COORDINATING ACTIONS OF OTHERS DURING AN EMERGENCY

Chapter 1

Introduction

1.1  Background

Coordination means working together in a logical way toward some common result or goal. The operational definition of coordination, however, varies among personnel from different agencies. Definitions of coordination range from centralised coordination to simple information sharing between organisations. (International Federation of Red Cross and Red Crescent Societies, 2000).

Coordination becomes viable when agencies actively participate in the coordination process. Participants must act to secure and maintain the confidence of others, thereby creating an atmosphere of respect and good will. The possibility of participating in relevant decision making is one way to build confidence. The coordination mechanism should not be used as a way to subordinate or gain advantage over other agencies. A coordinated approach toward achieving a common goal will work best when areas of authority and responsibility are clearly defined. Coordination should advocate the principle of impartiality, i.e. the provision of relief solely on the basis of actual needs, not on the objectives of a particular agency. (International Federation of Red Cross and Red Crescent Societies, 2000).

Emergency departments must possess the staff and resources necessary to evaluate all individuals presenting to the emergency department (ED). Emergency departments must also be able to provide or arrange treatment necessary to attempt to stabilize emergency patients who are found to have an emergency medical condition. Because of the unscheduled and episodic nature of health emergencies and acute illnesses, experienced and qualified physician, nursing, and ancillary personnel must be available 24 hours a day to serve those needs. (American College of Emergency Physicians, 2014)

The emergency physician, emergency nurse, and additional medical team members are the core components of the emergency medical care system. These personnel must establish effective working relationships with other health care providers and entities with whom they must interact. These include emergency medical services providers, ancillary hospital personnel, other physicians, and other health care and social services resources. The emergency physician is responsible for the medical care provided in the ED (Emergency Department). This includes the medical evaluation, diagnosis, and recommended treatment and disposition of the emergency patient, as well as the direction and coordination of all other care provided to the patient. (American College of Emergency Physicians, 2014)

1.2  Purpose

1.2.1        General Purpose

   To demonstrate and explain about coordinating Actions of Others During an Emergency.

1.2.2        Specific Purpose

1)      Students can understand the concept of coordination

2)      Students can understand the concept of emergency departement.

3)      Students can understand the concept about coordinating Actions of Others During an Emergency.

1.3  Benefits

Students know and understand about coordinating Actions of Others During an Emergency.

Chapter 2

Presentation Topic

2.1  Coordination

2.1.1        Definition of Coordination

Coordination means working together in a logical way toward some common result or goal. The operational definition of coordination, however, varies among personnel from different agencies. Definitions of coordination range from centralised coordination to simple information sharing between organisations. (International Federation of Red Cross and Red Crescent Societies, 2000).

Between these two opposing viewpoints is a definition of coordination in which agencies have the will, instruments and trained personnel for effective collaboration with each other. Perhaps the greatest challenge to coordination is the inherent difficulty of identifying a common purpose and approach among agencies whose mandates, methods, resources and systems are diverse. The incentive to coordinate comes from experiences where the lack of coordination results in conflicts and misunderstanding. (International Federation of Red Cross and Red Crescent Societies, 2000).

2.1.2        Advantages of coordination

Coordination takes extra effort, time, resources and commitment. Some fear, rightly at times, that it will add another layer of bureaucratic decision making that will hinder their ability to maneuver. Coordination when well done, however, has many positive benefits, that can far outweigh many of its disadvantages. These benefits include (International Federation of Red Cross and Red Crescent Societies, 2000).:

1)      Improved efficiency, cost-effectiveness and speed of response

Organisations begin the process of sharing information either before an emergency occurs or quickly thereafter, coordination can improve the efficiency and speed of disaster response. This will occur when organisations have mechanisms in place to quickly assess the needs of the affected population and when organisations have shared with each other the resources that each brings to the response. These types of coordination activities enable decisions to be taken quickly.

