Emergency

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BANGALORE BAPTIST HOSPITAL

DEPARTMENT OPERATING MANUAL Version No: 05
Effective Date :
PM/DOM-05/ER EMERGENCY
01/06/18
Contents
1. SCOPE OF THEDEPARTMENT ........................................................................................................... 2
2. TRIAGE OF ADULT & PEADIATRIC PATIENTS ............................................................................. 3
3. DISASTER MANAGEMENTPLAN ...................................................................................................... 4
5. GUIDELINES FOR INTRA HOSPITAL TRANSFER OF STABLE PATIENT ................................ 21
6. TRANSFER OF CRITICALLY ILL PATIENTS ................................................................................. 23
7. PROTOCOL FOR ADMISSION HIGH RISK PATIENTS THROUGH EMERGENCY ................... 24
8. GUIDELINES FOR HANDLING BROUGHT DEAD CASES ........................................................... 25
9. GUIDELINES FOR HANDLING THE UNKNOWN PATIENT – ..................................................... 27
10. BREAKING BAD NEWS ................................................................................................................. 28
11. SOP FOR HANDING OVER............................................................................................................ 30
12. PROCEDURES FOR FUNCTIONING IN THE EMERGENCY .................................................... 31
13. FLOWCHART OF PATIENT DEATH IN THE EMERGENCY .................................................... 37
14. PROTECTION OF CHILDREN FROM SEXUAL OFFENCES ACT(1,2) .................................... 38
15. MEDICAL EVALUATION OF A CHILD SUBJECTED TO SEXUAL ABUSE........................... 39
16. SOP FOR IDENTIFICATION OF PATIENT IN EMERGENCY ................................................... 41
Reviewed & issued by: Division Head Approved by: Director(CEO)

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1. SCOPE OF THEDEPARTMENT
1.1. Purpose
1.1.1. To lay down the processes and procedures for the effective functioning and operation
of the Emergency Department.
1.2. Scope of thedepartment
1.2.1. To lay down the procedures for the process pertaining to the Emergency Department
connected to the Hospital.
1.2.2. To attend to and admit patients based on their triage priorities and conditions to the
concerned departments of the Hospital and to ensure that all patients prioritized as
critical emergency shall beattended by an EMO within 5 minutes of reaching the
Emergency, even as the Nurse gives immediate attention.
1.3. Responsibility
1.3.1. The HOD and staff of the Emergency Department hold the responsibility to ensure the
implementation of the instructions and other procedures laid down.
1.4. Quality Objectives
1.4.1. The staff will provide treatment with the set standards of professionalism. This entails
confidentiality and quality care for patients. Treatment would be provided in such a
way as to ensure minimum scope for error, ensuring good accuracy. Our patients will
be treated with equality and respect. We shall endeavor to value the patient’s time and
minimize waiting time

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2. TRIAGE OF ADULT & PEADIATRIC PATIENTS

Priority I Priority II Priority III
Cardio Pulmonary Arrest Past Seizure, Now alert Minimal pain no risk factors
HR < 50/min, >150/min Dehydration – Persistent Minor symptoms of Pre-
vomiting/Diarrhoea Existing condition
Circulatory Compromise – BP < Moderate shortness of breath– Low risk history-
80mm Hg, Shocked Adult/child spo2 < 90% Asymptomatic now
Airway compromise – Severe Chest pain – non cardiac moderate Minor wounds – Abrasions,
Stridor severity minor lacerations (no
Respiratory Distress with drooling suturing required)
RR < 10/min Fever with Immunosuppresion / Scheduled revisit – Wound
Lethargy – Any Age review, complex dressings
Significant/Dangerous/Unknown Mild Traumatic Brain Injury Class Immunization only
Drug ingestion I/II Haemorrhage
Drowsy, Decreased Response, Minor to Moderate pain – Any cause
Unresponsive – GCS < 13 requiring analgesia
Ongoing/Prolonged Seizure Trauma – High risk history with
nohigh-risk factors
Chest Pain -Likely Cardiac Cause Limb injury – Deformity, severe
laceration, altered sensation
Very Severe Pain of any cause Stable neonate
Trauma – Major multi-trauma / Foreign body aspiration without
Severe localised Trauma/Absent respiratory distress
pulse
Haemorrhage – Class III/IV Dysphagia without respiratory
distress
Fever with altered sensorium Swollen hot joint
Acute Hemiparesis / dysarthria / Eye inflammation/foreign body/acid-
aphasia alkali splash
Significant/Dangerous
Envenomation

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3. DISASTER MANAGEMENTPLAN
The hospital (BBH) has a disaster management plan for external and internal
disaster, which have been framed by the safety committee.
3.1. External Disaster: External disaster can be due to a natural calamity (e.g. earth quake) or
due to a man made emergency e.g. fire bomb blast. In such situation it is presumed that a
large number of patients (people) will need immediate treatment, therefore it is necessary to
mobilize all the hospital resources (men and material) in a planned and efficientmanner.In the
event of an External disaster, it will be coded as PURPLE and when an external fire occurs
both code purple and red will be announced. In case of prior intimation of mass casualty
imminent arrival due to an external disaster, Code Purple Stand-by will beannounced.
3.2. EXTERNAL DISASTER MANAGEMENTPLAN: Capacity for Emergency treatment at
BBH in a critical condition due to any external disaster shall be decided by the command
nucleus depending on the bed status and the staffing.
Situation – This plan caters to mass casualties above 10 in number caused due to
major disasters.
3.3. Command nucleus: BBH has a nucleus of officials for handling external and
internaldisaster. Baptist Hospital Number: 22024700
Sl.No Designation Contact Mobile
1. Director 22024305 9448496614
2. Dy. Director / Head of Administration 22024380 9448496603
3. Dy. Director /Chief of medical service 22024445 9480827843
4. Chief of Disaster team 22024334/416 9740787540
5. Head of Emergency service 22024316 9740787540
6. Head of Projects and Securities 22024377 9448496604
7. Safety Manager 22024534 9448496605
8. Security Consultant 22024398 9448496601
9. Safety officer 22024533 8105128013
10. Chief Nursing Officer 22024307 9448496611
3.4. Activation of contingency plan to externaldisaster –

3.4.1. Information of any external disaster will be received at the information desk at BBH or

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by any superior authority. On receiving information, the desk shall do the following
(to the extent possible)
a. Identification of informant.
b. Phone number of informants
c. Nature of disaster
d. Location
e. Possible number of victims
f. Approximate time of arrival
3.4.2. When the call is received during working hours the information desk will then inform
the Director (CEO), Chief of Disaster Team, Chief of Medical Services, Chief of
Nursing Services, Head of Support services and Security through fastest means of
communication.
3.4.3. If the call is received during Non-Working hours the information desk will then inform
Resident Administrator or the First Administrator on call who in turn will inform the
Director (CEO), Chief of Disaster Team, Chief of Medical Services, Chief of Nursing
Services, Head of Support services and Security through fastest means of
communication
3.4.4. The Director (CEO)/ Chief of Disaster Team on receipt of the information, shall assess
the situation and activate the external disaster plan by declaring CODE PURPLE
&CODE RED in case of external fire. ―CODE PURPLE STANDBY‖ shall be
announced by CEO/Chief of Disaster Management /Resident administrator in case of
prior intimation of mass casualty.
3.4.5. The following department shall then be informed by information centre and the person
receiving the call shall ensure the respective department supervisors are informed.
Sl. No. Department Contact No.s
1. Blood bank 376
2. Pharmacy 311/336
3. Nursing 307
4. Lab 431/432/309
5. Radiology 429
6. MRD 313/550

