Chương 3: Quyết định 01/2008/QĐ-BYT Cấp cứu trong bệnh viện (cấp cứu trong các cơ sở khám bệnh, chữa bệnh)

Chapter 3.

EMERGENCY IN HOSPITAL (EMERGENCY IN HEALTHCARE FACILITIES)

Article 7. Emergency system in hospital

1. Emergency system in polyclinics

a) Regarding special-grade polyclinics: Emergency department, Intensive care department and Poison control center shall be established;

b) Regarding grade I local polyclinics: Emergency department, Intensive care department and Poison control center shall be established;

c) Regarding grade I/II polyclinics: Emergency department, Intensive care and Poison control department shall be established. Besides, there shall be emergency chambers according to specific purpose of the hospital;

d) Regarding Grade III/IV polyclinics and ungraded polyclinics: Department of emergency – intensive care – poison control shall be established.

2. Emergency system in specialized hospitals

The departments of emergency, intensive care and poison control shall be established and arranged depending on functions, tasks and characteristics of each speciality, ensuring the best conditions for emergency activities.

3. Emergency system in private hospitals

Depending on the licensed speciality and characteristics of each hospital, the emergency system specified in clauses 1 and 2 of this Article or emergency chambers shall be established to provide promptly emergency care for patients.

Article 8. Functions and tasks of Emergency department

1. General functions and tasks

a) Receive and provide treatment for any emergency case that is transferred to the hospital;

b) Conduct assessment and conduct triage and take appropriate emergency measures in the order of priority until the patient is no longer in critical condition; within 48 hours, the patient shall be transferred to the intensive care department or an appropriate speciality depending on his/her condition;

c) Arrange working shifts for officials, applicable to special-grade and grade I/II hospitals; arrange fulltime-working tasks for officials, applicable to grade III/IV or ungraded hospitals

d) Strictly comply with the procedures and professional regulations in hospital;

dd) Establish emergency line to cooperate with the Intensive care department in providing professional support for the emergency system in the specialities in hospital;

e) Tightly cooperate with 1-1-5 emergency center in providing emergency care and emergency transport outside the hospital on request;

g) Carry out scientific researches, hold consultations and provide propagation about emergency treatment for the community;

h) Provide training for medical officials; give instructions on emergency treatment for medical officials of inferior facilities.

2. Specific tasks

a) Medical stations of communes, local polyclinics and other clinics:

- Handle the common emergency cases;

- Regarding the cases exceeding the professional capability, provide emergency aid then request assistant of the superior facilities or transfer the patients to the nearest hospital.

b) Department of emergency – intensive care – poison control of grade III/IV polyclinics and ungraded hospitals

- Handle the common emergency cases;

- Continue the emergency aid and intensive care for the patients that are transferred from the inferior facilities or from the clinical department inside the hospital;

- Regarding the cases exceeding the professional capability, hold medical consultations then request assistant of the superior facilities or transfer the patients to the superior facilities.

c) Emergency department of grade II polyclinics

- Handle the common emergency cases; Regarding the cases exceeding the professional capability, hold medical consultations then request assistant of the superior facilities or transfer the patients to the superior facilities;

- Carry out emergency aid outside the hospital and receive the mass of emergency;

d) Emergency department of grade I polyclinics and special-grade polyclinics

- Is the ultimate facilities receiving the cases that are transferred from the inferior facilities;

- Cooperate with the intensive care department and poison control department in providing emergency aid in accidents, disasters and mass of poisoning;

- Cooperate with training institutions in providing training for doctors and nurses.

Article 9. Responsibilities and power of individuals in Emergency departments

1. Head of Emergency department:

Apart from the general responsibilities and power of the Head of a clinical department, the head of an Emergency department shall fulfill the following responsibilities:

a) Organize the operation of department according to the Regulations on emergency treatment, intensive care and poison control;

b) Inspect and expedite the implementation of the regulations in the receipt, emergency aid and treatment towards the patients. Cooperate with the intensive-care department and other clinic department in providing professional assistance for the emergency system in hospital;

c) In special cases like mass emergency, disaster emergency, epidemic emergency, Head of department shall report to the director of the hospital to provide emergency aid effectively.