2)      A framework for strategic decision making on issues of common concern

Through a coordinating mechanism, all response organisations have the opportunity to identify the needs of the emergency and to participate in an organised strategic planning process.

3)      A unified strategic approach to disaster response

Discrepancies between agencies over standards of assistance, linking relief with longer-term rehabilitation efforts and differences in conceptual approaches to response all represent challenges to achieving a harmonised response. Disaster response, which is not coordinated and does not try to harmonise standards and approaches, leads to differential treatment of the population. This can lead to competition for resources, conflict and distrust—all of which exacerbate the problems of the disaster-affected population.

4)      Elimination of gaps and duplication of services in meeting the needs of the affected populations

If organisations are successful in coordinating their activities as described in the first three benefits above, there should be neither gaps nor duplication in services and resources to meet the needs of the affected population.

5)      Appropriate division of responsibilities based on an organisation's comparative advantage

In an emergency, there will be clarity about some of the operations of all agencies. Their comparative advantages and spheres of operation are known and accepted by all. On the other hand, the areas of operation of many agencies will likely overlap in terms of mandate, resources, geographic location or capabilities. Therefore, one of the key challenges is determining who will take on a task when two or more organisations are ready and able to do it.

At their best, coordinated activities that consider the comparative advantages of responding organisations result in humane, neutral, and impartial assistance; in increased management effectiveness; in a shared vision of the best possible outcomes for a given situation; in a seamless approach to service delivery; and in donor confidence resulting in sufficient resources to achieve the desired outcomes.

2.1.3        Preconditions to coordination

The chances of achieving effective coordination are greatly enhanced when several preconditions have been met. Coordination is a process that works best when it is :

a)      Participatory

b)      Impartial

c)      Transparent

Coordination becomes viable when agencies actively participate in the coordination process. Participants must act to secure and maintain the confidence of others, thereby creating an atmosphere of respect and good will. The possibility of participating in relevant decision making is one way to build confidence. The coordination mechanism should not be used as a way to subordinate or gain advantage over other agencies. A coordinated approach toward achieving a common goal will work best when areas of authority and responsibility are clearly defined. (International Federation of Red Cross and Red Crescent Societies, 2000). Coordination should advocate the principle of impartiality, i.e. the provision of relief solely on the basis of actual needs, not on the objectives of a particular agency. This impartiality should be maintained in both pre- and post-disaster periods. Coordination requires trust and trust requires transparency—the willing flow of information and open decision making processes. The real motives of decision making should be clear to all participants and acceptable to the affected population.

2.1.4        The spectrum of coordination activities

Coordination, as illustrated in the diagram below, can be described as a spectrum of activities, starting with simple information sharing leading to collaboration and then to joint development of plans and programs. The activities discussed below are loosely listed in an ascending level of sophistication. Although each activity can lay the foundation for successive ones, the given order should not be taken too literally since some activities can be performed simultaneously and, in some cases, less difficult activities are bypassed in favour of higher priority, more challenging ones. (International Federation of Red Cross and Red Crescent Societies, 2000).

 

1)      Information sharing

Lack of understanding or simple miscommunication often prevent organisations from realising that they share many interests, especially when it comes to the welfare of their beneficiaries. Often, they may desire the same end-goal and may share many philosophical and conceptual approaches.

Sharing and exchange of information is one of the basic coordination activities. Agencies can share their objectives, mutual interests, strengths and limitations, viewpoints and many other things including (International Federation of Red Cross and Red Crescent Societies, 2000) :

a)      the roles and responsibilities of each agency and specific resources they have for disaster

b)      preparedness and response

c)      geographical area of operation

d)     purpose of planned activities

e)      priority needs and gaps in assistance

f)       issues related to the situation or context (e.g. political situation, security, local conditions)

g)      other information characterising the input of each agency

2)      Collaboration

Collaboration is more than simply sharing and exchanging information. Collaboration means that agencies assess the situation together, share ideas on how to overcome the problem and initiate practical responses together.