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7. Canteen services (F and B) 415/383

8. Housekeeping 340
3.5. Sequence of action (CODE PURPLE)
3.5.1. Responsibility
Overall responsibility Director (CEO) / Deputy Director and Safety Committee
Chairperson
Supervision – Chief Disaster Management / Chief of Medical Staff/ Deputy Director/
Resident Administrator/ Administrator on call
Mobilization & allocation of work
a. To consultants – Asst. Head medical services
b. To Nursing – CNO
c. To Allied health – Head Allied health sciences
d. Support service- Head Support service
3.5.2. Admin: Once CODE PURPLE has been announced and external disaster management
plan activated members of the command nucleus shall assess the situation and ensure
that the disaster is effectively managed and proper communication established.
3.5.3. Control Room: The information centre will be converted into the command centre in
the event of the disaster. In the event of a disaster detailed action plans are given to
each and every department.
3.5.4. General instructions
a. After notification and before arrival of casualties in case of major disaster, suspend all
routine work immediately clearing all patients from out-patient department and
suspending elective surgery list.
b. Each ward should assess the bed occupancy status and inform Chief of Nursing
Services / Resident administrator. Sufficient trolleys and wheelchairs are to be placed
at OPD entrance.
c. The area in front of information centre must be cleared and personnel to be deployed
by respective in-charge to planned areas.
d. Employees should report as follows:
i. Additional nursing personnel-OPD
ii. Medical staff – OPD

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iii. Drivers – maintenance building

iv. Paramedical staff-respective departments
v. All others- OPD waiting room for assignment
e. If it is necessary send a vehicle to the site, with the team comprising of the driver, two
nurses, two medical officers, and one PCD staff (if space available) and will also
carry the necessary equipments.
f. In case of any clarifications, the command nucleus can be reached on 424/454/500
3.5.5. Casualties Arrive in Hospital
a. Triage of patients on arrival to be done by two doctors (Orthopedist or Surgeon and
One Emergency Physician/Medical Officer) assisted by at least one nurse and several
helpers will triage the incoming casualty. A temporary triage area will be set up
adjacent to information centre. Patient triaged as Red and Yellow will be moved to
Emergency and Surgical OPD. Those patients requiring transfer such as
Neurosurgical patients should be referred when stable.
b. Patients triaged as green will be shifted to ENT OPD. Tags must be placed on all
patients with name and registration number. Nurses should remove personal
belongings of each victim which is placed in a bag, tied, labelled and taken to
business office. This is secured in the presence of 2 people and counter signed i.e. one
from admin and from business office.
c. Voluntary blood donors are to go to designated area for the blood collection in the
blood bank. Relatives and onlookers are to be restricted outside the OPD entrance.
d. Casualties dead on arrival or dying in OPD must be identified by name or description
and name tag. They will be triaged as black. Their names will be listed in the register
after they are pronounced dead. They must be listed in the death register; bodies will
be moved to mortuary.
e. Press staff having proper identification may wait in health plan lounge.
f. Dealing with the dead at the scene of a major accident is primarily the responsibility
of the police on behalf of the District Magistrate. A doctor shall only pronounce the
death in the presence of police officer and any dead bodies shall be tagged. The list of
the patient‘s names will be displayed in the notice board adjacent to the emergency
room by the MRD personnel in-charge.

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3.5.6. Disaster Management Kit

The hospital has a disaster management kit in Emergency room which shall be sent with the disaster
management team for patient care during the transportation time from disaster site to BBH. This
disaster kit shall be checked once in a month by Pharmacy in-charge and the drugs with nearest
expiry will be stuck on the kit. Nearing expiry they will be replenished as required.
The list of medicines in the disaster management kit is as follows

SI. No MEDICATION QUANTITY
1. Inj. Diclofenac 10 amps
2. Inj. NS 500m1 10
3. Inj. RL 500m1 10 x 5
4. IV Set 10
5. Jelco 18G 10
6. Jelco 20G 10
7. Suction Cath. 14 10
8. Roller Bandage 6” 10 x 6
9, Roller Bandage 4” 10 x 6
10. Long Leg U Splint 5
11. Long Arm U Splint 5
12. Short Leg U Splint 5
13. Short Arm U Splint 5
14. Glove Box- Clean 1
15. Betadine Solution (500m1) 1
16. Hydrogen Peroxide 1
17. Disposable apron 50
18. Disposable Mask 100
19. Laceration set 5
20. Mercuerome solution 1
21. 2-0 Ethilon 12
22. 3-0 Ethilon 12
23. 4-0 Ethilon 3
24. Irrigation Fluid (Normal Saline) 10 x 5
25. Dressing pads 20
26. Gauze packs 20
27. 2cc Syringes 10
28. 5cc Syringes 10
29. 10cc Syringes 10
30. 20cc Syringes 5
31. Ventury Mask 5
32. Paper Plaster 2.5cm 3
33, Jelco 24 5
34. Paediatric oxygen mask 5

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35. Adrenaline 10 amps

36. Atropine sulphate 10 amps
37. Dopamine 5 amps
38. Lignocaine + adrenaline 2 vials
39. Plain lignocaine 2 vials
40. Haestril 4
41. Midazolam 2 vials
42. Tramadol inj 10 amps
43. Ondansetron 10 amps
44. Burette set 2
45. Isolyte —p 2
46. Ambu bag adult 1
47. Ambu bag paed 1
48. Cervical collar medium 5
49. Cervical collar small 5
50. Glove medium 1
51. Plaster Roll 1
52. Micropore 5
53. Scissors 1
54. POP 6” 10
55. POP 4” 10
56. Soft Roll 6” 5
57. Soft Roll 4” 5
58. Glove- Sterile 7 20
59. Glove- Sterile 8 20
60. Central Line 2
61. Inj Methyl Prednisolone 6
3.6. Medical Teams –

3.6.1. Emergency Treatment Team –
Upon notification of a mass casualty, the emergency staff with the help of security
should suspend routine activity and transfer necessary supplies into the area outside
information centre. The triage team (includes an orthopedician or surgeon, one
Emergency physician/Medical officer and nurse begin triage and reorganize incoming
causalities. (Ref – TRIAGE policy) The triage nurse will write patient‘s name on tag
and tie on patient‘s wrist.
3.6.2. Surgical Team
Chief of Disaster Team/Chief of Medical Services alerts the Head of surgery.

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The surgical team shall report to the Triage Area and take over the management of the actively ill
patients after initial triage. The Chief of Surgery shall appoint one surgeon to be part of initial
Triage Team and delegate responsibilities to other consultants and residents. Additional
personnel required from other departments will be reviewed and activated in consultation with
the Director (CEO)/control room.
3.6.3. Orthopaedic Team
Chief of Disaster Team/Chief of Medical Services alerts the Head of Orthopaedics who will
appoint one surgeon to be part of initial Triage Team. He will mobilize other doctors and the
plaster technician and take over the care of those requiring orthopaedic management.
3.6.4. Physiotherapy
Provide necessary splints, plaster of pairs and assist in managing orthopaedic injuries
3.6.5. Medicine Department Team
Chief of Disaster Team/Chief of Medical Services will inform the Head –Medicine if
there are medical emergencies who in turn will alert other consultants and residents
and take over medical cases.
3.6.6. Paediatric Team Chief of Disaster Team/Chief of Medical Services will inform the
Head-Pediatrics if there are paediatric emergencies, who in turn will alert other
consultant and residents and take over paediatric cases.
3.6.7. ENT Chief of Disaster Team/Chief of Medical Services will inform the Head –ENT
To assess & manage maxillofacial injuries. To organize & keep tracheostomy sets ready.
To help surgical team in suturing.
3.6.8. Anaesthesiology Team
The 10Anaesthesia1010 department will take the lead in resuscitation. Chief of Disaster
Team/Chief of Medical Services shall alert the Head Anesthesia who in turn will alert the other
consultants. One or more 10Anaesthetist1010st shall go to the Emergency to help in resuscitation
of patients and to assess the pre-operative condition of patients requiring surgery. The elective
surgery list shall be cancelled/ postponed and wards informed accordingly. The OT nurse
incharge shall be informed immediately to initiate the arrangements in OT.
3.6.9. ICU/HDU
The ICU in charge assesses the feasibility of shifting patients out of ICU .Also passes
information to the command nucleus regarding the number of ICU beds available for causalities.