2. Doctor of Emergency department:

a) Receive the emergency case, carry out physical examination, provide emergency treatment according to the Guidance on emergency treatment, fully record of the development of condition of the patient. Cooperate well with the emergency divisions in emergency system of hospital;

b) Comply with the technical procedures for emergency treatment;

c) Report the complicated cases to directors of department for medical consultancy;

d) Transfer sufficiently the conditions of patient to the officials in charge of the next shift.

3. Nurse of Emergency department:

a) Receive emergency patients, conduct triage and provide emergency aid for serious case and report to doctors for prompt treatment;

b) Prepare the emergency drugs, tools and vehicles according to the regulations;

c) Expeditiously comply with the technical procedures for emergency treatment;

d) Supervise closely and provide care for the patient to discover the abnormal signs for prompt treatment and reporting to doctors;

dd) Transfer sufficiently the information about care for patient to the nurse in charge of the next shift;

e) Fill emergency drugs according to the regulation, preserve emergency drugs and tools, receive and transfer emergency drugs and tools between the shifts.

4. Other staff of the department shall comply with the arrangement of the head of department.

Article 10. Facilities, equipment and human resources of Emergency department

1. Facilities and equipment

a) General requirements

- The emergency department shall be located conveniently for the receipt, transport and compliance with the emergency request, including: patients receiving and classifying rooms,

- The emergency department shall be equipped with emergency signs, guiding arrows, emergency light (at night) and shall be provided with sufficient light, prioritized electricity and well-operated provisional power and lighting system;

- There shall be health books and medical records serving the emergency treatment;

- There shall be sufficient equipment, technical devices and drugs for emergency treatment according to the list prescribed for specific grade of hospital.

Basic equipment/devices include:

+ Oxygen and compressed air supply system;

+ Fresh water supply system;

+ Devices serving the diagnosis and emergency function exploration, intervention, and on-site testing, equipment serving the provision of emergency treatment for patients and conformable vehicles serving the transport of patients.

+ Administration system;

b) Specific requirement

- Medical stations of communes, local polyclinics and other clinics

+ There shall be emergency chambers with 1-2 beds;

+ There shall be basic equipment for first aid.

- Department of emergency – intensive care – poison control of III/IV-grade polyclinics and hospitals that have not been graded

There shall be at least 05 beds and stretcher with wheels, 01 chamber for pregnant women.

- Emergency department of II-grade polyclinics

+ There shall be at least 10 emergency beds and stretchers with wheels;

+ There shall be 01 chamber for pregnant women.

- Emergency department of I-grade polyclinics and special-grade polyclinics

+ There shall be at least 20 emergency beds and a number of stretchers with wheels;

+ Emergency operating rooms shall be located in emergency wards (depending on conditions of specific hospitals).

2. Human resources

a) There shall be a staff of doctors and nurses who have been provided with training in professional skills in emergency treatment.

b) Officials in charge of providing emergency treatment shall be provided with additional and updated training often.

Article 11. Functions and tasks of Intensive-care department

1. The Intensive-care department is a clinic department in charge of continuing the treatment and intensive care for patients transferred from the Emergency department and other clinic departments in the same hospital.

2. The Intensive-care department shall cooperate with the Emergency department in providing emergency aid outside or inside the hospital in case of mass emergency, disaster emergency.

3. The Department of intensive care shall cooperate with the Emergency department in providing professional assistance for the emergency system in hospital.

4. If the case exceeds the professional capacity, the Intensive-care department shall hold a medical consultation and request the assistance of superior facilities or transfer the patients to a superior hospital.

5. Emergency department of I-grade and special-grade polyclinics

- Emergency department is the ultimate facilities receiving the cases that are transferred from the inferior facilities;

- The Emergency department shall cooperate with other ultimate facilities in medical consultation and treatment;

- The Emergency department shall cooperate with universities, colleges and medical schools in training doctors and nurses specialized in intensive care.

- Emergency department shall conduct scientific researches and provide professional directions for the inferior facilities.