3)      Joint strategic planning and programming

Planning is a fundamental component of disaster management. It is essential before the onset of an emergency, and even more so, once it has begun. Failure to foresee an emergency and anticipate changes in the relief efforts, such as in the location and number of affected persons, has too often resulted in needless suffering and deaths. (International Federation of Red Cross and Red Crescent Societies, 2000).

2.2  Emergency departments

Emergency departments must possess the staff and resources necessary to evaluate all individuals presenting to the emergency department (ED). Emergency departments should also be able to provide services to stabilize patients with emergency conditions. Because of the unscheduled and episodic nature of health emergencies and acute illnesses, experienced and qualified physician, nursing, and ancillary personnel must be available 24 hours a day to serve those needs. Policy sections include (American College of Emergency Physicians, 2014) :

1.      Resources and Planning (American College of Emergency Physicians, 2014)

A.    Responsibilities and Public Expectations

1)      EDs should be staffed by qualified personnel with knowledge and skills sufficient to evaluate and manage those who seek emergency care. EDs should be designed and equipped to facilitate this work. 

2)      Timely emergency care by an emergency physician and emergency nursing staff physically present in the ED must be continuously available 24 hours a day, seven days a week.

3)      Emergency patient evaluation and stabilization must be provided to each individual who presents for such care. Consistent with applicable standards and regulations, the patient or applicable guarantor is financially responsible for the charges incurred in the course of this care. 

4)      EDs should participate in an active public education program that details the intended scope of services provided at the facility. 

5)      EDs should support existing EMS systems and provide medical direction where appropriate. 

B.     Necessary Elements

This section of the guidelines outlines elements of administration, staffing, design, and materials needed for the delivery of emergency care. (American College of Emergency Physicians, 2014).

1)      Administration 

a.       The emergency facility must be organized and administered to meet the health care needs of its patient population. A written organizational plan for the ED consistent with hospital bylaws and similar to the organizational plan of other clinical departments in the hospital should exist.

b.      Operation of the ED must be guided by written policies and procedures.

c.       The medical director of an ED, in collaboration with the director of emergency nursing and with appropriate integration of ancillary services, must ensure that quality, safety, and appropriateness of emergency care are continually monitored and evaluated. The ED medical director should have oversight over all aspects of the practice of emergency medicine in an ED.

d.      All new staff members working in an ED should receive a formal orientation program that addresses the mission of the institution, standard operating procedures of the ED, and the responsibilities of each member of the ED staff.

2)      Staffing

a.       Appropriately educated and qualified emergency care professionals, including a physician and a registered nurse, shall staff the ED during all hours of operation. 

b.      An emergency medical director shall direct the medical care provided in the ED.

c.       All physicians who staff the ED, including the medical director, should be subject to the hospital’s customary credentialing process and must be members of the hospital medical staff with clinical privileges in emergency medicine. Emergency physicians should have the same rights, privileges, and responsibilities as any other member of the medical staff, as outlined in the organized medical staff's various categories of medical staff membership.

d.      Each physician should be individually credentialed by the hospital medical staff department in accordance with criteria contained in ACEPs policy on physician credentialing. All emergency physicians who practice in an ED must possess training, experience, and competence in emergency medicine sufficient to evaluate and initially manage and treat all patients who seek emergency care, consistent with the physician’s delineated clinical privileges

3)      Facility

a.       The ED should be designed to provide a safe environment in which to render care and should enable convenient access for all individuals who present for care. 

b.      The ED should be designed to protect, to the maximum extent reasonably possible consistent with medical necessity, the right of the patient to visual and auditory privacy. 

c.       Radiological, imaging, and other diagnostic services such as those outlined in Appendix 3 must be available within a reasonable period of time for individuals who require these services. 

d.      Laboratory services such as those outlined in Appendix 4 must be available within a reasonable period of time for the provision of appropriate diagnostic tests for individuals who require these services. 