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3.6.10. OPDs
Nursing professionals should clear existing patients from OPDs.
Supply medical boxes to be placed near rooms
Trolleys and wheel chairs to be by entrance
Furniture in each OPD room pushed against wall
Check resuscitation equipment
Minor surgery room –open door to corridor and clear as obstruction as possible
Corridor benches to be moved (one in middle ) to corridor by administration and one bench to be
designated for bleeding donors
3.7. SUPPORT TEAMS
3.7.1. Medical Records
a. The MRD head shall mobilize staff to register patients – get accurate information –
name, address, date of birth, person to be contacted phone/address.
b. Send the chart to the Triage Area with out delay and process admissions in the same
manner as quickly as possible
c. Details of ‗Brought dead cases should be recorded in a separate book.
d. The MRD should provide bed status date/number of casualties to the control rooms.
e. 25 numbers of pre numbered charts with hospital ID printed on the cover of the charts
shall be generated and kept in Emergency for use during mass casualty. It shall be
f. clearly mentioned in the HIS as ―DUMMY NUMBERS FOR DISASTER
MANAGEMENT‖.
g. 20 Numbers of pre numbered wrist bands shall also be placed inside each of the charts.
h. After the mass casualty has been controlled, wherever information available, patient
detail shall be updated in the HIS.
i. In case the pre numbered chart are used during mock drills, the used chart shall be kept
separately and labelled as ―MOCK DRILL‖, the same shall be indicate in the HIS
before inactivating the Hospital ID
j. MRD shall not give information to anyone regarding patients.
3.7.2. Laboratory
a. Staff shall keep ready required stains, media, reagents, kits etc. For laboratory tests
and dispatch of reports should be prioritized.

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b. Senior staff shall assess the situation and arrange additional personnel.
c. The department shall maintain a roster of names, address and phone nos of all staff.
3.7.3. Blood Bank
a. The blood bank chief shall:
b. Make necessary arrangements for grouping cross matching and issue of blood.
c. Make arrangements to bleed up to 3 donors at a time within the blood bank and bench
outside the corridor.
d. Call any voluntary donor on list.
e. Strictly follow blood testing protocols for all donors.
f. Arrangement to procure additional quantity of blood and liaise with other authorized
blood banks.
3.7.4. Radio Diagnosis
a. The HOD on being alerted shall be responsible for ensuring the presence of adequate
staff.
b. The senior technician should ensure that the necessary personnel shall be available to
take x-rays.
c. Facility for resuscitation of patients should be available in the department to take care
of any exigencies.
d. A separate portable x-ray machine should be available for unstable patients.
3.7.5. Pharmacy/Pharmacy Stores
a. Use disaster kit for immediate supply of medication
b. Mobilize additional IV fluids, sets, cannula, catheters and any supplies as needed.
c. Keep a record of items distributed.
3.7.6. General Stores
a. Arrange necessary items immediately as per the requirement.
b. Keep a record of items distributed.
3.7.7. Nursing Services
a. The Nursing Superintendent mobilizes adequate nurses to the Emergency and other
designated areas.
b. OPD in charge:
c. Assign at least 2 aides and 1 nurse in each room.

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d. Ensure medical boxes of supplies and emergency equipment is ready.

e. Arrange shifting of patients to ward.
f. Mobilize information regarding availability of beds.
g. Transport
h. The head of transport service is alerted and arrangements are made for all available
ambulances and other vehicles like van/jeeps.
i. Liaise with private ambulance if necessary.
j. Vehicles should be available to transport patients to other hospitals and to bring in
additional staff.
k. Ambulance periodically checked for basic essential facilities.
3.7.8. Housekeeping/Linen/Laundry
a. The incharge housekeeping alerted by the information staff.
b. Housekeeping incharge will mobilize additional helpers in the Emergency and
designated areas.
c. Additional staff will be mobilized to shift patients, bring linen. IV fluids, blood and
take specimen to laboratory.
d. Laundry shall ensure supply of linen to Emergency, wards and OT.
e. Toilets and working area to be cleaned frequently.
3.7.9. Maintenance
a. Monitor supply of gases.
b. Assure electrical supply
c. Assure water supply.
3.7.10. Dietary/Canteen
a. Provide safe drinking water points for visitors / staff.
b. Provide refreshments to the designated triage area, emergency and other areas.
3.7.11. Security
a. Notify chief of security / main office to get additional help.
b. Notify police for help.
c. Clear the area in front of emergency for arrival of ambulance.
d. Clear crowds in area outside OPD. Only casualties allowed in building, ―NO
VISITORS TO BE ALLOWED‖.

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e. Press personnel with identification to be directed to health plan lounge

f. Direct traffic so that ambulance have free access
g. Protect key installations of the hospital
h. Cordon off the triage area.
i. Communicate with Emergency and control room.
3.7.12. Mortuary
a. Dead bodies transferred to mortuary accompanied by a security staff.
b. A record should be maintained about the number of dead bodies and personal
particulars.
c. A wrist band should be tied to each body to facilitate identification.
d. All dead must be submitted for medico legal autopsies.
e. All dead bodies will be stored in the mortuary.
f. Photographs and finger prints of unidentified / unclear bodies preserved.
g. Unclaimed bodies are required to be preserved for 72 hours and then send to municipal
burial grounds after due permission from police.
3.7.13. Guest Relation
a. A separate waiting area in the OPD designated for relatives and a guest relations
officer is assigned to ensure their comfort and needs.
b. Guest Relation staff shall be stationed in the waiting area to interact with the relatives.
3.7.14. PCD And Social Service
a. Assist security in dealing with crowds.
b. Enquiry counter to be set up to get names of casualties and give available information.
c. Assist the family in case of deaths.
3.7.15. Business Office
a. Provide support to technical services and facilitate emergency funds
b. Mechanism of insurance coverage, reimbursements facilitated.
c. The personal property of patients (tied and labelled) will be kept in business office for
safe keeping, the responsibility of which will be taken by the nurses.
3.7.16. Director/Chief Disaster Management Team( Designated By Director(CEO))
a. Liaison with press or media – give any information as authorized by Director (CEO).
b. Liaison with police

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3.7.17. Training of Staff and Periodic Checks

a. Staff shall be familiarized with all aspects of the plan, especially the role of each
person in an emergency situation.
b. The resuscitation equipment, emergency drugs, in the Emergency and ambulance shall
be checked regularly.
3.7.18. Emergency Kit:
a. A list of emergency drugs, dressing materials, instrument trays, airway equipment that
are anticipated shall be kept in the Emergency which have to be sent immediately to
the non clinical department. All clinical departments have their own emergency trolley
3.7.19. Networking
a. Alternative arrangements with other hospitals for referring patients shall be made. A
list of hospitals in the vicinity with information on operating capacity and facilities,
phone numbers shall be kept in the Emergency. The hospital shall also network with
Disaster Management Cell of BBMP, police, fire department, other voluntary agencies
3.7.20. Termination of the Plan
a. Chief of Disaster Management /Chief of Medical Services should notify the control
room and the individual departments depending on the fulfilment of their roles.
b. After termination the hospital activities should return to normal.
c. Meeting held to critically evaluate the plan and discuss ways of improving.

