There are 2 ways to be admitted to hospital; either by a direct referral to the ward by going to a consultant privately, or through emergency. Entrance to the emergency department is not through main reception, but rather through an adjacent entrance. For most of us, the idea of visiting the accident & emergency department is a daunting prospect.
The Accident & Emergency Department
A medical emergency is a situation whereby an individual encounters an immediate risk to their life or long-term health. It can be commonly referred to as a life or limb situation This is normally prior to acute injury, disease or illness.
The emergency department at Mater Dei Hospital is made up of different rooms, each designed for a specific purpose for better functionality and service. There is a triage room (where patients are sorted according to the severity of trauma or injury, and need of treatment), a room for paediatric cases, and a day clinic for patients whose condition is not life threatening.
The emergency department is also divided in 2: trauma and non trauma.
Non trauma patients are mainly cardiac, neurological or surgical patients.
Trauma patients are not too common in Malta, however they are on the rise due to a recent increase in motor vehicle accidents and construction site accidents.
Upon arriving at the emergency room, one is greeted at a reception desk and asked for detailed information. This includes but is not limited to name and surname, ID card number and presenting complaint. This is only written as a simple, concise clinical description, meaning that if one is experiencing left hand pain, that is what will be written. However, the receptionists are very experienced and will assess the initial condition and severity. They will then discreetly call the nurses to check up on the patient. All this is monitored by the nurses in the triage room.
The Professionals
All nurses and doctors working at the emergency department are all highly trained individuals with multiple years of specialisation and previous experience in various wards. This exposes them to different conditions and procedures giving them maturity in their practice. This enables them to carry out certain procedures such as an ESI. This stands for Emergency Severity Index and is used to further aid the triage. This index aids the emergency staff by scoring the patients, and in turn listing priorities. Priority 1 cases are taken straight through for intervention by doctors.
Figure 1 shows how patients are given priority according to certain signs.. This is used in Malta’s Accident & Emergency Department.
Use of the health care professionals
The Health Care Professionals’ (HCP) job is always evolving within hospitals and in the community. In an emergency setting, things are similarly ever-changing. HCPs such as physiotherapists and radiographers are always present and stationed at the emergency department. Physiotherapists are called upon mainly for chest physiotherapy, whilst radiographers carry out medical imaging such as ECGs, ultrasounds and X-rays.
Other health care professionals such as podiatrists and mental health nurses are on call. Unfortunately, they are a limited resource and their time and expertise are usually needed elsewhere. There are other professionals which are on call such as social workers and psychologists. HCPs such as occupational therapists are then present in the wards for the follow-up care.
Ambulance
In case of an emergency it is important to remember that the right number to call is 112. This will not connect directly to the emergency department but rather to the emergency services department. Upon picking up, the personnel on the line will ask the caller’s location and requirement. This will ensure to the right response team and assistance. In the case of a medical emergency, the caller will be redirected to the ambulance department where they will be asked to describe the situation. In most cases, the professionals on the line will direct the caller with a set of protocols and manoeuvres in case emergency medical intervention such as CPR is needed.
Malta has a one minute dispatch with a very good recovery time. There are 2 types of responses; green for cases which are not severe, and red/orange for priority 1 and trauma cases.
There is a standard of 1 emergency nurse and 2 paramedics in each ambulance, however this might change according to the situation by sending doctors which are specialised in emergency care.
The Emergency Room in Malta is always a busy place. Many may complain that they spend a long time waiting to be seen. A longer waiting time however, usually signifies a less severe condition. One should remember that health centres are used for many cases where specific emergency services are not required by the patient.
On the scene of an accident, the initial first responder may not be a qualified nurse or doctor. This solidifies the need of first aid as a response at any given situation prior to the arrival of an ambulance is crucial. The use of first aid helps to save lives as one is preventing the worsening of condition and helping to preserve life, until professional help arrives. In Malta, first aiders are protected by the “Good Samaritan Law” stating that they are not legally responsible if the condition of the injured person worsens. One could also make use of the app “112mt” for emergencies. This application uses one’s location from their phone and calls directly.
We all have our part to play to help save a life.