Article 12. Responsibilities and power of individuals in Intensive-care department

1. Apart from the general responsibilities and power of the head of a clinical department, a head of Intensive-care department shall fulfill the following responsibilities:

a) Maintain 24/7 operation by shift-work or full-time work according to the specific condition, organize an effective working chain;

b) Classify the patients according to the seriousness and characteristics of the illness;

c) Take responsibilities for the quality of the diagnosis, treatment and care for patients of the department. If the illness becomes worse or the diagnosis could not be made within 48 hours, a medical consultation shall be held;

d) Prepare areas, personnel, and equipment in case of mass emergency or disaster emergency;

dd) Update regularly the knowledge, increase the technological and professional skills of officials, draw up plans on training in professional skills for doctors and nurses of the department;

e) Preside over and carry out the scientific researches, apply the technological advance in work.

2. Responsibilities of doctors of Intensive-care department:

a) Receive patients transferred from the Emergency department and other clinical departments;

b) Examine patients at their beds, prescribe testing, treatment and carry out the procedures according to the regulations. Fully record the conditions of patients and the instructions to the medical records and the health supervision records of doctor;

c) Report the conditions of patients to heads of department after examining patients; seek opinions of heads of department in difficult cases, hold medical consultation if necessary;

d) Comply with the procedures for diagnosing, treating, emergency treatment, and recovery;

dd) Hand over patients and instructions accurately, sufficiently and with hand-over books;

e) Regularly study to update and increase the professional knowledge and skills. Participate in scientific research and training in application of advanced technique.

3. Responsibilities of nurses of Intensive-care department:

a) Comply with the technical procedures and professional regulations in hospital;

b) Receive, preserve and use drugs, tools and vehicles according to the regulations to be ready for serving patients;

c) Expeditiously comply with medical instructions. Supervise the take notes sufficiently the development of illness and the compliance with medical instructions to the supervision records of nurses;

d) Promptly report to doctors or the nurse leader when patients display an abnormal sign or when there are difficulties in the compliance with medical instruction or the care for patients;

dd) Transfer sufficiently the information about care for patient to the nurse in charge of the next shift.

4. Other staff of the department shall comply with the arrangement of the head of department.

Article 13. Facilities, equipment and human resources of Intensive-care department

1. Facilities and equipment

a) The Department of intensive are shall be organized continuously and reasonable to facilitate the provision of intensive care and treatment for patients;

c) The Intensive-care department shall be equipped with: normal chambers, isolation chambers, sterilized chambers, operation chambers, vehicle, machinery and tool-storing chambers, food-preparing chambers, tool-cleansing places, etc.

c) Drugs, medical equipment and vehicles:

- Central oxygen-supplying system;

- Central compressing and sucking system;

- Prioritized electricity sources and provisional electricity sources;

- Fresh water, sterilized water and hot water systems;

- Hospital beds specialized for emergency recovery equipped with nurse call system;

- Constant supervision system;

- Equipment serving diagnosis and supervision at patients’ beds (X-ray machine, ECG machine, ultrasound scanner, quick testing machine, shade lamp, etc.)

- Devices serving treatment (electric syringe pump, invasive and noninvasive positive pressure ventilation machine, Ambu bag, vacuum system, automated external defibrillator, continuous renal replacement therapy machine, endoscopy machine, etc.)

- Vehicles (stretcher cart, wheelchair, personal oxygen device, respiratory device, etc.) - Emergency recovery drugs according to the list approved by the director.

2. Human resources

a) There shall be a staff of doctors, nurses and orderlies who have been provided with training in professional skills in emergency treatment.

b) Officials in charge of providing emergency treatment shall be often provided with additional and updated training.

Article 14. Functions and tasks of Department of Emergency – Intensive care - Poison control

1. Works as the clinic department in charge of continuing the treatment and intensive care for patients transferred from the clinic departments in the hospital.

2. Participate in the provision of emergency treatment inside and outside hospital in case of mass emergency and disaster emergency.

3. Cooperate and provide professional assistance for the emergency system in hospital.

4. If the case exceeds the professional capacity, the Department of Emergency – Intensive care – Poison control shall hold a medical consultation and request the assistance of superior facilities or transfer the patients to a superior hospital.