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4. GUIDELINES FOR INTER HOSPITAL TRANSFER OF PATIENT

4.1. Purpose: To transfer patient who have been undergoing treatment in the hospital for various
investigations not done at Bangalore Baptist Hospital or shift for further care.
4.2. Scope: This applies to all patients who need to be transferred either temporarily or
permanently to other health care institutions.
4.3. Responsibilities and Authorities
Emergency RMO, Nurse, Nursing Supervisor, Administration.
4.4. Procedure
The decision to transport a critically ill patient must be based on an assessment of the
potential benefits of transport weighed against the potential risk. The basic reason for moving
a critically ill patient is a need for additional care either technology and / or specialists, not
available at the patients current location. If the diagnostic test or procedural intervention
under consideration is unlikely to alter management or outcome of that patient then need for
transfer must be questioned.
Risk to the patient during transport can be minimized through careful planning. To provide
for this, at least four concerns need to be addressed.
4.5. Communication, Personnel, Equipment, Monitoring
First patients who needs to be transfer to other institutions should be identified –
4.6. Criteria:
4.6.1. Facility not available in the hospital.
4.6.2. Facility usually available but presently unavailability of beds.
4.6.3. Patient to be transferred only for investigations.
4.6.4. Patients to be transferred for temporary procedures.
4.6.5. Patient choice, LAMA, on request
4.6.6. Financial constraints.
4.7. Before the transfer of patient to any other institution bed availability must be
confirmed with appropriate transfer of information.
The decision to transfer a patient is the responsibility of the attending Physician at the
referring hospital. The transfer should not compromise the patient‘s outcome.
Resuscitation and stabilization should begin at the referring hospital and continue until
transfer is complete. Current regulations and good medical practice require that the

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competent patient or the legally authorized representative of an incompetent patient give

informed consent prior to inter hospital transport. This must include a presentation of the
risks Vs benefits of transport with documentation in the medical record and signed consent
document.
4.8. Preparing a patient for inter hospital transport
4.8.1. All critically ill patients need secure intravenous access before transport. If peripheral
venous access is unavailable, central venous access is established. If needed, fluid
resuscitation and inotropic support are initiated.
4.8.2. A patient should not be transported before air way stabilization if it is judged likely
that air way intervention will be needed en route .The air way must be evaluated
before transport and secured as indicated by Endotracheal tube(or tracheostomy).
4.8.3. For trauma victims, spinal immobilization is maintained during transport unless the
absence of significant spinal injury has been reliably verified.
4.8.4. A nasogastric tube is inserted in patients with an ileus or intestinal obstruction and in
those requiring mechanical ventilation. A Foley catheter is inserted in patients
requiring strict fluid management, for transports of extended duration, and for
patient‘s receiving diuretics.
4.8.5. If indicated, chest decompression with a chest tube is accomplished before transport.
4.8.6. Soft wrist and/or leg restraints are applied when agitation could compromise the
safety of the patient. If the patient is agitated or un cooperative, the use of sedatives
and/or neuromuscular blocking agents may be indicated.
4.8.7. All relevant documents, laboratory & radiographic studies are copied for the receiving
facility.
4.8.8. Referral register is being to be maintained all relevant details.
4.9. Transport vehicle requirements
4.9.1. Vehicles should be appropriate to the task in terms of design and equipment. Regular
inspection and servicing of vehicles is required (appropriate documentation for same
to be maintained – in charge of the transport / ER/ maintainancedepts).
4.9.2. Particular requirements related to:
4.9.3. Safety
4.9.4. Adequate space, with room for an attendant at the head end side

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4.9.5. Adequate power and gases for life support systems

4.9.6. Adequate suction &vaccum pressures
4.9.7. Easy access for embarkation and disembarkation
4.9.8. Adequate lighting and internal climate control
4.9.9. Restrains for stretcher and equipments
4.9.10. Acceptable noise and vibration levels
4.9.11. Adequate speed and response times
4.9.12. Good communication system both internal and external
4.9.13. Audible patient monitoring alarms routed through attendants headsets where noises is
unavoidable, in addition to usual alarms
4.9.14. Appropriate seating and restraints for staff
4.9.15. Impaired gravity drip of fluids.
4.9.16. Medication and the emergency equipments in the ambulance are checked on a daily
basis by the concerned nurse from the Emergency.
4.9.17. It shall be documented in ―Ambulance Register‖
4.9.18. It shall be sealed with date after each check.
4.9.19. The intactness of the seal is checked prior to each dispatch.
4.9.20. Driver has the responsibility of checking medication and emergency equipments prior
to every emergency call/requirement of the ambulance, the same shall be documented
in the Ambulance Inventory Register‘.
4.10. Pre transport coordination and communication to include:
4.10.1. The referring physician must contact a physician at the receiving hospital who is
authorized to admit patients to describe the patient‘s condition and to obtain advice
about stabilization and transport. The admitting physician at the receiving hospital
must have accepted the patient and confirmed that appropriate resources are available
at the receiving hospital before the transfer begins.
4.10.2. A nurse to nurse report shall be given by the referring facility to the accepting
hospital.
4.10.3. A copy of relevant documents shall accompany the patient.
4.10.4. A discharge summary summarizing condition, treatment of the patient will be given to
the patients/relatives regardless of DAMA/LAMA/Referral status

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4.10.5. Accompanying personnel

4.10.6. A minimum of two persons in addition to the vehicle operator, shall accompany the
patient. The accompanying personnel should be a registered Nurse and a doctor who
are capable of providing advanced air way management including endo tracheal
intubation, intra venous therapy, arrhythmia interpretation and treatment, and basic
and advanced cardiac and trauma life support.
4.11. Minimum equipment that shall be available
4.11.1. For Air way and Ventilator Management
4.11.2. Resuscitation bag and mask of proper size and fit for the patient]
4.11.3. Oral airways, laryngoscopes, and endotracheal tubes of proper size for the patient.
4.11.4. Oxygen source with a quantity sufficient to meet the patients anticipated consumption
with at least one hour reserve in addition
4.11.5. Suction apparatus and catheters
4.11.6. Cardiac monitor including defibrillator
4.11.7. A blood pressure cuff
4.11.8. Materials for intravenous therapy including cannulas, solutions, tubing, needles and
syringes, and devices for regulation of continuous intravenous infusions
4.11.9. Drugs for advanced cardiac resuscitation, the management of acute physiologic
derangements, and the specific needs of that patient (e.g. sedatives, antibiotics)
4.11.10. Communications equipment to allow contact between the transporting vehicle
and both the referring and receiving hospitals.
4.12. Monitoring during transport
4.12.1. All critically ill patients being transported shall have a minimum level of monitoring
4.12.2. Continuous ECG monitoring
4.12.3. Intermittent measurement of
4.12.4. Blood pressure
4.12.5. Respiratory Rate
4.12.6. Continuous monitoring by pulse oximetry is strongly recommended
4.12.7. Intubated patient receiving mechanical support of ventilation should have airway
pressure monitored. If a transport ventilator is used, it should have alarms to indicate
disconnections or excessively high airway pressures.

