Emergency Departments and Pre-Hospital Care

Emergency care is delivered in two closely linked working environments: pre-hospital care, where the patient is first assessed and supported outside the facility, and the emergency department (ED), where the patient is triaged, resuscitated, investigated and prepared for definitive care. The handover between them is a high-risk moment and must be organised.

• Describe the purpose, layout and functions of an emergency department.
• Explain the sequence and principles of pre-hospital care.
• Compare EMT responsibilities in both environments.
• Give a safe structured handover from ambulance to emergency-unit team.

An emergency department (also called casualty, accident and emergency, emergency unit or emergency centre) is a facility area designed to receive and manage patients with acute illness or injury at any hour or at short notice. Its purpose is not simply to see patients quickly. It identifies life threats, prioritises urgency, starts resuscitation, makes early diagnoses, relieves pain, initiates treatment and decides the safest destination.

• Reception/triage area: first contact, registration after immediate clinical priorities, initial observations and triage category.
• Resuscitation area: high-acuity monitored space with airway, suction, oxygen, emergency drugs, defibrillator and rapid team access.
• Assessment/treatment cubicles: focused examination, treatment and privacy for stable or moderately unwell patients.
• Observation area: short-term monitoring and repeated assessment while diagnosis or response to treatment becomes clear.
• Procedure, isolation or decontamination areas: used according to infection risks, hazardous exposure and local layout.
• Support services: laboratory, imaging, blood bank, pharmacy, theatre, security, cleaning and portering—essential partners, not optional extras.

Triage is a rapid clinical sorting process. It is not a full diagnosis and it is not “first come, first served.” The triage provider identifies immediate threats and assigns a priority level according to local protocol. A patient may need re-triage because illness can worsen while waiting.

Pre-hospital care is care given before the patient reaches a health facility. It includes dispatch advice, first responders, EMT/ambulance services, rescue, on-scene assessment, treatment, safe packaging, transport, monitoring and communication with the receiving facility. It may occur on a road, home, school, workplace, market, health centre or remote community.

1. Prepare and respond: receive information, check PPE/equipment, consider hazards, plan the route and request appropriate support.
2. Scene size-up: identify danger, number of patients, mechanism of injury/nature of illness, need for additional resources and safest access/exit.
3. Primary assessment and immediate treatment: use ABCDE; control catastrophic bleeding before or during airway care when appropriate.
4. Decide priority and destination: identify whether the patient needs rapid transport, specialist care, rescue support or a lower-acuity pathway.
5. Focused history and secondary assessment: when life threats are addressed, obtain SAMPLE history and examine from head to toe or by system.
6. Package and transport: position, immobilise or splint when indicated; maintain warmth, privacy and monitoring; secure equipment and patient.
7. Reassess and communicate: repeat observations, watch trends, notify the receiving facility and adjust care if condition changes.
8. Handover, document and restock: transfer responsibility safely, complete records, clean/decontaminate and restore readiness.

Before touching the patient, ask: Is it safe for me, my partner, the patient and bystanders? Look for traffic, unstable vehicles, fire, electricity, violence, weapons, crowds, chemicals, smoke, animals, infection hazards and unsafe structures. Use PPE. If the scene is unsafe, withdraw, request police/fire/rescue support and work from a safe position.

The emergency department should know about a critically ill patient before arrival whenever communication is available. Early notification allows the ED to prepare a resuscitation bay, blood, theatre, security, isolation or specialist team. On arrival, the EMT gives a concise handover and remains available for questions until responsibility is clearly accepted.

• M – Mechanism/Medical complaint: “Motorcycle collision, hit by vehicle 25 minutes ago.”
• I – Injuries/Information: “Open left femur injury; no obvious chest injury; no known medical history.”
• S – Signs: “Initially confused; pulse 128, BP 88/56, respiratory rate 28, SpO₂ 93% on oxygen.”
• T – Treatment: “Direct pressure and tourniquet/haemostatic method as indicated, splint applied, oxygen, warming, two reassessments; no deterioration during transfer.”

Include time of onset/injury, allergies, medicines, pregnancy possibility where relevant, response to treatment and any safeguarding/safety concerns. Do not use vague statements such as “patient is bad”; give observations and trends.

• The ED triages, resuscitates, investigates, stabilises and decides disposition.
• Pre-hospital care begins with safety and continues through transport and handover.
• ABCDE, repeated observations and early communication are essential in both settings.
• A high-quality handover protects the patient from lost information and duplicated or delayed treatment.

1. State six core functions of an emergency department.
2. Explain why triage is not first come, first served.
3. List the eight steps of safe pre-hospital care.
4. Give five hazards to identify during scene size-up.
5. Use MIST to hand over a patient with severe asthma.

