Haramaya General Hospital Emergency Care Assessment Tool Date Signal Function Perform at all times? Respiratory Failure I. Obstructed airwayCan your facility manage an obstructed airway? Manual manoeuvres Relief of obstruction 4 4 5 IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes Includes head tilt, chin lift, jaw thrust 1 prep by Harif A(M.Sc) Use of suction Surgical airway II. Respiratory Distress - Can your facility manage a patient in respiratory distress? Signal Function Rescue breathing Three-way dressing Insertion of oral airway Bag valve mask ventilation Supraglottic device placement Administer critical therapeutics for reactive airway 6 disease Oxygen administration Endotracheal intubation Cricothyrotomy 5 6 □ □ □ No Yes No □ Yes □ No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. Perform at all times? □ □ □ □ □ □ □ □ □ □ □ □ Yes No Yes No Yes No Yes No Yes No Yes No □ □ □ □ □ Yes No Yes No Yes IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments Includes abdominal thrusts if conscious, CPR if unconscious, chest thrusts and back blows for infant E.g. any bronchodilators, adrenaline, steroids 2 prep by Harif A(M.Sc) Non-invasive mechanical ventilation Invasive mechanical ventilation □ □ □ □ □ No Yes No Yes No Shock Signal Function Perform at all times? I. Haemorrhagic Shock - Can your facility manage a haemorrhagic shock? □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. Physical manoeuvers for control of 7 haemorrhage Arterial tourniquet Pelvic wrapping Packing and suturing for control of haemorrhage Peripheral percutaneous intravenous access Intraosseus access Venous cutdown 7 □ □ Yes No □ □ □ □ □ □ Yes No Yes No Yes No □ □ Yes No □ □ □ □ Yes No Yes No IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments Direct pressure, pressure bandage, pressure points 3 prep by Harif A(M.Sc) Pathogen screened blood transfusion Signal Function Central venous access II. Other Shock - Can your facility manage other shock? ECG interpretation External defibrillation Needle decompressio of tension pneumothorax Administration of adrenaline (for anaphylactic shock) Administration of IV medications that require advance 8 monitoring Cardioversion Pericardiocentesis Signal Function 8 □ Yes □ No Perform at all times? □ □ IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments IF Policies Human HCW Supplies Infrastructure No Other/Comments Yes No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ □ □ □ □ □ Yes No Yes No Yes No □ Yes - If yes, circle one: IM IV □ No □ Yes - If yes, circle one: IM IV □ No □ Yes □ No □ Yes □ No Perform at all E.g. vasopressors, thrombolytics 4 prep by Harif A(M.Sc) times? III. Severe Sepsis/Septic Shock Can your facility manage severe sepsis/septic shock? Administration of isotonic IV fluids Administration of IV antibiotics and/or antimalarials Altered Mental Status I. Unconscious Patient - Can your facility manage an unconscious patient? Protect from 9 secondary injury Check and/or administer glucose if required. Administer insulin for hyperglycemia Signal Function Perform head CT NOT, WHY? Resources training equipment medication Human Resources HCW training Supplies equipment medication indication □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes - If yes, circle one: PO IM IV □ No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes □ No □ Yes □ No Perform at all times? □ IF NOT, WHY? Policies Infrastructure No indication Other/Comments Yes 9 Specifically, is there adequate personnel/infrastructure to monitor blood pressure and avoid hypotension, avoid hyperthermia and cooling if necessary, avoidance of hypoxia, NGT to reduce aspiration risk) 5 prep by Harif A(M.Sc) Perform lumbar puncture II. Seizure - Can your facility manage seizures? Administer benzodiazepine Administration of parenteral magnesium sulphate for pregnant patient Administer locally appropriate antidote 10 for toxic cause III. Other - Can your facility manage other altered mental status conditions? Administer mental status examination Signal Function Management of extremes of temperature 10 □ □ □ No Yes No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes - If yes, circle one: PO IM IV □ No □ □ Yes No □ □ Yes No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No Perform at all times? □ □ IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments Yes No E.g. antivenom 6 prep by Harif A(M.Sc) Severe Pain I. General Severe PainCan your facility manage patients in severe pain? Administer opiate based analgesia II. Abdominal Pain Can your facility manage abdominal pain? Urine dipstick/HCG Oral hydration Placement of Foley catheter for urinary outlet obstruction Therapeutic paracentesis Ultrasound Signal Function III. Chest Pain - Can your facility manage chest pain? Administration of □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No Perform at all times? IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes 7 prep by Harif A(M.Sc) aspirin if ACS likely Chest x-ray Trauma I. General Trauma Can your facility manage general trauma? Trauma protocol implementation Initial appropriate 11 wound care Basic immobilization for fracture Reduction of fracture Cervical spine immobilization Signal Function Tetanus vaccine & IVIG as indicated Antibiotics for open fracture (PO/IM vs IV) Fasciotomy for compartment syndrome Rabies IVIG/ 11 □ □ □ No Yes No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No Perform at all times? IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments □ Yes □ No □ Yes - If yes, circle one: PO IM IV □ No □ Yes □ No □ Yes irrigate with potable water or sterile solution, surgically close clean acute wounds, dress, infection control as needed 8 prep by Harif A(M.Sc) vaccination as appropriate Access to general definitive surgical services Access to orthopaedic surgical services Access to neurosurgical services Chest tube insertion Thoracotomy Autotransfusion from chest tubes II. Burns - Can your facility manage burns? Signal Function Cooling care Escharatomy □ No □ □ Yes No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes - If yes, answer questions below. □ No - If no, please indicate why not. Perform at all times? □ □ □ □ IF NOT, WHY? Policies Human Resources HCW training Supplies equipment medication Infrastructure No indication Other/Comments Yes No Yes No Maternal Health I. Obstructive Labour - Can your facility manage obstructive laboury? □ Yes - If yes, answer questions below. □ No - If no, please 9 prep by Harif A(M.Sc) Administer uterotonic drugs (i.e. parenteral oxytocin) Perform assisted vaginal delivery Perform newborn resuscitation (e.g. with bag and mask) Access to surgical services (e.g. caesarean section) indicate why not. □ Yes □ No □ Yes - If yes, circle one: Routine Vacuum extraction forceps □ No □ Yes □ No □ □ Yes No 10 prep by Harif A(M.Sc)