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4.13. Documentation
4.13.1. The clinical records should briefly summarize the patient‘s clinical status before,
during and after transport, relevant medical condition and therapy given in the
Transfer in and out Transfer out forms.

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5. GUIDELINES FOR INTRA HOSPITAL TRANSFER OF STABLE PATIENT

5.1. Purpose: To help the patients undergo diagnostic / therapeutic procedures for continuing
care.
5.2. Scope – Transfer of Stable patients to the following departments.
5.2.1. CT Scan & MRI
5.2.2. UltraSonography
5.2.3. Stress test
5.2.4. ECG
5.2.5. Color Doppler
5.2.6. Radiology Examination
5.2.7. References to Consultants
5.2.8. Physiotherapy
5.2.9. Speech Therapy
5.2.10. Ophthalmic department
5.2.11. Ward shifting
5.3. Responsibility – Registrar/RMO/Staff Nurse/House Keeping operatives
5.4. Patients where deterioration is not expected situation where escort is not required
5.4.1. Stable vital signs
5.4.2. Not on continuous IV infusion / medication
5.4.3. GCS 15/15
5.4.4. Patient does not require oxygen or suctioning
5.4.5. Attender is available to escort the patient
5.4.6. Patient not on continuous monitoring system
5.5. Moderately unstable patient (nurse escorts the patient)
5.5.1. Patient requiring oxygen
5.5.2. Patient requiring continuous monitoring
5.5.3. Patients requiring suctioning
5.5.4. Receiving continuous IV infusion / medication
5.5.5. Altered sensorium/ delirium/ conscious
5.5.6. Patients with risk for complication ex: stable patient with risk for intracranial bleed
5.5.7. Patient with vomiting/ diarrhea

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5.5.8. Vulnerable patient

5.6. Procedure
5.6.1. Check the Doctors written order for transfer.
5.6.2. Ensure that the patient /relative have been informed about the condition and transfer
of the patient.
5.6.3. Obtain informed written consent if required.
5.6.4. Ensure that the request is made for the concerned investigations via system and has
been received by the concerned staff.
5.6.5. Prepare the patient physically for the investigation as required.
5.6.6. Assess the mode of transport and the personnel to accompany the patient (done by
Staff Nurses).
5.6.7. Contact the department to ensure that they are ready to accept the patient.
5.6.8. Assess the patient‘s condition and record in the nurses notes prior to transfer (By Staff
Nurse).
5.6.9. Transport the patient on a wheel chair / trolley to the concerned
5.6.10. Department along with patient record accompanied by housekeeping
5.6.11. Make the patient comfortable and document his / her condition on return to the unit.
5.6.12. Obtain the report and inform any significant findings to the RMO / Registrar /
Consultant.
5.6.13. Attach the report to the patient record.
5.6.14. Information about the report given to patient/ attenders by the concerned doctor

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6. TRANSFER OF CRITICALLY ILL PATIENTS

6.1. Purpose: To provide intensive monitoring and management of critically ill patients from
ward to ICU and emergency room to ICU.
6.2. Scope Critically ill patients
6.3. Responsibility
RN/Team leader/Head Nurse/RMO/Registrar/Intensivist/Nursing/supervisor/Customer Care
/House keeping operatives.
6.4. Procedure
6.4.1. Assess the criticality of the patient.(RN)
6.4.2. Inform RMO/Registrar and activate code blue (SOS) as needed..
6.4.3. Check for availability of ICU bed.
6.4.4. Inform ICU staff about the transfer
6.4.5. Inform relative/patient regarding the transfer and make sure that they understand the
need for the transfer and the financial implications.
6.4.6. Shift the patient on the bed immediately to the ICU. RN /RMO/Intensivist
accompanies the patient to the ICU.
6.4.7. Ongoing assessment and management to be carried out during the transport.
6.4.8. Ensure the transfer summary is kept ready which includes name of the primary
consultant, reason for transfer, significant findings, diagnosis, procedures performed,
treatment carried out and condition on transfer.
6.4.9. Ensure that the patient is made comfortable on ICU bed and prompt nursing
assessment carried out by the ICU nurse and the Intensivist.
6.4.10. Document the sequence of events objectively that lead to the transfer.
6.4.11. Endorse the patient‘s records and belongings to the assigned RN.
6.4.12. Ensure the name and signature is taken on admission slip.
6.4.13. Ensure that Changes of bed number and ward is reflected in the system.
6.4.14. Ensure that the transfer information is also given to Dietician.

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7. PROTOCOL FOR ADMISSION HIGH RISK PATIENTS THROUGH

EMERGENCY
Patient walks in to ER
Patient is triaged
Triage II Triage I Triage III
Medical resident/Consultant takes decision to admit &

authorizes the emergency protocol for admission
Communicate to patient regarding

availability/ non availability of beds
Bed Not Available Bed Available In-case of availability of bed

after one hr follows temporary
parking bed facility & initiates
Patient all investigation procedures
transferred/ Admission
referred out along
with doctor / Nurse
DAMA N
Staff Nurse: Use Pre numbered charts and takes consent for
deviation in admission process
Staff Nurse: Telephonically inform MRD

regarding admission with the Pre-numbered
chart In case of usage of pre-
numbered it will be
MRD will ensure completion
replenished by MRD within
of registration/admission
24hrs.
process
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8. GUIDELINES FOR HANDLING BROUGHT DEAD CASES

8.1. All brought Dead Cases must be assessed and re-assessed before being declared dead
following signs:
8.1.1. Pupils dilated and fixed
8.1.2. Carotid pulse absent
8.1.3. No sign of respiration
8.1.4. No heart sounds on auscultation
8.1.5. No reflexes
8.1.6. ECG showing no cardiac activity (flat line)
8.2. After seeing all the above signs you declare that patient is brought dead, after taking a quick
but complete history and confirming the identity of the patient as well as that of the
attendees.
8.3. ECG must be taken for ALL cases brought dead cases to document death. The expense must
be borne by the relatives in Emergency of at the time the body is handed over to the police.
If the patients are unwilling to register and bear the cost, the same must be documented and
noted in all cases.
8.4. Cases brought dead due to alleged or obvious foul play/ accidents must be registered as
MLC cases.
8.5. MLC Registration must be done by the Emergency medical officer/ the attending doctor if
8.5.1. The case is brought dead and the history and circumstance are not correlating / in case
of any suspected foul play.
8.5.2. Patient is under the age of 45 years and brought dead without any obvious cause of
death.
8.5.3. Cases brought dead with improper history creating a suspicion of an offence
8.6. Note: If the police refuse to receive the memo please note the time and date it was sent and
the same is to be documented in the chart and the memos should be filled in the chart.
8.7. Note: In any case body cannot be with held forcibly from relatives.
8.8. MLC can be avoided for a brought dead case and body can be released to the relatives if
8.8.1. Patient is over 45 with proof of previous illness is there and, any treatment/ follow up
documents of other hospitals can be accepted and to be photocopied and attached in
the file.

