A New Vision On European Emergency Departments The Resuscitation Room

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A new vision on European Emergency Departments : The Resuscitation Room P. Gayol*, N. Flacke-Vordos, A. Trinh-Duc, J. Fogelman, C. Lebaupin, P. Espinoza, V. Jauriac, P. Aillres, D. Coppin, D. Calmes-Coppin * Emergency Department. Strasbourg University Hospital (Nouvel Hpital Civil). FranceAncient European Affairs Committee of the French Society of Emergency Medicine (SFMU) Pertinent DisclosuresFinancial support (partially) * BMS UPSANo consultants No personal gainINTRODUCTION IDefinitionDespite the fact that vital emergencies represent a minority of patients in the ED ( 5 % ), they require an organizational strategy of human and material resourcesAmong its specific areas, the Resuscitation Room (RR) is a key area of an emergency departmentAdmission area which usually contains several individual resuscitation bays (or several beds in a bay) fully equipped for patients with a real or potential vital distress : In fact, unstable patients and those with an impairment of vital functionsINTRODUCTION IITRADITIONAL TERMS Resuscitation Room (anglo-saxon world)S.A.U.V. or salle de Dchocage (France)Box ra or Box Dchoc (Belgium)Sala de reanimacion (Spain)Sala de emergencia or sala de reanimaao or sala de ressuscitaao (Portugal)Schock raum (Germany)INTRODUCTION IIIIn France (February 2003) :Emergency department policy : Implementation and management of the resuscitation room*[Recommandations concernant la mise en place, la gestion, lutilisation et lvaluation dune Salle dAccueil des Urgences Vitales (S.A.U.V.)] *Societ Francophone de Mdecine dUrgence, 2003 (www.sfmu.org)INTRODUCTION IVEmergency department policy (France, 2003)Admission area for patients with real or potential vital emergenciesOpen 24 Hours a day, with free bed as soon as possibleAt least 2 bays (or beds) if ED > 15000 patients per yearNo bed for critical care or normal care patients For medical and surgical admissionsA senior emergency physician in charge of the RR With admission criteria (scores) Equipped for respiratory or CV resuscitation With treatment protocols for most frequent illnessesEasy access to Lab and Radiology REPORT BACKGROUNDThe ancient European Committee of the French Society of Emergency Medicine has visited 18 Emergency Departments (ED) in 7 European countries between 2003 and 2006 It mission was : to create a number of contacts to emergency professionals in Europe with focus on physicians and nurses in ED, and to know their organisation for the management of emergency patients 7 COUNTRIESLISBONMADRIDLONDONBRUSSELSBERLINWARSAWHELSINKIMETHODS IThe Committee formed delegations to visit 1 to 3 ED in the following capital cities: Berlin (3) Lisbon (3) Brussels (3) London (3) Helsinki (1) Madrid (3) and Warsaw (2)Country selectionA questionnaire was designed and presented to the physician in charge of the ED Answers are taken jointly from the medical and paramedical staff, and questionnaire completed by the delegation on the spot METHODS IIAims : To describe Resuscitation Rooms of these 18 European ED The questions are derived from french recommendations in Emergency department policy about the RR, published in 2003 QUESTIONS CONCERNING THE RRDoes EDRR exist ? (autonomous ED ?) Location (easy access ?) Hours of service and number of bays (or beds in a bay)Physician in charge of the RR (decision on admission)The patients stay time Indications and treatment protocolsPatient types (medical, surgical and/or trauma) Requirement as intensive or normal care bay End-of-life patient admissions Respiratory and cardiovascular resuscitation equipmentIMV and/or NIMV employmentWith ED nurses (number ? ; what kind of diplma ?) METHODS IIIRESULTS I18 ED visited (number of patients/year)Berlin : 20000 / 42000 / 45000 (107000) Brussels : 25000 / 32000 / 37000 (94000)Helsinki : 33000Lisbon : 91000 / 164000 / 200000 (455000)London 44000 / 80000 / 100000 (224000)Madrid : 164000 / 188000 / 219000 (571000)Warsaw : 20000 / 57000 (77000)TOTAL : 1061000 european patientsRESULTS IICOMMUN POINTS (I)RR always existed and was embedded in ED (18/18), autonomous ED (14/18)Acc