Provision of necessary medical care

Tasks (measures)

Imple-menters

Action

Time

Comments and documentation

1. Screening of patients in need of necessary medical care (first aid and emergency care) at the reception

REG

Urgently notifies the D about the patient’s arrival based on the profile of care required, if necessary, calls the on-call D, and, where necessary, accompanies them to the doctor’s or treatment room.

Without delay* following the patient’s arrival

ID documents

(if any);

F 025/a

F 025/a-LK

2. Booking an appointment for the patient to see a doctor at the reception of the Polyclinic and starting MD

REG

If the patient is registered with the Polyclinic, verifies documents and records on a computer database.

If the patient is not registered with the Polyclinic, completes a temporary medical record.

Without delay* following the patient’s arrival

3. Seeing the patient in a room. Initial examination and preliminary diagnosis

On-call or family D

Examines the patient and assesses their condition:

If necessary because of the patient’s health condition, N calls consultant Ds or an ambulance to take the patient to the hospital.

Performs urgent tests to clarify the diagnosis, makes a preliminary diagnosis and, if necessary, makes arrangements for specialist consultations or hospitalisation, as well as gives instructions to the N.

15 mins from receiving information

4. Drawing up a test and treatment

plan

D with N

Prescribe treatment, additional necessary tests and consultations and book repeat appointments.

Without delay* following

initial examination and preliminary diagnosis

made

5. Implementing prescriptions

N

Implements D’s prescriptions, informs the D/DM about any issues

Records nursing procedures and nursing actions in the medical record

Without delay*,

based on the deadline provided by the D in the medical record.

N

Transports the patient to the specified unit along with their medical record. After performing the actions prescribed to the patient, returns them to the room.

Without delay*,

based on the D’s instruction

Emergency medical care category

Time to start the provision of care

Acute clinical conditions or indications for emergency medical care to be provided

1

2

3

Category 1

(immediate)

Immediately, with the patient’s condition being assessed and treatment actions performed simultaneously.

1. Obstructed airways (complete airway obstruction).

2. Respiratory arrest or gasping for breathing (agonal breathing).

3. Ongoing very heavy bleeding.

4. Cardiopulmonary insufficiency.

5. Shock.

6. Ongoing convulsive seizure.

7. Impaired consciousness with complete unresponsiveness to voice and pain.

8. Acute chemical eye injury.

Category 2

(very urgent)

Emergency medical care must be started for the patient no later than within 10 minutes from their arrival at a health care institution.

1. Very severe / unbearable (9-10 points) pain.

2. Heavy bleeding that has not been stopped.

3. Impaired consciousness (responds only either to voice or pain, or responds abnormally).

4. During clinical evaluation, the skin is felt very hot and/or the measured body surface temperature for a child up to 6 months of age is 38.5^oC or above, for a child aged 6 months to 18 years, 40^oC or above.

5. During clinical evaluation, the skin is felt cold and/or the core body temperature (measured in the oesophagus or rectum) is below 35^oC.

6. Very low SpO2 (< 92% breathing ambient air or < 95% with oxygen therapy prescribed).

7. Allergy or bite (sting) with Quincke-type oedema and/or a history of anaphylactic reaction, and/or tongue/facial oedema.

8. Acute shortness of breath (increased work of respiratory muscles, unable to speak in sentences, stridor, salivation).

9. Inhalation injury to the respiratory tract.

10. Bite of a venomous animal.

11. Acute sensory and motor disorders.

12. Meningeal symptoms or meningism.

13. Acute haemorrhagic rash.

14. Local infection of tissues with emphysema or vascular damage.

15. Vomiting blood or bowel movements with fresh or altered blood.

16. Diabetes mellitus with hyperglycaemia and ketoacidosis.

17. Severe injury.

18. Pathology of the limbs with a circulatory disorder.

19. Penetrating eye injury or acute complete loss of vision.

20. Vaginal bleeding (of any intensity) with the pregnancy of over 20 weeks.

21. Poisoning (or suspected poisoning) with hazardous or very hazardous substances, overdose of medicines.

22. Mental illness or behavioural disorder with a high risk of self-harm and/or harm to others, history of self-harm, characteristic active actions to harm oneself or a desire to escape in order to self-harm.

23. A known congenital or acquired immunosuppressive condition coupled with a suspected infectious disease.

24. Acute chemical burn.

25. If a patient is suspected of being infected with a particularly dangerous infection, the patient must be isolated.

Category 3

(urgent)

Emergency medical care must be started for the patient no later than within 30 minutes from their arrival at a health care institution.

1.     1. Severe pain (6-8 points).

2.     2. Minor bleeding that has not been stopped.

3.     3. A history of loss of consciousness and/or seizures over the past 24 hours.

4. During the clinical evaluation, the skin of a child aged 6 months to 18 years is felt is very hot and/or the measured body surface temperature is 38.5^oC or above.

4.     5. Unclear medical history: the findings do not match the details in the medical history or there is suspected violence against or mistreatment of the child.

5.     6. Low SpO₂ (< 95% breathing ambient air).

6.     7. Sudden vision impairment.

7.     8. Allergy or bite (sting) with a spread rash or blisters that have appeared over the past 24 hours.

9. Poisoning with an average risk of self-harm (the desire to self-harm is declarative).

8.     10. Mental illness or behavioural disorder with a clear medical mental history and/or a moderate risk of self-harm (the desire to self-harm is declarative) and/or the risk of inflicting harm on others.

11. Any injury coupled with congenital or acquired disorders of the coagulation system.

Category 4

(standard)

Emergency medical care must be started for the patient no later than within 60 minutes from their arrival at a health care institution.

