ORGANIZATION OF THE

EMERGENCY SERVICES
DR. LUIS CUROTTO
PALOMINO
 Improve the quality of care provided to
PURPOSE patients in the emergency services of public
and private establishments in the Health
Sector.

Establish technical-administrative standards for

patient care in emergency services.
AIM
GENERAL

• Provide health care in emergency services, according to

established standards, with quality and timeliness criteria.
• Strengthen the organization and operation of emergency services
GOALS for patient care.
SPECIFIC
• Ensure the adequate flow of resources intended for patient care
in emergency services and promote their rational use.
AREA OF APPLICATION

This Technical Health Standard

is applicable in all
public and private establishments
of the Health Sector that have
emergency services

LEGAL BASE

• Law No. 26842 – General Health Law

• Law No. 27604 – Law that modified the General Health Law, regarding the
obligation of health establishments to provide medical care in cases of
emergencies and births.
• Law No. 27657 – Law of the Ministry of Health
• Law No. 27813 – Law of the National Coordinated and Decentralized Health
System.
• Ministerial Resolution No. 769-2004-MINSA, which approved NT No. 021-
MINSA/DGSP/V01: “Technical Standard for Categories of Health Sector
Establishments”
 DAMAGE: Compromise of the state of health in degree
diverse. Damage to the emergency service
MEDICAL AND/SURGICAL EMERGENCY: A medical and/or surgical
emergency is understood as any sudden or unexpected condition that
requires immediate attention by putting life or health in imminent danger or
Priority Yo
Priority II Major Urgency
Priority III minor urgency
Priority IV
that may leave disabling consequences on the patient. Corresponds to
patients with damage classified as priority I and II.
EMERGENCY SERVICES NETWORK
emergency organized according to c
OBSERVATION ROOM: area
of the emergency service
th permanence
and
of short
e stay th attention,
e
and

treatment, re-evaluation
observation permanent of
patients with damag of
priority I and II, in a period e
should not exceed 12
hours.
EMERGENCY SERVICE: is the organic or functional unit in low-complexity hospitals, in charge of
providing emergency medical-surgical care in a timely and permanent manner during the 24 hours
a day to all people whose life and/or health is in a situation of emergency. emergency. Depending
on their level of complexity, they can resolve different categories of damages.
EMERGENCY TOPIC: area of the emergency service intended
for the care, evaluation, diagnosis and treatment of patients with
priority II and III damage. The topics can be differentiated
according to the demand and level of complexity of the health
establishment.■ —

06Dlen-Gneco topic that

surgery
TRIAGE: area of the emergency service intended for the initial evaluation of the
patient, in which the damage is prioritized and the referral for the care that the case
warrants is decided. This area must function primarily in those where demand
exceeds the supply of services. It will be led by a health professional trained in the
identification of priorities

Triag
e
TRAUMA RESUSCITATION OR SHOCK UNIT: area of the emergency service
intended for the evaluation, diagnosis and immediate treatment of patients with
Priority I damage.
 OF THE ORGANIZATION AND
FUNCTIONING

Health establishments categorized as II-1, II-2, III-1 and III-2 must have Emergency Services that
operate 24 hours a day, 365 days a year. Establishments III-1 and III-2 may have differentiated
emergency services according to the demand they serve .

Every health establishment is obliged to provide emergency

medical-surgical care to any person who needs it, in
accordance with the provisions of Law No. 27604 and
Supreme Decree 016-2002/SA.
Head of Guard specialist in Internal Medicine or Emergency and Disaster Medicine and with the
greatest competencies for emergency care and service management.
A basic team of professionals and healthcare personnel,
preferably full-time.
• Internist
• General Surgeon
• Obstetrician-gynecologist
• Pediatrician
• anesthesiologist
• Emergency Physician
• Doctors from other specialties (depending on availability and level of complexity of the
establishment).
• Nurse
• Obstetrician
• Nursing Technician.
 According to demand and level of complexity

appropriate and timely for this staff.

The Chief Medical Officer on Duty will define the

role

knowledge.

In addition to the basic team established, it must have the support of other specialists through the
rotation system of on-call personnel and the programming of retention personnel ,
determining the transportation mechanism.
They must have information for the user, related to rates, staff roles, family visits and other
conditions of service. Have standards regarding the provision of medical information.

and those responsible for the different

Emergency areas in shifts
having to publish it in each area to
 The health establishment, according to the demand and care needs, must schedule a doctor
with skills to care for emergencies and the permanent evaluation of critical patients who
present at the Health Services.

Access to the Emergency Service must be direct from the public

road, and be located close to the Intensive Care Unit, Surgical
Center, Obstetric Center, Clinical Pathology Service and Diagnostic
Imaging.
The Em Service
has the following
services: •Triage
•Admission •Aten
Topic(s)
•Observation
Room(s) •Reani
Shock Trauma
Unit, as
appropriate.