Study sources: WHO Emergency Care Toolkit; WHO Prehospital Emergency Care Operational Guidance; Uganda Ministry of Health EMS policy documents.

An Emergency Medical Technician (EMT) is a trained pre-hospital care provider who assesses, treats, monitors and transports people with illness or injury within an authorised scope of practice. The EMT links the community, emergency response and receiving health facility.

• Describe the core role of an EMT.
• Explain clinical, safety, communication and professional responsibilities.
• Apply EMT responsibilities to scene care, transport and handover.

1. The EMT's Role
2. Core Responsibilities
3. Patient-care Workflow
4. Professional Conduct
5. Exam Focus

The EMT is not simply a driver or a person who carries patients. The EMT brings organised emergency care to the patient, identifies immediate threats, starts indicated treatment, decides on safe transport and communicates essential information to the receiving team. The exact procedures permitted depend on national policy, service protocols, training level, equipment and medical direction.

Before approaching, the EMT assesses traffic, fire, electricity, violence, unstable structures, hazardous materials, crowds and infection risk. Use personal protective equipment and request police, fire, rescue or additional clinical resources when needed. A rescuer who becomes injured cannot help the patient.

Use a systematic primary assessment such as ABCDE: airway, breathing, circulation, disability and exposure. Treat life-threatening problems first. A focused history, vital signs and secondary assessment follow when the patient is stable enough. Identify patients needing urgent transport and a specific facility.

Responsibilities include protocol-authorised care such as airway positioning, ventilation support, oxygen where indicated, bleeding control, shock management, glucose assessment, seizure protection, splinting, positioning and medicine administration only when trained and permitted. Never perform a procedure merely because it is requested or has been seen elsewhere.

Select safe lifting methods and equipment, protect the patient from falls, use stretcher straps and consider trauma, pregnancy and respiratory needs. During transport, reassess vital signs, continue treatment, record changes and balance speed with road safety.

Clear communication prevents dangerous delay. Report location and resource needs, explain care calmly to patients and relatives, alert a receiving facility for critical patients and give concise handover. ATMIST or SBAR can include the problem, history or mechanism, assessment, vital signs, treatment, response and concerns.

Every case record should include times, findings, vital signs, treatment, response, destination and handover. Before and after each shift, check vehicle safety, oxygen, suction, monitoring equipment, PPE, medicines, consumables, communication devices and stretcher function. Report defects and stock gaps promptly.

1. Receive information and prepare the correct equipment.
2. Approach only when the scene is safe.
3. Identify and treat immediate life threats using ABCDE.
4. Gather focused history and repeat vital signs.
5. Decide destination and request additional help or early facility notification.
6. Move and secure the patient safely.
7. Continue care, reassessment and documentation during transport.
8. Give structured handover and restock or report after the case.

An EMT team reaches a rider after a collision. Traffic is active and a crowd is gathering. The team first establishes a safe working area, uses PPE and requests traffic control. The patient has major leg bleeding and is confused. The EMT controls bleeding, assesses airway and breathing, checks circulation and consciousness, prepares the patient for safe transfer, communicates with the receiving facility and reassesses throughout transport. On arrival, the crew provides a structured handover.

• Work within training, scope of practice and service protocols.
• Respect patient dignity, privacy, culture and confidentiality.
• Seek consent when possible; act in the patient's best interests when emergency incapacity applies under authorised practice.
• Remain calm, honest and respectful; never promise outcomes that cannot be guaranteed.
• Do not abandon a patient after taking responsibility unless care is transferred appropriately.
• Avoid discrimination, unsafe driving and careless social-media use.
• Participate in debriefing, skills updates and quality-improvement review.

The EMT must recognise when a patient needs a higher level of care, more resources or medical consultation. Good practice includes requesting help early, communicating limitations, choosing an appropriate destination and documenting decisions. Working beyond scope or improvising unsafe care can harm the patient and the team.

• An EMT is a pre-hospital clinician, not only a transport worker.
• Scene safety comes before patient contact.
• ABCDE guides management of immediate life threats.
• Care continues during transport and ends after a safe handover.
• Scope, protocol, documentation and confidentiality are professional duties.

1. List six responsibilities of an EMT at an emergency scene.
2. Explain why care in transit is an EMT responsibility.
3. Describe a structured clinical handover.
4. State four professional limits or ethical duties of an EMT.
5. Apply the EMT workflow to a road traffic crash.

• WHO Emergency Care Toolkit
• Uganda Ministry of Health: National Emergency Medical Services Policy