4)      Equipment and Supplies

a.       Equipment and supplies must be of high quality and should be appropriate to the reasonable needs of all patients anticipated by the ED. 

b.      Necessary equipment and supplies such as those outlined in Appendix 1 must be immediately available in the facility at all times. 

c.       Evidence of the proper functioning of all reusable direct patient care medical equipment must be documented at regular intervals. 

5)      Pharmacologic/Therapeutic Drugs and Agents

Necessary drugs and agents such as those outlined in Appendix 2 must be immediately available. A mechanism must exist to identify and replace all drugs before their expiration dates.  

6)      Ancillary Services

a.       Lab

b.      Radiology

c.       Anesthesia

d.      Respiratory Therapy

e.       Electrocardiography

C.     Relationships and Responsibilities 

Responsibilities for the Continuity of Patient Care Emergency care begins in the prehospital setting, continues in the ED, and concludes when responsibility for the patient is transferred to another physician or the patient is discharged. To promote optimal care of emergency patients, this transfer of responsibility should be accomplished in an effective, orderly, and predictable manner. This section describes the relationships that should exist between facilities and providers for proper continuity of care. (American College of Emergency Physicians, 2014).

1)      Prehospital Setting

a.       Prehospital emergency care should be provided consistent with the ACEP policy, “Medical Direction of Emergency Medical Services    

b.      EDs must be a designated part of the EMS and community disaster plans and must have roles defined by the local EMS/disaster coordinating body. Protocols and procedures should be in place defining the EDs interface with the EMS system. 

c.       Patients should be transported to the nearest appropriate ED in accordance with applicable laws, regulations, and guidelines.

2)    Emergency Facility 

a.       ED personnel must be familiar with medical care protocols used by the prehospital providers in their community. 

b.      All individuals with potentially lethal or disabling illnesses or injuries or other potential emergency medical conditions who present or are brought to the facility must be evaluated promptly. Appropriate measures must be initiated to stabilize and manage these patients.  

D.    Patient Disposition

1)        Appropriately qualified physicians who will accept responsibility for the care of patients must be identified in advance by the hospital and its medical staff for patients requiring admission or transfer to an inpatient bed or observation/holding unit. Consistent with applicable laws and regulations, the hospital and its medical staff must provide to the ED a list of appropriate “oncall” specialists who are required to respond to assist in the care of emergency patients within reasonable established time limits. (American College of Emergency Physicians, 2014).

2)        Patients admitted or transferred to an observation/holding unit should be managed in a manner consistent with guidelines specified in ACEP’s  related policies. (American College of Emergency Physicians, 2014).

3)        Appropriately qualified physicians or other appropriate and qualified health care professionals practicing within the scope of their licensure who will accept follow-up responsibility for patients discharged from the ED should be identified in advance by the hospital and its medical staff. The hospital and its medical staff must provide the ED with a list of appropriate on- call specialists or other appropriate referral services who will render follow-up services to ED patients within a reasonable period of time after discharge. (American College of Emergency Physicians, 2014).

4)        Transfer

a.       When patient transfer is indicated, the emergency facility must have a written plan for transferring patients in a vehicle with appropriate patient care capabilities including life support (eg, ambulance, advanced life support, basic life support, fixed-wing, rotor). When necessary, means should be available to provide nursing or physician staffing of transfer vehicles. Medical records necessary for ongoing care must accompany the patient; if these are not available at the time of transfer, they must be expeditiously provided to the receiving facility (eg, by fax transmission) in accordance with EMTALA.

b.      Patients with potentially lethal or disabling conditions or other emergency medical conditions must not be transferred from an emergency facility unless appropriate evaluation and stabilization procedures have been initiated within the capability of the facility. Transfer of patients to a facility with greater capability and resources should be arranged as necessary.

c.       All transfers must comply with local, state, and federal laws and be consistent with ACEP policies related to patient transfer.