INTAKE/BOX
The Emergency Service must permanently have diagnostic support services that ensure immediate
attention and according to their level of complexity, these services must be very close to or within the
Emergency area.
The Emergency Service must have the necessary biomedical equipment for provision under
reasonable safety conditions. The biomedical equipment and non-expendable medical material used
in emergency care must be subject to preventive and corrective maintenance, as a priority.
reference is in each
coordinated and ional
and local.
The Emergency Service will coordinate with the
Intensive Care Service and Anesthesiology Services
the continuity of the care required by the patient in an
emergency situation. The attention will be referred to:
• Advanced and prolonged CPR.
• Mechanical Ventilation and Ventilatory Support.
• Hemodynamic and Cardiovascular Resuscitation.
• Trauma and Neurotrauma.
They must have a continuous, operational and preferably exclusive telephone
and radio communication system. Likewise, they must have a public
telephone in the family waiting area.
must be carried out
between: •Emergency
Services. •Guard Chiefs.
radio communication

•The regulatory center for

patient transportation and
emergency services, in
those health institutions
where it is implemented.
Support from social workers. They must
coordinate the support and presence of a
representative of the Peruvian national police
in the emergency services.

In the event that the patient or legal representative

does not authorize the performance of the surgical
act and in the case of an emergency intervention, a
representative of the Public Ministry will be notified
to expedite the actions that may take place to
safeguard the life and health of the patient. . In
addition, it is necessary that the patient and
responsible family member sign the "Release of
Liability" form.
SERVICE
EMERGENCIES
Univ. Adrián Jesús Navarrete Saravia
DIAGNOSIS AND TREATMENT
SUPPORT SERVICES
O Clinical Pathology
• Depending on the category of the establishment, there is
support from the Clinical Pathology service, exclusive or not,
24 hours a day.

O Diagnostic Imaging
• Depending on the category of the establishment, the
emergency service has an exclusive or non-exclusive
Diagnostic Imaging area, which provides support 24 hours a
day.
HUMAN RESOURCES
O According to the needs of the demand, the level of complexity and the available resources.

O In First Level Care establishments

• Medical surgeon capable of providing basic CPR, basic trauma support and patient management in an emergency

situation.

• Nurse capable of providing basic CPR and nursing care in emergencies.

• Nursing technician trained to participate in emergency care.

O In Health establishments II-1, II-2, III-1 and III-2

• Chief Medical Officer of the Service

HUMAN RESOURCES
OR
Doctor with a second specialization degree in emergency and disaster medicine.

OR Proof of recertification and participation in continuing medical education.

OR Proof of continuous work for more than 3 years in the emergency service, for
hospitals II and III.
HUMAN RESOURCES
• Chief Medical Officer of the Service

° Studies in management or administration of health services or hospitals.

° Not be subject to ethical sanctions.

° In II-1 hospitals there will preferably be a permanent or non-permanent emergency doctor.

• Service Doctor
° Doctor with specialty according to the team on duty.

° Accredit work exclusively in the emergency service on your shift.

• Head of emergency service nursing

° Registered nurse and preferably with a specialty.

° Accredit continuous work in the emergency service, greater than 3 years for hospital II and 5 years for

hospital III.

° Have a certificate/proof of participation in continuing education.

° Have studies in management or service administration.

° Not be subject to ethical sanctions.

° Have proactive skills and attitudes, psychological and emotional stability, good physical health and ability

to work.
HUMAN RESOURCES
• Nursing care

° Registered nurse preferably with a specialty or competence in the management of patients in

emergency situations.

° Certification/proof of participation in training activities related to the specialty.

° Accredit work exclusively in the emergency service.

° Have proactive skills or attitudes, psychological and emotional stability, good physical health and work
capacity.
• Nursing technician

° Nursing technician certification in accordance with current provisions.

° 6 months training and experience in critical areas.
° Ability to assimilate and develop proactive skills and attitudes, psychological and emotional stability,
good physical health and work capacity.
• Obstetrician

° Registered obstetrician.
° Certificate/proof of participation in training activities in obstetric emergencies.
° Have proactive skills and attitudes, emotional psychological stability, good physical health and work
capacity.
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MINIMUM HUN 1AIN RESOURCES ACCORDING TO CATEGORIZATION OF HOSPITALS.
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OC research or similar.
INFRASTRUCTURE
° The emergency service must be
located on the first floor of the
establishment in an area with
immediate and direct access from
the street

° Areas should be considered

available adjacent to the
emergency to be used in the
expansion of disaster care.
WORK AREAS

