TRAUMA AND EMERGENCY

1. All clinics provide trauma and emergency services.

2. Reduce intentional and unintentional injuries among adolescents, including teenage suicide. (National Year 2000 Goals, Objectives and Indicators.)

3. Increase the proportion of emergency health staff who has basic ambulance assistance qualifications, and who are able to provide emergency care to victims of poisoning, injuries and maternal emergencies. (National Year 2000 Goals, Objectives and Indicators.)

STANDARDS

1.1 Wits University PHC Training Manual for Trauma.
1.2 Primary Health Care Manual of the Essential Drugs Programme.
1.3 The South African Medicines Formulary.
1.4 Any local protocols as decided by the medical directorate of clinic services.

2.1 There is an "Emergency Box", containing those items which are needed in an emergency, and a system in place for replenishing it when it has been used.
2.2 The following equipment is kept available:

2.2.1 Clean, preferably sterile, instruments for suturing, with adequate replacements or a sterilising system.
2.2.2 Suture materials
2.2.3 Equipment and IV solutions according to the Essential Drug List.
2.2.4 Stretchers, with or without wheeled trolley.
2.2.5 Crutches.
2.2.6 Wheeled chair.
2.2.7 Body bags / shrouds for dead bodies.

NOTE: Even where skills are not routinely available it is still worth having emergency equipment that can be used by visiting staff.

3.1 The following drugs should be kept, as part of an "emergency box" according to EDL

4.1 A clinic has staff capable of dealing with any anticipated trauma in a safe and effective way and to stabilize and refer patients as appropraite.
4.2 Staff have skills to identify the nature of injury, and decide on the management needed and its urgency.
4.3 Assess the significance of possible poisoning and institute appropriate counter-measures
4.4 Understand the psychological implications of attempted suicide and ability to render effective immediate care.

5.1 Staff have a clear understanding of:

5.1.1 Indications for transfer and degrees of urgency, as outlined in local policy.
5.1.2 The mechanism of transfer and the immediate referal channel.
5.1.3 The management of seriously ill patient during transfer.
5.1.4 The management of less severe injuries without transfer.

5.2 A reliable means of communication and transport is available when required.

6.1 A mechanism is in place at District level to identify the significant causes of trauma locally.
6.2 Staff identify possible interventions that might be made, involving the community in discussion of implementation and education both in schools and communities.
6.3 The consultation in the clinic is used as an opportunity for talking about prevention and first aid of burns.

7.1 A reliable patient-held record system is available.
7.2 Data is routinely recorded and used to anticipate and prepare for disasters

8.1

9.1 The clinic staff collaborate with the Police and Social Welfare Departments.
9.2 The clinic have clear guidelines on referral and support from the District Hospital and Ambulance Service.