill

CHENNAI: Visit the Emergency Department (ED) in any of the government hospitals in the city, and you’d be hard-pressed to find a doctor or a nurse or any of the staff not working. While it’s heartening to know that there is a doctor or a medical practitioner on duty 24-7 at an ED, even on weekend, let’s not forget that the hustle-bustle of ED takes a toll on its doctors too.

The ED at any GH gets more number of patients on weekends, mainly due to accidents – drunk-driving, regular trauma cases and falling from heights.

Rajiv Gandhi Government General Hospital, Stanley Medical College and Hospital, and Kilpauk Medical College and Hospital receive a large number of these cases during the weekends. They also receive a hundreds of referral cases from districts like Kancheepuram, Chengalpattu and Tiruvallur.

Less out-patient services

While weekends are busier in the ED usually, the lack of a separate out-patient department at the GHs piles on the cases on the ED.

“On weekends, we see a majority of accident cases, trauma cases, fall or accident due to drunk-driving. This calls for emergency care, surgical procedures and orthopaedic intervention,” said Dr R Muthuselvan, dean of Kilpauk Medical College and Hospital.

The Super Speciality services are not operational on Sunday and as per the regulations, they have to be given a day off. “That’s mainly on Sunday. But there are less number of workers on those days. So, certain cases have to be sent to the ED of respective hospitals,” said a health officer from a GH in the city.

Lifestyle changes

While people engage in more number of outdoor activities over the weekends, it also increases cases to the EDs.

Dr V Bhavani, anaesthetist at Stanley Hospital explained how the prevalence of partying and outdoor activities involving alcohol leads to more number of accidents.

“It’s common for people to go on long drives, attend parties and gather together for drinks on weekends and at night. When it’s about the festivals and celebrations, it’s extra work for us,” she added. “The non-trauma cases can also be alcohol-induced. Since pancreatitis and gastritis can also be suddenly induced due to alcohol, it can occur as acute pain among all ages. White eating outside, the consumption of high fat food can also lead to such issues.”

She pointed out that healthcare workers face safety issues when patients were under the influence of alcohol. “Some of them even abuse workers, and get violent too. Drunk people misbehave and it becomes difficult to restrain them to bed, diagnosing or shifting them to a treatment facility,” rued Dr Bhavani.

Referrals from suburbs

Despite being the District Head Quarters Hospital, the Kancheepuram GH does not have any doctors on weekends.

There are around 65 doctors in Kancheepuram GH in various departments but during the weekend, the hospital has only trainee doctors and nurses. Senior doctors would visit the hospital in the morning and leave after signing in.

Sources said that on weekends, a minimum of 10 accident cases would be reported on the highways in Kancheepuram and they would be brought to the GH. Due to lack of doctors in the GH, surgeries are not possible. So, patients are referred to private hospitals in the locality or the GHs in Chengalpattu district and Chennai.

“Even the hospital staff urge the family of the injured to visit a nearby private hospital citing unavailability of doctors, and that it would take more time to get them treated,” the source added. “In Chengalpattu GH, though doctors are available 24-7, there aren’t enough nurses especially during the weekend. There should be 700 nurses in the hospital but currently, there are only 140 posts filled.”

During the weekend, there are not enough number of nurses on duty. This leads to overburdening and over-working of healthcare workers on a regular basis. For instance, one nurse will be asked to do multiple tasks simultaneously.

TAEI to rescue

The Tamil Nadu Accident and Emergency Care Initiative (TAEI) offers relief to the GHs by offering better management of accident and emergency cases.

The State’s initiative to form an ED besides a casualty ward had helped in better management of cases with a set protocol and categorisation of cases. In all GHs, it has a HoD, professor, associate professor and post graduates in all the government hospitals.

“The department attends to the immediate need of a patient, irrespective of which speciality the case falls under. We attend to the patient for the first time, and then the speciality doctors are contacted for further treatment. Trauma, burns, stroke, heart attack, paediatrics and poisoning are the main issues. They’re called the six-pillar concept, and entirely managed by the ED. The moment a person calls an ambulance, all details are tracked and through a pre-intimation number, TAEI staff inform the hospital,” said Dr Thirunarayanan, ED professor at Stanley Hospital.

He added that every hospital has a specific pre-arrival intimation contact number so that the patient-findings can be done immediate. “We keep track of the treatment, scans, tests, rehabilitation, etc, under one roof for better patient-management,” he stated.

Infra needed

The GHs are trying to keep up with the increasing patient-load by upgrading and improving services but it never seems to be enough.

“We have to ensure that doctors are available 24-7, even on weekends. In case of an emergency, the postgraduate students are trained to coordinate with orthopaedic consultants, plastic surgeons, anaesthetists, neurosurgeons, operation theatre workers, and radiologists that operate round the clock,” said an emergency consultant from the Kilpauk Medical College and Hospital.

Dr Thirunarayanan stated that ventilator support, defibrillator and ICU facilities were always available. “We triage the patient within the ward and check for pulse, blood pressure, airway, breathing and circulation to check for resuscitation and ensures that the patient is stable. We have to stabilise the patient when they are unconscious and check for eye-movements, motor responses and verbal responses,” he averred.

He added that if the patient required a life-saving surgery, consent is sought from the attendants. “We immediately call with the chief doctor and speciality consultant and then conduct the surgery. Doctors report on immediate-basis for such procedures,” he said.

The GH in Tiruvallur has two senior medical staff after 2 pm. But on weekends, and in the absence of affordable private hospitals and other primary healthcare facilities in rural areas, the healthcare staff finds it challenging to manage cases. Doctors across all GHs opine that despite the specific protocols, the increase in footfall in the weekends can be managed only with upgraded facilities and more number of staff members.

“The cases are at least 30% higher than the weekdays, and the staff is at least 30% less on weekends. This is where the balance goes for a toss. The increase in the number of staff and better availability of radiology and pathology facilities on weekends would be good for the public and also reduce the burden on healthcare workers,” said an ED official at RGGGH.