1. Moderate pain (4-5 points).

2. Children under 8 years of age with a potential risk of serious complications because of their medical history (a chronic illness or previous life-threatening events or illnesses) and clinical signs (changed behaviour or state of consciousness, respiratory or circulatory disorders, impaired fluid intake or diuresis, raised body temperature and rash).

3. Fever of >38^oC in children persisting with antipyretic medicines taken for more than 24 hours.

4. Acute dehydration.

5. Inhalation of toxic fumes.

6. Other injuries (not listed in categories 2 and 3) and accidents over the past 48 hours with increasing swelling/increasing dysfunction.

7. Bites of rabid or potentially rabid animals/scratches with saliva spread.

8. Tick bite.

9. Suppuration of maxillofacial area.

10. Disorders of artificial stomas (where bags need to be changed or flushed out).

11. Complications after medical intervention (torn suture, purulent discharge, increasing swelling, insufficient immobilisation) that have occurred up to 48 hours after the treatment or discharge from an inpatient health care institution.

12. Foreign bodies (existing or suspected) in tissues or natural body openings/body cavities that have occurred over the past 48 hours.

Emergency medical care category

Time to start the provision of care

Acute clinical conditions or indications for emergency medical care to be provided

1

2

3

Category 1

Immediately, with the patient’s condition being assessed and treatment actions performed simultaneously.

1. Existing or imminent cardiac and/or respiratory arrest. Patient after resuscitation.

2. Respiratory rate (RR) is < 10 times a minute

RR is >29 times a minute.

3. Systolic arterial blood pressure (hereinafter the SABP) is < 80 mmHg.

4. Loss of consciousness and unresponsiveness to pain or reaction of < 9 points on the Glasgow Coma Scale (hereinafter the GCS).

5. Convulsions of the whole body.

6. Intravenous medicine or drug overdose that caused hypoventilation and hemodynamic impairment.

7. Acute chemical eye injury.

Category 2

Emergency medical care must be started for the patient no later than within 10 minutes from their arrival at a health care institution.

1. Acute, life-threatening respiratory and/or circulatory disorder.

2. Acute loss of large amount of blood (25% or more of circulating blood).

3. Very severe/unbearable pain for various reasons, where the intensity of pain is rated 9-10 points on a ten-point scale.

4. Hypoglycaemia or hyperglycaemia with a risk of developing a hypoglycaemic coma, diabetic ketoacidosis or hyperosmolar hyperglycaemia.

5. Fever with clinical signs of sepsis (at least two of the following signs: RR is > 22 times per minute, SABP is < 100mmhg, impaired consciousness of any level). Total body cooling with the temperature of < 36^oC.

6. Severe injury.

7. High risk medical history:

7.1. consumption of large amounts of sedatives or consumption of toxic substances of other origin;

7.2. other life-threatening poisoning;

7.3. life-threatening exposure to environmental factors (generalised allergic reaction).

8. Mental and behavioural disorders:

8.1. aggression or violence that threaten the patient and others;

8.2. intense psychomotor agitation, where a physical restraint of an individual’s freedom is required due to a threat to themselves or others.

Category 3

Emergency medical care must be started for the patient no later than within 30 minutes from their arrival at a health care institution.

1. Hypertensive crisis with rapidly progressing signs of cardiovascular and/or central nervous system damage.

2. Moderate bleeding with clinical signs present for any reason.

3. Somnolence/slow response for any reason (< 13 points on the GCS).

4. Oxygenation < 90 percent.

5. Recurrent seizures recorded over the past 12 hours.

6. Recurrent vomiting and/or diarrhoea with systemic intoxication.

7. Acute dehydration.

8. Head injury and short-term loss of consciousness.

9. Severe pain rated 6-8 points on a ten-point scale where urgent pain relief is required.

10. Acute focal neurological symptomatology.

11. Limb injury that led to impaired blood circulation.

12. Mental and behavioural disorders:

12.1. attempted suicide or threat of such an act;

12.2. acute psychosis;

12.3. severe psychological trauma that causes behavioural disorders;

12.4. severe depression;

12.5. pronounced psychomotor agitation.

13. Penetrating eye injury or acute complete loss of vision.

Category 4

Emergency medical care must be started for the patient no later than within 60 minutes from their arrival at a health care institution.

1. Fever of > 39^oC, persisting with oral medicines taken for more than 24 hours.

2. Acute cardiac arrhythmias (supraventricular tachycardia, atrial fibrillation, atrial flutter, broad complex tachycardia) or conduction disorders (2^nd-3^rd degree AV block, atrioventricular rhythm) occurring over the past 48 hours.

3. Urinary retention, anuria, complications in a patient on dialysis: A-V shunt thrombosis, fall/thrombosis/dysfunction of a dialysis catheter.

4. Severe withdrawal condition that is likely to result in complications due to risk factors (history of psychosis, seizures; may result in complications due to intercurrent acute and chronic diseases; compulsive craving for psychoactive substances).

5. Bites, scratches and saliva spread by rabid or potentially rabid animals.

6. Other injuries (not listed in categories 2 and 3) and occurring accidents over the past 48 hours with increasing swelling/increasing dysfunction.

7. Tick bite.

8. Suppuration of maxillofacial area.

9. Disorders of artificial stomas (where bags need to be changed or flushed out).

10. Light vaginal bleeding or abdominal pain during pregnancy.

11. Complications after medical intervention (torn suture, purulent discharge, increasing swelling, insufficient immobilisation) that have occurred within up to 48 hours after the treatment or discharge from an inpatient health care institution.

12. Foreign bodies in tissues or natural body openings/body cavities that have occurred over the past 48 hours.