Article 15. Responsibilities and power of individuals in Department of Emergency – Intensive care – Poison control

1. Apart from the general responsibilities and power of Head of a clinical department, the Head of the Department of Emergency – Intensive care – Poison control shall fulfill the following responsibilities:

a) Maintain 24/7 operation by shift-work or full-time work according to the specific condition, organize an effective working chain;

b) Classify the patients according to the seriousness and characteristics of the illness;

c) Take responsibilities for the quality of the diagnosis, treatment and care for patients of the department. If the illness becomes worse or the diagnosis could not be made within 48 hours, a medical consultation shall be held;

d) Prepare areas, personnel, and equipment in case of mass emergency or disaster emergency;

dd) Update often the knowledge, increase the technological and professional skills of officials, draw up plans on training in professional skills for doctors and nurses of the department;

e) Preside over and carry out the scientific researches, apply the technological advance in work.

2. Responsibilities of doctors of Department of Emergency – Intensive care – Poison control:

a) Receive patients transferred from other clinical departments;

b) Examine patients at their beds, prescribe testing, treatment and carry out the procedures according to the regulations. Fully record of conditions of patients and the instructions to the medical records and the health supervision records of doctor;

c) Report the conditions of patients to heads of department after examining patients; seek opinions of heads of department in difficult cases, hold medical consultation if necessary;

d) Comply with the procedures for diagnosing, treating, emergency treatment, and recovery;

dd) Hand over patients and instructions accurately, sufficiently and with hand-over books;

e) Constantly study to update and increase the professional knowledge and skills. Participate in scientific research and training in application of advanced technique.

4. Responsibilities of nurses of Department of Emergency – Intensive care – Poison control:

a) Comply with the technical procedures and professional regulations in hospital;

b) Receive, preserve and use drugs, tools and vehicles according to the regulations to be ready for serving patients;

c) Expeditiously comply with medical instructions. Supervise the fully record of the development of illness and the compliance with medical instructions to the supervision records of nurses;

d) Promptly report to doctors or the nurses' leader when patients display an abnormal sign or when there are difficulties in the compliance with medical instruction or the care for patients;

dd) Transfer sufficiently the information about care for patient to the nurse in charge of the next shift.

5. Other staff of the department shall comply with the arrangement of the head of department.

Article 16. Facilities, equipment and human resources of Department of Emergency – Intensive care – Poison control

1. Facilities and equipment

a) The Department of Emergency – Intensive care – Poison control shall be organized continuously and reasonable to facilitate the provision of intensive care and treatment for patients;

b) The Emergency – Intensive care – Poison control department shall be equipped with: normal chambers, isolation chambers, sterilized chambers, operation chambers, vehicle, machinery and tool-storing chambers, food-preparing chambers, tool-cleansing places, etc.

c) Drugs, medical equipment and vehicles:

- Central oxygen-supply system;

- Central compressing and sucking system;

- Prioritized electricity sources and provisional electricity sources;

- Fresh water, sterilized water and hot water systems;

- Hospital beds specialized for emergency recovery equipped with nurse call system;

- Constant supervision system;

- Equipment serving diagnosis and supervision at patients’ beds (X-ray machine, ECG machine, ultrasound scanner, quick testing machine, shade lamp, etc.)

- Devices serving treatment (electric syringe pump, invasive and noninvasive positive pressure ventilation machine, Ambu bag, vacuum system, automated external defibrillator, continuous renal replacement therapy machine, endoscopy machine, etc.)

- Vehicles (stretcher cart, wheelchair, personal oxygen device, respiratory device, etc.);

- Emergency recovery drugs according to the list approved by the director.

2. Human resources

a) There shall be a staff of doctors, nurses and orderlies who have been provided with training in professional skills in emergency treatment, intensive care and poison control;

b) Officials in charge of providing emergency treatment, intensive care or poison control shall be often provided with additional and updated training.