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8.8.2. Any patient with documented h/o of previous illness that could have contributed to
his/ her death (Please file copy of documents).
8.9. For any MLC associated queries please contact Hebbal Police Station in this number (080-
23330907)
8.10. Bodies of those brought dead following a RTA, hanging or poisoning (MLC) should be
kept in the mortuary and handed over only to the police.
8.11. Death certificates can be issued for those BROUGHT DEAD on request stating the
known severe illness as cause of death. However if a known patient is brought dead due to
an unknown cause, accident or poisoning (MLC) – No death certificate should be
issued.
8.12. For all brought dead patients, a certificate can be issued (at request) on the hospital
letterhead just mentioning the time the patient was brought dead to Emergency- But DO
NOT mention alleged or obvious cause of death.
8.13. All brought dead cases must be entered in the appropriate register
8.14. After confirmation with MRD – Update death certificate details

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9. GUIDELINES FOR HANDLING THE UNKNOWN PATIENT –
Unknown patient presents

to the Emergency
All Unknown patients

Stabilise ABCs regardless presenting are MLCs -
of presence of attender, Inform the Vigilance
cost issues or other factors officers at BBH and
Security team
Search patient for

Take history from Do not delay treatment or
valuables and attempt to
public/ambulance that diagnosis for unknown
identify patient and unlock
brought patient patients
phone to contact relatives
Admit patient under the

Relatives contacted -
Inform consultant on Emergency Dept and get
Inform regarding arrival
floor/HOD of Emergency relevant investigations
of patient and condition
Medicine department done regardless of
briefly
financial status
Relatives not Reachable -

Inform Senior
Intimate police again and
resident/Consultant on call
ensure vigilance officer is
of concerned department
on scene
If police want to shift Make plan to admit in

patient to Government Ward/HDU/ICU after
hospital/want to find discussing with consultant
relatives - Note PI of relevant dept
number, name and phone
number of the police
constable and comply by
their wishes.

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10. BREAKING BAD NEWS

10.1. Preparation-
10.1.1. Physician preparation – Diagnosis is verified and confirmed.
10.1.2. Place preparation – All counselling should be carried out in the Counselling room in
the Emergency. If the room is not available, take the relatives to a private space, draw
the curtains around the patient’s bed and begin to counsel. Have tissues, chairs and
water ready in case the patient/relatives become upset.
10.1.3. Many patients want to have someone else with them but this should be the patient’s
choice. When there are many family members, ask the patient to choose one or two
family representatives. Ensure presence of senior staff member and pastoral care
department member. Counselling should not be performed alone and there must be at
least two health care workers present.
10.1.4. Time preparation-The doctor should allot dedicated time to break bad news and
should be free to do it.
10.1.5. Confirm identity before breaking bad news.
10.1.6. Verify prior knowledge-, ―What have you been told about the medical situation so
far? Or ―What is your understanding of the reasons we did the MRI?. Based on this
information you can correct misinformation and tailor the bad news to what the
patient understands.
10.1.7. Give a WARNING shot- Warning the patient that bad news is coming may lessen the
shock that can follow the disclosure of bad news and may facilitate information
processing. Examples of phrases that can be used are ―’Unfortunately I’ve got some
bad news for you’ or ―’I’m sorry to tell you that’…. Do not use vague uncertain
terms while delivering news.
10.1.8. Give information slowly-Give time for information processing and closure is by
asking questions if the information has sunk in. Responding to the patient’s emotions
is one of the most difficult challenges of breaking bad news. Patients’ emotional
reactions may vary from silence to disbelief, crying, denial, or anger. Show empathy
and care while breaking bad news. Silence is as helpful at such times as empathetic
words are.

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10.1.9. When patients get bad news their emotional reaction is often an expression of shock,
isolation, and grief. In this situation the physician can offer support and solidarity to
the patient by making an empathic response. Contact persons details can be given for
further queries.

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11. SOP FOR HANDING OVER

11.1. Every member of staff has a responsibility to ensure effective clinical handover of patient
care within the emergency department, on discharge, or on transfer to another person or
professional group on a temporary or permanent basis
11.2. Staff engaged in clinical handover should receive structured orientation to the
departments’ handover procedure(s) and ongoing education in communication techniques
that support safe handover e.g. recognition of high risk patient types
11.3. Scheduled clinical handover times should occur at the start of each shift, as well as other
times as dictated by service demand.
11.4. Handing over for the doctors must be done at the bedside of the patient with the handing
over book. Details of the patient, his condition, and the relevant investigations sent and
his/her overall plan must be documented in the Handover Book.
11.5. Handing over would take place between 8AM-8.30AM and would involve all staff and
doctors of the previous night shift and the present morning shift.
11.6. Similarly the next handing over would happen between 8pm-8.30pm and would involve
the evening and night duty staff, and the evening and the night duty emergency
residents/medical officers.
11.7. Doctors and staff coming in for afternoon shifts and at various other times can take verbal
handovers regarding patients but must strive to go through each chart to know the brief
details of every case.
11.8. Responsibilities include ensuring a handover environment that facilitates the transfer of
essential information, allows and supports questions and clarifications relating to an
individual patient‘s care, assists in the generation of an ongoing management plan for
patients and ensures both the appropriateness and understanding of staff members in
taking over responsibility for care of a patient, equipment concerns and difficulties and
concerns during each shift.
11.9. Emergency departments should involve patients and carers in the clinical handover
process, such that they are informed about the nature of their ongoing care; the doctor
providing it and answer any concerns or questions

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12. PROCEDURES FOR FUNCTIONING IN THE EMERGENCY

12.1. Registration procedure:
12.1.1. Patient is received, triaged and a brief history is collected. Patient and his/her relatives
are dealt with in a gentle, caring and courteous manner.
12.1.2. Vital signs are checked and concerned doctors are informed.
12.1.3. Relatives are sent for registration with a slip scribed with ―Emergency with the
concerned unit mentioned on it.
12.1.4. If the patient is a medicolegal case (MLC), MLC is also scribed on the slip.
12.1.5. Patient is shifted into the Emergency to Red/Yellow Zone based on his/her triage.
Handover is given by the triage staff to the Zone staff with ISBAR documented by the
triage staff.
12.1.6. IV Cannulation and collection of Investigation as per doctor’s order is done by the
Zone staff in charge of the patient (NOT BY TRIAGE STAFF)
12.1.7. All Red Zone patients will have at least two samples collected after cannulation –
Lavender (EDTA) and Red (Clot Activator)
12.2. Investigations –
12.2.1. Investigation payment slip is given to the patient following which investigations are
sent through the chute
12.2.2. Red Zone patients take precedence over other zones.
12.2.3. ECGs and ABGs of Red Zone are done first and sent first.
12.2.4. Urine collected is sent every half an hour.
12.2.5. In the event of chute block, aides will be responsible for taking the samples of Red
Zone stat to the lab and Yellow Zone patients every one hour.
12.2.6. Following up of investigations shall be the responsibility of the treating doctor and the
nurse in charge of the patient.
12.3. Bed Arrangement
12.3.1. The treating doctor will inform the department concerned and the nurse regarding the
possible bed needed for the patient if planned for admission.
12.3.2. Nurse in charge of the patient will speak to the patient/relatives and plan for
General/Semi/Private bed. If HDU/ICU beds costs will be explained to them.

