Medical Emergencies in an Ambulatory Medical Clinic – A Preparedness and Response Plan

Medical Emergencies in an Ambulatory Medical Clinic – A Preparedness and Response Plan

Posted on August 27, 2012

Medical Emergencies in an Ambulatory Medical Clinic – A Preparedness and Response Plan

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

August 27, 2012

Last August 9, 2012, I received a text from Dr. Pinky B.  The text reads: I need to equip our new clinic with emergency measures for any reaction to injections or IV that we are doing.  Whom do we ask for standard requirements and staff training?”   I texted her back and said I will research and get back to her.  I made a pledge to my friend Pinky and I will try to deliver, no matter what, even just best effort.

I have been thinking also of this situation and need in the past, actually since I started operating a private medical clinic late 1981.  Although I have some preparedness plan, like having on hand epinephrine ampules, hypodermic and butterfly needles, airway tube, intravenous fluid, etc., I have always wondered even up to now whether they are enough and whether I am really prepared in case a medical emergency occurs while a patient is in my clinic.  What I have been doing more intently is to always hope there will be no medical emergency in my clinic.  In fact, I dread its occurrence as I am not sure whether I will be able to handle them properly and adequately.

At times, not very frequent, in my clinic, I administer parenteral drugs, such as chemotherapy and local anesthetics. When I do this, I am always wary of the possible adverse reactions that may occur with these parenteral administration of drugs.

Since after I received the text of Pinky, I have been researching on the presence of the so-called “standard requirements” in an ambulatory medical clinic for medical emergencies.  I surfed the  Internet and asked medical colleagues.  As of this time, the answer is none.

What do I do now? As I have said earlier, I made a pledge to my friend Pinky.  I will try to deliver, no matter what, even just best effort.

What I will do is to come out with my thoughts, perceptions, opinions and recommendations (TPORs) on this topic: Medical Emergencies in an Ambulatory Medical Clinic – A Preparedness and Response Plan.

There are two types of settings for an ambulatory medical clinic, one is within a hospital perimeter and one is outside.  The difference between the two ambulatory medical clinics as influenced by their setting lies in the readiness to get medical assistance from an external team in case a medical emergency occurs in the clinic.  No doubt, theoretically at least, it will be easier to get external medical assistance in the ambulatory clinic located within a hospital perimeter as practically all hospitals nowadays have a 24/7 cardiopulmonary resuscitative team and there is a 24/7 hospital emergency room or department nearby.

A question I wonder aloud: Is an ambulatory medical clinic located within the hospital perimeter not required or exempted from having a medical emergency preparedness and response plan just because of the presence of hospital cardiopulmonary resuscitative team and an emergency room nearby?

My answer is no.  My stand is that all ambulatory medical clinics whether within or outside a hospital perimeter should have a medical emergency preparedness and response plan.  The one within the hospital perimeter is not exempted because quick timing, aside from the needed procedures being properly done, in the administration of the initial yet crucial resuscitative measures commonly affects outcome.  The presence of a hospital cardiopulmonary resuscitative team does not always ensure quick arrival of the team to the clinic where the patient with a medical emergency is located.  Likewise, the presence of an emergency room nearby does not always ensure quick accessibility to it from the clinic.

The other reason is that all medical clinics by virtue of the nature of their professional service, which is medical, is expected by the public and the community to have the capability and competency in rendering at least first-aid and basic life support to any medical emergencies in their areas of responsibility.

Thus, to repeat, my stand is that all ambulatory medical clinics whether within or outside a hospital perimeter should have a medical emergency preparedness and response plan.

Having said that, I shall now try to formulate and develop a template for a medical emergency preparedness and response plan for ambulatory medical clinics.

  1. Risk assessment

First thing to do is to do a risk assessment based on the nature of the medical services being offered by the ambulatory medical clinics.

Off-hand, I can classify the services into two broad categories:

  1. Without special medical procedures (just interview, physical examination, advice, and prescription)
  2. With special medical procedures (such as parenteral administration of drugs; biopsy; cauterization; endoscopy; etc)

Based on the services the patients are seeking and will go through in the clinic, identify all potential risks or possible medical emergencies that may occur.  Below is a table that illustrates this step.

Medical Emergencies

Without special medical procedures

With special medical procedures

Sudden cardiopulmonary arrest

Stroke

Seizure
Asthmatic attack

Fainting

*Adverse reactions to drugs / chemicals administered

*Burns

*Bleeding

*Others

*Need to be more specific (e.g. allergic reactions; anaphylactic shock; respiratory depression; etc for adverse reactions; burns in unintended areas during cauterization; uncontrollable bleeding during a biopsy procedure)

II. Response Needs in Terms of Medical Management, Things Needed, and Training

After identifying the potential risks and all possible medical emergencies that may occur in the ambulatory clinic, map out a response or control plan in case the emergencies occur.

General, across-the-board (all-hazards) responses:

  1. Administer first-aid and basic life support as indicated and as appropriate.
  2. Call for external assistance as indicated.
  3. Discharge or transfer to an emergency room or to a hospital for admission as indicated.
General Responses

Things needed

Remarks

Administer first-aid and basic life support as indicated and as appropriate. Basic know how on first-aid and basic life support; basic equipment and materials; drugs; etc. At least one physician or a staff in the medical clinic trained to do first-aid and basic life support
Call for external assistance as indicated. List of emergency numbers of potential external assistance Updated list and readily retrievable
Discharge or transfer to an emergency room or to a hospital for admission as indicated. List of contact numbers of emergency rooms nearby Updated list and readily retrievable

Specific responses for specific medical emergencies:

Medical Emergencies

First-aid and Basic Life Support

(General and specific according to type of emergencies – to be spelled out in a clinic document)

Basic Equipment, Materials, and Drugs Needed

(to be specified and made readily available)

Training of Staff

(at least one staff – preferably, a physician)

Sudden cardiopulmonary arrest

 √

 √

 √

Stroke

Seizure

Asthmatic attack

Fainting

*Adverse reactions to drugs / chemicals administered**

*Burns**

*Bleeding**

*Others

*Need to be more specific (e.g. allergic reactions; anaphylactic shock; respiratory depression; etc for adverse reactions; burns in unintended areas during cauterization; uncontrollable bleeding during a biopsy procedure)

**As applicable, i.e., those clinics doing special medical procedures with the corresponding risks.

III. Indicators of Preparedness in Response to Medical Emergencies in Ambulatory Medical Clinic

  1. Presence of the a document called Medical Emergencies Preparedness and Response Plan that contains at least the abovementioned essential elements (risk assessment, response needs – medical management, things needed, and training)
  2. Inventory of things needed – regularly updated at planned intervals
  3. Evidences of training of staff and regularly updated at planned intervals
  4. Presence of emergency numbers – regularly updated and readily retrievable
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