Article 17. Functions and tasks of Poison-control department

a) Provide emergency – intensive care – poison control – treatment inside or outside the hospital for acute/chronic poisoning cases and other medical diseases;

b) Conduct quick testing to discover toxicity serving the diagnosis, treatment and scientific research;

c) Provide training for doctors, nurses and technicians of the inferior facilities in poison control;

d) Conduct scientific researches in field of poison control;

dd) Cooperate with Vietnamese and foreign agencies that are relevant in poison control;

e) Fulfill the tasks concerning the information and consultancy about poison control towards people inside and outside hospital.

Article 18. Responsibilities and power of individuals in Poison-control department

1. Apart from the general responsibilities and power of the Head a clinical department, the Head of Poison-control department shall fulfill the following responsibilities:

a) Maintain 24/7 operation by shift-work or full-time work according to the specific condition, organize an effective working chain;

b) Triage the patients;

c) Take responsibilities for the quality of the diagnosis, treatment and care for poisoned patients. If the illness becomes worse or the diagnosis could not be made within 48 hours, a medical consultation shall be held;

d) If the patient commits suicide or is suspected committing suicide, a medical consultation with Psychiatric doctors so as not to miss out any causes;

dd) Any suspicion of violation concerning poisoning shall be reported to the Director of Hospital and concerning agencies for cooperation in investigation;

e) Arrange the premises, mobilize human resources and equipment in case of mass emergency or disaster emergency;

g) Update often the knowledge, increase the technological and professional skills of officials, draw up plans on training in professional skills for doctors, nurses, pharmacists and physicians of the department;

h) Preside over and carry out the scientific researches, apply the technological advance in work.

2. Responsibilities of doctors of Poison-control department:

a) Receive patients transferred from outside the hospital or from other clinical departments, except for the cases suspected of acute diarrhea that are infected.

b) Examine patients at their beds, prescribe testing, treatment and carry out the procedures according to the regulations. Fully record the conditions of patients and the instructions to the medical records and the health supervision records of doctor;

c) Report the conditions of patients to heads of department after examining patients; seek opinions of heads of department in difficult cases, hold medical consultation if necessary;

d) Comply with the procedures for diagnosing, treating, emergency treatment, and recovery;

dd) Hand over patients and instructions accurately, sufficiently and with hand-over books;

e) Regularly study to update and increase the professional knowledge and skills. Participate in scientific research and training in application of advanced technique.

3. Responsibilities and power of nurses:

a) Comply with the technical procedures and professional regulations in hospital;

b) Receive, preserve drugs, tools and vehicles according to the regulations to be ready for serving patients;

c) Expeditiously comply with medical instructions. Supervise and fully record of the development of illness and the compliance with medical instructions to the supervision records of nurses;

d) Promptly report to doctors or the nurses’ leader when patients display an abnormal sign or when there are difficulties in the compliance with medical instruction or the care for patients;

dd) Transfer sufficiently the information about care for patient to the nurse in charge of the next shift.

4. Other staff of the department shall comply with the arrangement of the head of department.

Article 19. Facilities, equipment and human resources of Poison-control department

1. Facilities and equipment

a) A clinical unit with at least 5 beds carrying out concurrently the poison-control information;

b) A poison testing unit that is located separately or in the Biochemistry department of the hospital for carrying out quick testing and qualitative testing.

2. Human resources

There shall be a staff of doctors, nurses and physicians that have been provided with training in professional skills in poison-emergency aid and poison testing.

Article 20. Functions and tasks of Poison-control center

Apart from the functions and tasks like the Poison-control department, a Poison-control center shall fulfill the following functions and tasks:

1. Give the Ministry of Health the consultancy in poison-control;

2. Provide consultancies in poison-control for every entities in multiple forms, especially via 24-hours hotline;

3. Collect, treat, report and retain information; preside over the establishment of information storage serving the poison-control research;

4. Joint the local and international Poison-control unions.

Article 21. Facilities, equipment and human resources of Poison-control centers

1. A Poison-control center:

a) A clinical department shall be equipped with 10 beds for emergency aid for acute poisoning and mass poisoning; emergency vehicles like the intensive-care department; besides, there shall be poison-cleansing equipment and antidotes;

b) A separate poison testing laboratory that is equipped serving quick testing, qualitative testing and quantitative testing (for toxins, chemicals, noxious gases, drugs);

c) A poison information unit.