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12.3.3. Nurse in charge/Treating doctor will speak to the Resident Administrator/Bed

Manager and arrange the required bed for the patient.
12.3.4. IF the patient is to go to ICU, the treating doctor must speak to the ICU
doctor/consultant and arrange a bed for the patient.
12.3.5. Once patient is seen by the admitting department and nature of bed is confirmed,
relatives will be given the advance slip.
12.3.6. The details of payment done are written on Emergency care level form.
12.3.7. Other charges are charged in the final bill.
12.4. Medications:
12.4.1. Medicines and other supplies are used from the Emergency stock for emergencies.
12.4.2. Prescriptions are given for the concerned replacements.
12.5. Discharge:
12.5.1. Discharge order must be confirmed with treating doctor.
12.5.2. Discharge summary to be given for all Priority I and II patients.
12.5.3. Discharge summary to be given regardless of DAMA/LAMA/Referral
12.5.4. Charges for other procedures are written on treatment record.
12.5.5. Replacement of medications is ensured and investigations are handed over to the
relatives/patient.
12.5.6. Follow up information is given to the patient/relatives.
12.6. Inpatient:
12.6.1. The Emergency care level form is attached with the admission papers.
12.6.2. All stat medicines are given in the Emergency.
12.6.3. If possible, replacement is immediately obtained relatives are explained that the
pharmacy bill will be entered in the final bill.
12.6.4. Pharmacy inpatient prescription is entered in the system as credit.
12.7. Delay in admission (when bed is not available immediately)
12.7.1. All possible things are done for the patient in Emergency till the bed is ready (x- ray,
labs, medicine etc.)
12.7.2. The patient is sent to ward after informing the ward sister and after entering admission
details on the computer.
12.7.3. Admission Discharge Time Sheet is filled.

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12.7.4. One doctor and one nurse accompany the ICU admission patient. Ward admission
patients are accompanied by a ward aide/nurse.
12.8. Referral
12.8.1. The concerned consultant is informed about the case.
12.8.2. Registration and procedures are charged.
12.8.3. Bed is arranged for the patient at another hospital of their choice. If not possible then
bed is arranged at any other available hospital.
12.8.4. Referral letter is given and reason for referral is documented in the chart. Name of
doctr/staff of the hospital patient is being sent to is informed to the patient/relative and
documented on the referral letter.
12.8.5. If hospital ambulance is provided, ambulance charges are collected.
12.8.6. If patient is intubated/unstable; one doctor and one nurse accompany the patient.
12.9. Brought dead case:
12.9.1. All brought dead cases are registered and charged for the same.
12.9.2. The doctor and the Pastoral Care staff are informed.
12.9.3. A letter is given on hospital letter head (Not for MLC cases) mentioning the time the
patient was brought dead to Emergency.
12.9.4. Cause of death is not mentioned.
12.9.5. When young patient is brought dead to the Emergency with no obvious cause, the
case is discussed with the consultant and a decision taken whether to inform the police
or not.
12.10. Death certificate:
12.10.1. Death Certificate is not issued for patients brought dead, except for those patients
who have been seen regularly in our hospital.
12.10.2. The original copy of the death certificate is given to the attendant at the time of
handing over the body. The duplicate copy is kept in the patient‘s file.
12.10.3. Death Check list is checked for.
12.10.4. Patients on recent follow- up are issued a death certificate (on request) stating the
known severe illness as a cause of death.
12.10.5. ECG is taken for all brought dead cases to document death.

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12.10.6. If a known patient is brought dead due to an unknown cause, no death certificate is
issued.
12.10.7. The body is handed over, as soon as possible.
12.10.8. If there is any delay in transport, the body is kept in the mortuary.
12.10.9. Charges for the mortuary are made as per the protocol.
12.10.10. Linen is provided to all dead bodies and is charged separately.
12.10.11. Pastoral Care Department staff is called while releasing the body from mortuary.
12.11. Procedure for Death Certificate :
12.11.1. Open SAGE Accpac Doctor’s Desktop and open the M/A Discharge tab and select
Birth/Death Info
12.11.2. Select status as Death and Form 4 or 4a depending on the situation. Form 4 is to be
used for Died in ER and Form 4a in Brought Dead.
12.11.3. Select status of patient – Admitted/Not admitted
12.11.4. Enter hospital number of patient and details entered during registration will appear.
Reconfirm details of name, gender, age, address and other details from a reliable
relative; if possible with ID Proof
12.11.5. If any changes need to be made, send relative to records department.
12.11.6. Enter details of Cause of Death, Immediate cause and antecedent causes and other
significant conditions in the given spaces.
12.11.7. If the patient is brought dead, mention brought dead in the Other significant
conditions column.
12.11.8. Enter time of death based on ECG (Be vary of Date changes)
12.11.9. Select manner of death and enter details of doctor verifying death and relative
details
12.11.10. Recheck details with the relatives of the patient before saving. Inform them that
changes cannot be made after saving.
12.11.11. Save the certificate and print two copies; declaring doctor must sign on both of
them after checking details on the certificate and hand over one copy to the
relatives of the patient.
12.11.12. In the event of any error or print out issues, relatives must be directed to come back
to records department the next working day.

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12.12. Medico Legal Cases(MLC):

12.12.1. Patient is explained about the reason for MLC and MLC charges.
12.12.2. Necessary treatment is initiated.
12.12.3. Police is informed, as soon as possible via the MLC police information memo in
duplicate
12.12.4. Relevant entries are made in the MLC register and police intimation slip in triplicate.
One copy is kept in the patient file, second copy given to the police and the third copy
is kept in the police information book.
12.12.5. MLC outpatients are discharged from Emergency after the police are informed. They
can leave the hospital before the police arrive.
12.12.6. All MLC records and X- rays are not issued to the patient‘s relatives as they are
required for further legal course of action. However if the soft copy of the Xrays are
available for viewing in the VEPRO software, the same after confirmation with the the
attending doctor and consultant may be handed over to the patient and his attenders
12.12.7. When a patient who has been registered as an MLC in another hospital and brought to
the Emergency in a critical condition, the police are informed immediately. After
noting the MLC number.
12.12.8. In case of death, body is not released till the police arrive.
12.12.9. Body is handed over to the police after making relevant entries in the MLC register.
12.12.10. No death certificate is issued for MLC cases.
12.12.11. ECG is taken by Emergency staff, as per the protocol.
12.13. Autoclaving:
12.13.1. Items to be sent to the CSSD are sent by the ward aide.
12.13.2. A CSSD register is maintained.
12.14. Meetings:
12.14.1. Monthly departmental meetings are held.
12.14.2. Minutes of the meeting are entered in the Minutes Register.
12.15. Maintenance
12.15.1. Equipment not working is entered in the Repair Register and is sent to the
Maintenance Department.

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12.15.2. Preventive Maintenance is done as per the schedule. Entries are made in the
Preventive Maintenance Register.
12.16. Inventory:
12.16.1. Annual inventory of equipment/ furniture are taken monthly and entered in the
Inventory Register.
12.16.2. Monthly inventory of linen is taken and entered in the Linen Inventory Register.
12.17. Narcotic drugs:
12.17.1. Narcotic drugs are updated during every shift. Entries are made in the Narcotic
Register.
12.18. Formats to fill in:
12.18.1. The relevant formats of Nursing Division and the Departmental records are filled
in wherever necessary.