2.3  Coordinating Actions Of Others During An Emergency

 

The first step includes a triage visit with a nurse when patients arrive by their own means to the emergency room. This nurse will assess the patient and collect a set of vitals, including blood pressure and temperature, prior to the emergency room visit (Tri-County Health Care, 2015). This defined process helps the staff prioritize issues based on established emergency guidelines. In all but a few instances, patients under the age of 18 must have parental or guardian consent before their emergency room evaluation. Patients who plan to be out of town, for example on vacation, should leave a written consent designating who can authorize care in their absence. Most often, this is an individual who will be caring for any children under the age of 18, whether family member or a friend.

The emergency physician, emergency nurse, and additional medical team members are the core components of the emergency medical care system. These personnel must establish effective working relationships with other health care providers and entities with whom they must interact. These include emergency medical services providers, ancillary hospital personnel, other physicians, and other health care and social services resources. The emergency physician is responsible for the medical care provided in the ED (Emergency Department). This includes the medical evaluation, diagnosis, and recommended treatment and disposition of the emergency patient, as well as the direction and coordination of all other care provided to the patient. A registered nurse is responsible for the nursing care of each emergency patient to include assessment, planning, and evaluation of response to interventions. (Tri-County Health Care, 2015).

The medical director of the ED and a pharmacy representative should develop a formulary of specific agents for use in an individual hospital's ED. Radiologic, imaging, and other diagnostic services, the specific services available and the timeliness of availability of these services for emergency patients in an individual hospital's ED should be determined by the medical director of the ED in collaboration with the directors of the diagnostic services and other appropriate individuals (American College of Emergency Physicians, 2014). The medical director of the ED and the director of laboratory services should develop guidelines for availability and timeliness of services for an individual hospital's ED. The following laboratory capabilities are suggested for hospitals with 24 hours. This list may not be comprehensive or complete. Point of care testing may be available for many of the below listed tests and may facilitate timely results.

The Clinical Encounter includes initial assessment when referring patients to the emergency department, PCP (Primary care provider) send patient information by fax or speak directly with an ED physician about the patient’s history and the reason for the ED visit. Then, formulation of plan after a patient has been evaluated in the ED, but before a definitive plan of care has been determined, emergency physicians reported they would only rarely contact primary care providers to clarify key points in the patient’s history or gather additional information. In cases where a shared electronic medical record was available, emergency physicians reported reviewing records of previous visits or hospitalizations. After that, disposition when a patient will be discharged and need prompt re evaluation, emergency physicians were most likely to contact primary care physicians to ensure follow up care would take place (National Institute for Health Care Reform, 2011). Primary care physicians who said emergency physicians regularly contacted them to coordinate follow up care reported this kind of contact was extremely helpful.

Physicians described several barriers to improved communication and coordination of care. Some of these were specific to particular communication modes, while others were overarching issues affecting all types of communication are real time communication in telephone, asynchronous communication in fax, text message and e-mail, shared electronic medical records. (National Institute for Health Care Reform, 2011). As show on the table below : Description of observed clinical roles.

Registered Nurse Coordinator (RN Coordinator)	A senior registered nurse responsible for coordinating the overall activities within the Emergency Department during each shift. The RN coordinator is not allocated a specific patient load.
Registered Nurse with an allocated patient load (RN with an APL)	A registered nurse responsible for the direct nursing care of patients within a specified area.
Emergency Department Registrar	A senior medical officer and trainee in the study of emergency medicine
Resident Medical Officer (RMO)*	A junior medical officer in the second or subsequent year(s) of hospital clinical practice
Intern*	A junior medical officer in the first postgraduate year of hospital clinical practice

