Commentary on the article: Role of emergency department of a super speciality government hospital during a seasonal epidemic in a developing country: A conundrum

Health care utilization by individuals in India is greatly influenced by gender, economic conditions, educational level, cultural believes, and geographic locations. ^[1] The situation becomes worse during an emergency (disease outbreak or a natural disaster) because of poor communication and slow public health response. In an emergency, loss of life and disability are found to be substantial due to limited resources and non-existence of disaster/emergency preparedness in India.

This is clearly indicated in the said study where sudden influx of a large number of dengue patients in the emergency ward of a super-speciality hospital in Lucknow, India, jeopardized the healthcare delivery system of the hospital. People were not aware of the available facilities of investigation and treatment for dengue in their locality and unnecessarily rushed to this super specialty hospital. Emergency department was absolutely not prepared to deal with this crisis. More than 30% of emergency beds became immediately occupied by dengue patients. A considerable number of patients requiring special care were either refused admission or had to wait for long time and unfortunately many dengue patients did not receive proper treatment. Similar disruption of quality service in a critical care unit was also reported following a nosocomial influenza outbreak in Chicago. ^[2]

On the other hand, risk of such hazards could be minimized through concept of preparedness planning. ^[3] Preparedness is the multilevel collaborative emergency response plan among the Government, local communities, health care facilities, and individuals to cope with emergency quickly and efficiently. Essentials steps of this process include identification of resources, defining roles and responsibilities of key persons, formulation of policies and procedures, communication and coordination of plans, plan for proper implementation along with rigorous monitoring, and early risk communication to public. ^[3],[4]

Emergency department of any health care facility is considered to be an important 24×7 safety net for providing continuous care characterized by prompt diagnosis, urgent treatment of acute conditions, and rapid inpatient admissions, if required. It also plays an important role during a crisis, but the role of pre-hospital emergency medical services during an outbreak is ill-defined in India. A team of emergency care experts from Cambridge, UK emphasized the role of emergency department in planning and management for getting prepared to combat any disease outbreak. ^[5] A cross-sectional analysis for identification of barriers in integration of hospitals for community emergency preparedness in US reported non-identification of a single discipline or professional group in hospital that are responsible for handling such an emergency. This resulted in severe communication gap among the hospital, affected people, and local stakeholders. ^[6]

It seems that every hospital should formulate their own preparedness plan in accordance with their existing infra-structure and manpower to meet emergency medical care demands. The essential steps for preparedness planning include: Identification of key personnel in the emergency department of healthcare facilities designated for preparedness planning along with stakeholders from local community. Predefining the role of concerned authorities (Government, hospital, local agencies, and individuals) during an outbreak is essential, in addition to the management of information about bed availability, availability of personal protective devices like masks, gloves, procurements, and stock piling of necessary equipments, and agreement on financial support associated with each step of planning.

It is also necessary to update hospital staff about ongoing national disaster preparedness plans, seasonal epidemics (like influenza, dengue, cholera etc.) and their trends over years, current status of any outbreak in the community, and preparedness planning of the healthcare provider as such. Each hospital staff should understand importance of their specific role and responsibilities during emergency which in turn will improve their motivation, compliance and efficiency. A mandatory training program should be organized at regular intervals for all hospital staff including doctors, nurses, paramedical, and other personnel for inculcating knowledge regarding disease, routes of transmission and preventive measures like personal protective equipments to minimize contamination and updating standard operating procedures for proper management of an outbreak. Procurement, stock piling and easy availability of necessary inventories within emergency department, infectious diseases wards and critical care wards should also be ensured.

A uniform protocol for emergency management should be developed across hospitals and should be followed stringently. While handling persons suspected to have infections, necessary precautions are to be taken to prevent unnecessary cross-infection (e.g. screening of febrile patients at emergency and isolating them). Necessary communication with concerned authorities, along with timely feedbacks is also considered to be an integral component of the emergency management. A well coordinated communication system should be established to provide real-time status update including information on admission, progress of disease, availability of bed and stock, safety measures etc. Good interaction between hospital staff and local community members involved in preparedness planning would likely improve the emergency response of the facility. Care should be taken to promote consistent dissemination of complete and accurate information to patients, their family members, public and media in real time for building a trusted relationship.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.150108