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13. FLOWCHART OF PATIENT DEATH IN THE EMERGENCY
Patient passed away in

Emergency
Non MLC MLC
Document series of
Flatline obtained after
CPR form filled and filed events leading to death in
adequate resuscitation as CPR form filled and filed
the Initial assessment
per ACLS protocol
chart
MLC Cases List –

 Assault, Battery, domestic violence, child abuse
Series of events leading to
Death declared to  Road traffic accidents, industrial accidents death documented in the
relatives and guardians  Suspicion of foul play initial assessment chart
 Electrical injuries
 Poisoning
 Burns and scalds
Death certificated filled  Sexual offences MLC memo sent to police
online in Accpac under station and details
form 4a after
 Criminal abortions documented in MLC
confirmation of details  Attempted suicide register
 Unnatural deaths
 Snake bite
 Drug abuse/overdose
Print death certificate two Body shifted to mortuary
copies - One given to  Dowry death and need for Post mortem
patient and one filed in  Dead brought to the Emergency Department; found explained to
chart deads relatives/guardians
 Death within 24hrs of hospitalisation without
diagnosis
 MLC must be made regardless of consent of
Body can be released only
patient if it is deemed appropriate to the police with the
memo
Note : In the event of relatives forcibly attempting to take an MLC Death patient home (Brought
Dead/Died in ER) – Document the same in the Emergency, a letter with the details of the patient and
the case in question shall be submitted to the Hebbala Poilce station as soon as possible intimating
them of the forcible removal of the body. This letter shall be signed by the treating doctor and
information regarding the same shall be conveyed to the HOD – Emergency Medicine Department

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Effective Date :
01/06/18
14. PROTECTION OF CHILDREN FROM SEXUAL OFFENCES ACT(1,2)

14.1. Any child brought to the hospital with a suspected sexual offence associated injury shall be
treated as an MLC. The child will be kept inside the Emergency with a parent/ guardian/
person the child reposes faith and trust in.
14.2. No delay shall be made in initiating treatment for the patient irrespective of financial status.
14.3. The Medicolegal details once collected shall be sent to the Hebbala police station irrespective
of victims desire. The Special Juvenile Police Unit shall also be intimated regarding the same.
14.4. The victim may or may not want to lodge a complaint, but requires medical examination and
treatment. In such cases, the doctor is bound to inform the police as per law. If the victim does
not want to pursue a police case, a medico-legal case (MLC) must be made and an informed
refusal documented.If the victim has reported with a police requisition or wishes to lodge a
complaint later, the information about MLC number and police station must be recorded.
14.5. Neither court nor the police can force the survivor to undergo medical examination without an
informed consent of the child/parent/guardian.

Page: 39 of 41
Effective Date :
01/06/18
15. MEDICAL EVALUATION OF A CHILD SUBJECTED TO SEXUAL ABUSE

15.1. A detailed history shall be taken including the menstrual history and the details of the incident.
15.2. An informed consent must be obtained, which is required for examination, collection of
samples for forensic examination, treatment and police intimation. If the child is >12 years of
age, consent should be sought from the child. For those <12 years, a parent or the guardian is
required to providing it. Such consent should be informed and the person providing the
consent should be clearly explained the purpose, risks, benefits and any adverse effects of the
examination, and the amount of time it will take. Consent should be taken before the
examination is conducted.
15.3. Doctors are legally bound to examine and provide treatment to survivors of sexual violence.
Timely reporting, documentation and collection of forensic evidence are important toward
investigation of the crime. Police personnel should not be present during any part of the
examination. Clothing of the victim must be preserved as forensic evidence.
15.4. Where the victim is a girl, the medical examination has to be conducted by a woman doctor in
the presence of the parent of the child or any other person in whom the child reposes trust or
confidence. If such a person cannot be present, the examination is conducted in the presence
of a woman.
15.5. CSA, whether confirmed or strongly suspected, must be reported to the appropriate
authorities. Detailed, well-documented medical records must be kept, since these are crucial in
legal proceedings, which may take place after a lapse of long periods.
15.6. CHILDLINE 1098: This is an emergency telephonic helpline, which can link children in
situations of abuse and neglect with sociolegal services. It is operational in more than 400
cities and districts across the India. Medical professionals and others should be aware of this
telephone helpline, and call it to refer cases of known or suspected child abuse or neglect.
Clinics and hospitals should prominently display this telephone number (1098). While making
the mandatory report, the doctor or other health professional should describe the nature of the
abuse and all involved parties. The doctor/reporter is not expected to investigate the matter, or
even know the identity of the perpetrator, which is left to the police and investigative agencies.
15.7. The POCSO Act envisages a multidisciplinary approach that will be conducive to medical
care and justice delivery for a sexually abused child. This can be achieved through
coordination and convergence between all key stakeholders such as Juvenile Police Units,

Page: 40 of 41
Effective Date :
01/06/18
Child Welfare Committees, District Child Protection Units, health professionals, mental health
professionals including psychiatrist, psychologist and counsellors, child developmental
experts, medical social workers, advocates, magistrates and members of legal profession.

Page: 41 of 41
Effective Date :
01/06/18
16. SOP FOR IDENTIFICATION OF PATIENT IN EMERGENCY

16.1. Patients will be identified with 2 identifiers.
16.2. All patients for admission will be put an identification band.
16.3. Patients treated as out patients in Emergency, will be identified by their name and the registration
card they have.

Emergency

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BANGALORE BAPTIST HOSPITAL

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

2. TRIAGE OF ADULT & PEADIATRIC PATIENTS

Reviewed & issued by: Division Head Approved by: Director(CEO)

3.4. Activation of contingency plan to externaldisaster –

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

7. Canteen services (F and B) 415/383

Reviewed & issued by: Division Head Approved by: Director(CEO)

iii. Drivers – maintenance building

Reviewed & issued by: Division Head Approved by: Director(CEO)

3.5.6. Disaster Management Kit

The list of medicines in the disaster management kit is as follows

Reviewed & issued by: Division Head Approved by: Director(CEO)

35. Adrenaline 10 amps

3.6. Medical Teams –

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

d. Ensure medical boxes of supplies and emergency equipment is ready.

Reviewed & issued by: Division Head Approved by: Director(CEO)

e. Press personnel with identification to be directed to health plan lounge

Reviewed & issued by: Division Head Approved by: Director(CEO)

3.7.17. Training of Staff and Periodic Checks

Reviewed & issued by: Division Head Approved by: Director(CEO)

4. GUIDELINES FOR INTER HOSPITAL TRANSFER OF PATIENT

Reviewed & issued by: Division Head Approved by: Director(CEO)

competent patient or the legally authorized representative of an incompetent patient give

Reviewed & issued by: Division Head Approved by: Director(CEO)

4.9.5. Adequate power and gases for life support systems

Reviewed & issued by: Division Head Approved by: Director(CEO)

4.10.5. Accompanying personnel

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

5. GUIDELINES FOR INTRA HOSPITAL TRANSFER OF STABLE PATIENT

Reviewed & issued by: Division Head Approved by: Director(CEO)

5.5.8. Vulnerable patient

Reviewed & issued by: Division Head Approved by: Director(CEO)

6. TRANSFER OF CRITICALLY ILL PATIENTS

Reviewed & issued by: Division Head Approved by: Director(CEO)

7. PROTOCOL FOR ADMISSION HIGH RISK PATIENTS THROUGH

Triage II Triage I Triage III

Medical resident/Consultant takes decision to admit &

Communicate to patient regarding

Bed Not Available Bed Available In-case of availability of bed

Staff Nurse: Telephonically inform MRD

8. GUIDELINES FOR HANDLING BROUGHT DEAD CASES

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

9. GUIDELINES FOR HANDLING THE UNKNOWN PATIENT –

Unknown patient presents

All Unknown patients

Search patient for

Admit patient under the

Relatives not Reachable -

If police want to shift Make plan to admit in

Reviewed & issued by: Division Head Approved by: Director(CEO)

10. BREAKING BAD NEWS

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

11. SOP FOR HANDING OVER