A clinical setting in which effective communication is imperative for the timely delivery of patient care is the emergency department (ED). The ED plays an important role within the health system. It is the main entry point to hospital for unplanned patient admissions of varying levels of acuity. It is a dynamic, unpredictable and complex environment operating twenty-four hours per day requiring rotating shifts of clinical and support staff. The managers, clinicians and support staff within the ED deal with a complex set of variables on a daily basis. In such an unpredictable and complex environment ED staff are faced with many organizational challenges such as ensuring adequate staff numbers and a balanced skill-mix on each shift as well as dealing with access block (delay in accessing a hospital bed for patients that need to be admitted). For example, if there are no beds available on the wards, the patients needing to be admitted are unable to be transferred from the ED, this then impedes the intake of people from the waiting room. (Spencer, Rosemary, 2002).

The flow of patients keep coming in but patients are unable to be moved out of the ED, staff often have to attend to patients on trolleys in the corridors or doubled-up in cubicles until room becomes available. In order to work effectively, ED clinicians need to be able to navigate and negotiate their way through a complex and highly pressured system. To do so, they require communication structures that support and facilitate their day-to-day needs, which in turn allow them to attend to the needs of their patients. (Spencer, Rosemary, 2002).

The overall aim of this research is to identify interventions that will improve and support communication in an ED setting. This will be achieved through gaining a deeper understanding of clinical communication practices, which more specifically involves (Spencer, Rosemary, 2002) :

a.       Examination and understanding of communication patterns in an ED setting, with a particular focus on clinical roles and interruptions.

b.       Identification of communication issues as perceived by ED clinicians.

2.3.1.      Outline of Methods

In order to examine ways in which communication can be improved upon and supported in the ED, two methods were utilised: observational studies using the Communication Observation Method and focus groups (Figure 2). (Spencer, Rosemary, 2002). As show on the table below : Communication Observation Method and focus groups.

Method	Output
1. Observational Studies Communication Observation Method Quantitative & qualitative analysis	Rich descriptions of communication patterns in the clinical setting
2. Clinician Focus Groups Qualitative analysis	Identification of communication issues & interventions to improve communication practices in the clinical setting

Both quantitative and qualitative analysis methods were employed to generate rich descriptions of communication patterns from the observational data. This was augmented further by the use of the focus groups to provide both validation of our primary analysis and to provide insights into clinicians’ experiences in relation to communication issues together with their ideas about possible interventions that may improve communication practices. (Spencer, Rosemary, 2002).

2.3.2        The Specialty Of Emergency Nursing

The profession of nursing is diverse, so too is the specialty of emergency nursing. Most specialty nursing groups are identified by their focus on one of the following (Emergency Nurses Association, 1999) :

a.       Specific body system

b.      Specific disease process/problem

c.       Specific age group

d.      Specific population, such as women’s health care or mental health

Emergency nursing crosses all these specifications and includes the provision of care that ranges from birth, death, injury prevention, women’s health, disease, and life and limb-saving measures. Unique to emergency nursing pratice is the application of the nursing process to patients of all ages requiring stabilization and/or resusciation for a variety of illnesses and injuries. (Emergency Nurses Association, 1999).

1)      Core

The scope of emergency nursing pratice involves the assessment, analysis, nursing diagnosis, outcome identifiation, planning, implementation of interventions, and evaluation of human responses to perceived, actual or potential, sudden or urgent, physical or psychosocial problems that are promarily episodic or acute, and which occur in a variety of settings. These may require minimal care to life-support measures; patient, family, and significant other education; education; appropriate referral and discharge planning; and knowledge of legal implications. (American Nurses Association, 1995).

Emergency nursing pratice is independent and collaboraive in nature. The practice of emergency nursing also includes the delivery of compassionate, competent care to consumers through education, research and consultation. (American Nurses Association, 1995).

Emergency nursing occurs in hospital emergency departements; prehospital and military settings; clinics, health maintenance organizations, and ambulatory care centers; business, educational, industrial and correctional institutions; and other health care environments. Emergency care is also at the point of contact with consumers; where they live, work, play or go to scholl. (American Nurses Association, 1995).