O Administrative area

• Reports

• Admission

• Treasury
WORK AREAS

• Social service

• Waiting room

• Secretary

• Medical and nursing headquarters (establishments

WORK AREAS

II-2, III-1 and III-2)

• Parking lot of

ambulances

• Area for the national police of Peru

WORK AREAS

° Optional
• Meeting room
• Library
 WORK AREAS
ei
th
WORK AREAS

Or other areas

• Nursing care center

• Nursing work area

• Environment for stock of medicines, materials or supplies

• Deposit of equipment and care instruments

O Support for healthcare personnel

• Changing room for female and male staff

• Staff break room

• Hygienic services for staff

HOSPITAL ENGINEERING
General lighting, emergency, tes.
eit in immediate condition. elec telephone line
group Motiv
es or
fire protection.
he
Natural ventilation and/or easy transit
conditioned.

r Sanitary facilities ation (shock-trauma),

surveillance unit of:
hot, drain

electrical installations built-in and with two

oo of outlets
built-in and with two
ground connection.

o p calling system and with

two
Signage of areas conditioned.
riente (06 per bed
evacuation.
oo
terna.
MATERIAL RESOURCES
OR List of biomedical equipment
CLASSIFICATION

PRODUCT II- II- III- III-

1 2 1 2
Portable gas and electrolyte analyzer x x

Neonatal secretion aspirator x x x

Rolling secretion aspirator x x x

Single channel infusion pump x x x

syringe infusion pump x x x x

Transport stretcher x x x x

Stretcher bed – multipurpose type x x x x

Capnograph plus pulse oximeter x x

Defibrillator with monitor and external paddles x x x x

portable fetal doppler x x x

Portable vascular doppler x x

transcranial doppler x x

Color Doppler ultrasound x x

portable ultrasound machine x x x

One channel electrocardiograph x x x

portable electrocardiograph x x x

Portable Body Warmer Equipment x x x

Fluid heating equipment x x x

Multiple misting equipment x x x x

Glucometer x x x x

Hemoglobinometer x x x x

adult laryngoscope x x x x

Pediatric – neonatal laryngoscope x x x x

Portable cardiopulmonary resuscitation case x x x x

Transportation monitor x x x

05-parameter vital functions monitor x x

06-parameter vital functions monitor x x

Neonatal vital functions monitor 05 parameters x

 O List of consumables

PRODUCT y vo
Basic closed circuit connector – blood lines Laryngeal mask – set with gastric devices o
Aerochamber u
Sharp surgical suture needle Hydrogen peroxide
Closed circuit connector – blood lines Fluid Heater Set
Lumbar (spinal) puncture needle Central ven pressure measurement set ei sa
Disposable disc electrode th
urine collection bag Micro-dropper equipment with graduated chamber er
Humidifier filter for mechanical fan Pre intracerebral monitoring set Y on
Hourly chest drainage container
e
Fluid warmer bag a
Antibacterial filter for mechanical ventilator Hemodynamic monit esophageal probe or eo
Disposable respiratory resuscitation bag

u to
oxygen hood Filter for intravenous solutions Blunt tip endotraq aspiration probe w/ flow the
glutaraldehyde e
Tracheostomy oxygen hood Interface for non-invasive ventilator control device of
l
Binasal oxygen cannula Aseptic bulb syringe for irrigation l in
Disposable double-way key Closed circuit endotracheal suction tube
Binasal cannula for oxygen and CO2
Disposable triple way key
tracheostomy tube Aseptic mask Chest drainage tube
Two-way Foley catheter
Multilumen central intravenous catheter Surgical mask and anti-particulate respirator for health nasogastric tube

Pediatric central intravenous catheter care May tubes

Disposable endotracheal tubes
Peripheral intravenous catheter Disposable nebulizing mask Elastic bandage
Chlorhexidine foam with dispenser Venturi oxygen mask Povidone-iodine foam with dispenser d or

Body warming cover Oxygen mask with reservoir

Laryngeal mask – set

SPECIFIC PROVISIONS
O Patient care
• Of entry and admission

• Emergency access must be direct and clearly

signposted.

• Every patient who arrives in an emergency

situation must enter the service without
obstacles.

• Surveillance or other personnel will facilitate

the entry and orientation of the patient and
their family member or companion, informing
the personnel on duty.

• For quick transfer of the patient, stretchers and

wheelchairs will remain at the entrance.

• After admission, Triage is the first area where

the patient must be evaluated.
• After being evaluated in Triage, the patient will be referred to the admission area.

• The admission area is responsible for the identity of the patient.

• The admission area must have a computer system or manual registry where the patient's data is
recorded.

• The emergency service must have admission

personnel while care is provided in the service.

This area must have immediate access to the
patient's medical history, if the patient is a
continuing patient.