2. Human resources:

There shall be a staff of doctors, nurses and physicians that have been provided with training in professional skills in poison-emergency aid and poison testing.

Article 22. Responsibilities and power of individuals in Poison-control centers

1. Director of Poison-control center:

Apart from the functions and tasks like the Head of Poison-control department, the director of a Poison-control center shall fulfill the following functions and tasks:

a) Provide consultancies for the Ministry of Health to build up the nationwide poison-control network;

b) Carry out the instruction on poison-control;

c) Cooperate with the incentive care system and polices in provide emergency aid for mass poisoning.

2. Other officials of the Poison-control center in carrying out the tasks according to the arrangement of the Director of center.

Article 23. The cooperation in emergency treatment for patients in hospital

1. General requirements

a) Departments in the same hospital shall cooperate together and stay prepared for receiving patients that are sent from the Emergency department, Emergency - Intensive care - Poison control department, Poison control center and the Poison control department;

b) If the condition of a patient receiving hospital treatment becomes worse or the condition of a patient transferred to the hospital is subject to emergency treatment, medical professionals of all relevant departments shall carry out the emergency measures appropriate to the condition of patients and request the help from specialist doctors if necessary;

c) Any patient that is prescribed to transfer to another ward shall be provided with emergency treatment and care during the transfer.

2. Requirements for clinical wards having emergency chambers:

a) Have the plate of emergency chamber, have light box of emergency at night, have sufficient lighting, have provisional electricity or lighting;

b) Having record paper for serious cases;

c) Have hospital beds and equipment, vehicles, drugs on the list according to speciality and type of hospital.

Article 24. Emergency patients subject to hospital transfer

1. Responsibilities of emergency standing doctors:

a) Notify the superior facility for preparation for receiving the patient;

b) Examine the condition of the patient before transfer and prepare the vehicle and tools for emergency treatment during the transport;

c) Provide sufficiently the following information in the medical record: diagnosis, drugs have been used, condition of the patient, the latest situation, reasons for hospital transfer, full name and position of the person who makes the hospital transfer record;

d) Serious-condition patients shall be provided with emergency treatment by emergency doctors/nurses during the transport; must not carry out the hospital transfer if the patient has high risk of death.

dd) The inferior facility shall receive the emergency patient sent back from the superior facility when his/her condition is stable.

2. Responsibilities of doctors or nurses transferring patients:

a) Comply with the instruction, take care and and supervise the patient during the transport;

b) Receive and transfer the hospital-transfer medical record, belongings of the patient, carry out the necessary procedures relating to the receipt of patient at the superior facilities. Doctors/nurses in charge of transferring patient shall leave only when the receiving hospital append the signature on the patient transfer paper/book.

3. Responsibilities of emergency doctors of the superior facilities:

a) Prepare drugs, vehicles and human resources for providing emergency treatment according to the information about condition of the patient that is provided;

b) Receive the patient and immediately carry out the appropriate emergency measures;

c) Notify the inferior facility the result of emergency treatment and the experience that needs to be learnt.

Article 25. Request for emergency assistance from the superior facilities

1. An emergency team may request for assistance from a superior facility in the following cases:

a) The situation exceeds the professional capacity or the condition of the patient is very serious that may lead to death on the way to the hospital;

b) Emergency vehicles are not available;

c) There are too many patients due to an epidemic or mass emergency/disaster emergency.

2. Responsibilities of the inferior facilities that request emergency assistance

a) Report to the patient’s family the disadvantages of the establishment and the request for emergency assistance from superior facilities;

b) Notify the condition of the patient and request the assistance from superior facility;

c) While waiting for the assistance of the superior facility, the establishment shall provide the patient with as best treatment as possible.

3. Responsibilities of the superior facilities:

The superior facilities are responsible for providing assistance for the inferior facilities. When the request for emergency assistance is received, the hospital shall arrange vehicles, drugs and officials for the inferior facilities. After being provided with emergency treatment, the patient shall be provide with treatment at the inferior hospital with the professional assistance of the superior facility or transferred to a specialized facility for further treatment./.

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