2)      Dimensions

Emergency nursing is multidimensional. The dimensions of emergency nursing include the responsibilities, functions roles, and skills that evolve fro a specific body of knowledge. These dimensions are demonstrated through emergency nursing characteristics, roles, processes, and behaviors. Characteristics of emergency nursing pratice include (American Nurses Association, 1995) :

a.       Assessment, analysis, nursing diagnosis, planning, implemntation of interventions, outcomes identifications, and evaluation of human responses of individuals in all age groups whose care is made more difficult by the limited access to past medical history and the episodic nature of their health care.

b.      Triage and prioritization.

c.       Emergency operations preparedness.

d.      Stabilization and resuscitation.

e.       Crisis intervention for unique patient populations, such as sexual assault survivors.

f.       Provision of care in uncontrolled or unpredictable environments.

g.      Consistency as much as possible across the continuum of care.

Other characteristics of emergency nursing environments include unanticipated situations requiring intervention, allocation of limited resources, need for immediate care as perceived by the patient/others, and contextual factors. Contextual factors are the variety of geographic settings, unpredictable numbers of patients, and unknown patient variables which include severity, urgency, and diagnosis. (Emergency Nurses Association, 1999).

Emergency nursing pratice is systematic in nature. The nursing process includes: inquiry, analysis, scientific thinking, and decision making. (Emergency Nurses Association, 1999).

Professional behaviors inherent in emergency nursing pratice are the acquisition and application of specialized core body of knowledge and skills, accountability and responsibility, communication, autonomy, and collaborative relationships with others. (Emergency Nurses Association, 1999).

CHAPTER 3

CLOSING

3.1  Conclusion

Coordination can be described as a spectrum of activities, starting with simple information sharing leading to collaboration and then to joint development of plans and programs. The activities discussed below are loosely listed in an ascending level of sophistication. Although each activity can lay the foundation for successive ones, the given order should not be taken too literally since some activities can be performed simultaneously and, in some cases, less difficult activities are bypassed in favour of higher priority, more challenging ones. (International Federation of Red Cross and Red Crescent Societies, 2000).

Lack of understanding or simple miscommunication often prevent organisations from realising that they share many interests, especially when it comes to the welfare of their beneficiaries. Often, they may desire the same end-goal and may share many philosophical and conceptual approaches. (International Federation of Red Cross and Red Crescent Societies, 2000).

A clinical setting in which effective communication is imperative for the timely delivery of patient care is the emergency department (ED). The ED plays an important role within the health system. It is the main entry point to hospital for unplanned patient admissions of varying levels of acuity. It is a dynamic, unpredictable and complex environment operating twenty-four hours per day requiring rotating shifts of clinical and support staff. (Spencer, Rosemary, 2002).

           

3.2  Suggestion

            From this paper, we hope that the students can understand and know about Coordinating Actions Of Others During An Emergency

REFERENCE

American Nurses Association. (1995). Nursing’s soccial policy statement. Washington, DC: Author.

Carrier, Emilly, et al. (2011). “Coordination Between Emergency and Primary Care Physicians. National Institute for Health Care Reform. Available on http://www.nihcr.org/ED-Coordination.

Emergency Nurses Association. (1999). Standards of emergency nursing practice (4th ed.). Des Plaines, IL: Author

Medicine, A. o. (2014). Emergency Departement Planning and Resource Guidelines. 564-571.

Societies, I. F. (2000). Improving Coordination. 6-12.

Spencer, Rosemary. 2002. Supporting Communication in the Emergency Departement. Funded by the NSW Department of Health. Published by the Centre for Health Informatics, University of New South Wales, SYDNEY NSW 2052.

Tri-County Health Care. (2015). Emergency Room Service. Available on http://www.tchc.org/service-emergency.aspx