Alternate ER page

Overview

This department is open 24 hours a day/7 days a week and is responsible for the management of all emergent and urgent patients in our region. The primary ER doc serves as medical control for all medevacs in and out of our region. The Emergency Department is designated a Level IV Trauma Center.

Unit Description (facility)

The Emergency Department contains 9 beds and 2 trauma bays. We have approximately 25,000 patient encounters per year, about 50 percent of them are for pediatric patients. The coverage of the ED is physicians 8 a.m.– 8 p.m. and 8 p.m.– 8 a.m., a second provider 10 a.m.– 10 p.m. (sometimes this is a pediatrician), and a PA/NP from noon to midnight.

GENERAL INFORMATION

• ER Overview
• Emergency Room Providers Job Description
• Pediatric Provider Job Description in the ER
• ER Documentation and Depart

ER SPECIFIC INFORMATION

Common ER Encounters

• Common ED Procedures
• Special ED Situations/Protocols
• Emergency Guidelines/Protocols
• Transfers to/from the ER
• Medevacs for the ER Provider
• Referrals from the ER

Referrals

1. Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
2. Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
3. Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.

RMT (Radio Medical Traffic)

1. There are 2 types of RMT: emergency/urgent and routine.
2. Emergency/Urgent are cases where the CHA sends in an RMT document to the message center proxy called NW emergency/urgent RMT. The CHA then calls the on-call inpatient doc for that village and they talk about the patient and what to do for the patient. These calls can sometimes end up in a medevac, sometimes the patient is sent to the ED via commercial flight and sometimes the patient is treated and sent home.
3. Routine RMT is handled by ambulatory providers and the CHA sends in a document and the provider responds is electronically.
4. Sometimes the CHA will call the ED and ask to talk to the ED doc, usually because they are doing CPR on a patient and haven’t had time to start any documentation. See above about activating medevac for CPR in progress (generally don’t.) You will be expected to talk the CHA through the case. These are highly stressful situations for the CHA – remember this is certainly someone they know and often a relative. There is often chaos in the background and it can be hard to hear the CHA or determine what is going on. Please be very patient at these times. The CHA will want you to make the determination when to stop resuscitative efforts. Generally speaking, we don’t have them do CPR for more than an hour. So at about the 45 minute mark, ask them to start thinking about stopping CPR. Sometimes they don’t want to and we let them keep doing CPR longer. This is especially true if it is a baby or a child. If it is a child, get the pediatrician on the phone if you think that will help. Link to code resuscitation section of Emergency RMT.
5. If you get other calls from CHAs regarding other emergencies (strokes, seizures, village deliveries, etc) re-direct CHAs to the NW doc on call for that village. Peds on call can also be contacted for any pediatric patient.