Standard Treatment Protocol of emergency Health Service Package

Constitutional Provision of Standard Treatment Protocol of emergency Health Service Package :

The Constitution of Nepal under the Article 35 Clause 1 mentions ‘Every citizen shall have the right to free basic health services from the state, and no one shall be deprived of emergency health services.’ The Public Health Service Act 2018 formulated to ensure the constitutional rights related to health, has defined “Emergency health services” as the initial and immediate service to be provided as it is necessary to free the lives of the persons from risk, save the lives or organs from being lost, whose lives are in the risky condition upon falling into unexpected incident or emergency condition. Constitutional essence of Emergency health services has been further addressed under Chapter 2 – Rights, Duties of Service Recipients and Responsibilities of Health Institutions, Article 33 of which describes establishment of emergency health service fund, while Article 48 of Chapter 6 describes Emergency health service and management. Furthermore, in the Chapter 4 of Public Health Regulation 2020, Rule 8 commits that ‘every health institution shall immediately provide emergency services to patients that have come for treatment in such institution and, if it is necessary, the patient shall be admitted to the hospital’, while Rule 7 ensures that ‘if the emergency health services required to treat the patient are not available in a given health institution, the health institution shall immediately provide whatever emergency health services are available, and after providing the reason for additional treatment, the patient shall be immediately referred to the most convenient health institution that provides the required services.’ Towards this, the Ministry of Health and Population has already developed the Basic health services package and some basic emergency health services have already been incorporated in this package

Common emergency diseases/conditions, as outlined in the Public Health Service Regulations 2020 Schedule 2 is presented, and are grouped as the following:

1. Respiratory emergencies: Shortness of breath, Acute exacerbation of chronic obstructive pulmonary disease (COPD), Bronchial Asthma, Pneumonia, Aspiration Pneumonia, Pneumothorax, Hemoptysis, Acute Pulmonary Embolism, Acute Mountain Sickness, High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE), Acute Respiratory Failure, Acute Respiratory Distress Syndrome (ARDS)

2. Cardiac Emergencies: Chest pain, Acute Coronary Syndrome, Acute Myocardial Infarction, Arrhythmias- tachyarrhythmias and bradyarrhythmias, Acute Pulmonary Edema, Cardiac Tamponade, Cardiogenic Shock, Hypertensive Emergencies

3. Neurological Emergencies: Coma, Seizures, Acute CNS Infections, Cerebrovascular Accidents, Guillain-Barre Syndrome (GBS), Raised Intracranial Pressure

4. Gastrointestinal Emergencies: Abdominal pain, Acute Gastritis, Acute Gastroenteritis, Acute Appendicitis, Acute Cholecystitis, Gastrointestinal Bleeding (GIB), Fulminant Hepatic Failure, Acute Pancreatitis, Strangulated/ Obstructed Hernia, Intestinal Obstruction, Hollow Viscous Perforation, Peritonitis

5. Genitourinary Emergencies: Renal Colic, Hematuria, Acute Retention of Urine, Testicular Torsion, Para phimosis

6. Gynaecology and Obstetrical Emergencies: Ectopic pregnancy, Antepartum Haemorrhage, Ruptured uterus, Pregnancy Induced Hypertension (PIH), Obstructed labour, Postpartum Haemorrhage, Puerperal pyrexia, Hyperemesis gravidarum

7. Orthopedics and Trauma: Head Injury, Abdominal and Pelvic Injuries, Chest injuries, Musculoskeletal Injuries, Compartment Syndrome, Traumatic Amputation, Dental Emergencies- Toothache/Odontalgia, Dental fractures, Temporomandibular joint (TMJ) Dislocation, Gum Bleeding

8. Metabolic Emergencies: Hypo/hyperkalemia, Hypo/hypernatremia, Hypoglycemia, Diabetic Ketoacidosis (DKA), Acute Adrenal Crisis

9. Ocular Emergencies: Foreign Body Eye, Sudden Loss of Vision, Chemical Injuries

10. ENT Emergencies: Epistaxis, Foreign body ENT

11. Burns: Thermal burns, Electrical and Lightening Injuries

12. Mental Health Emergencies: Alcohol Intoxication, Alcohol Use Disorders, Anxiety Disorder, Conversion Disorder, Depression, Acute Psychosis

13. Toxicological Emergencies: Outline of Poisoning, Organophosphorus Poisoning, Zinc Phosphide (Rodenticides), Aluminium Phosphide, Mushroom Poisoning, Wild Honey Poisoning, Dhatura Poisoning, Paracetamol Poisoning, Antidotes

14. Snake Bite, Animal Bite-Rabies, Insect Bite.

15. Paediatric Emergencies: Diarrhoea, Acute Respiratory Tract Infection-Acute epiglottitis, laryngitis and laryngotracheobronchitis, Pneumonia, Febrile Convulsions

16. Miscellaneous: Anaphylaxis, Needle stick injuries, Pain management in the Emergency

ABCDE approach in the Emergency Room

Utilization of the Standard Treatment Protocol

The guidelines provided in this Standard Treatment Protocol of Emergency Health Service Package is expected to be useful for all health workers including nurses and doctors and other health-care providers, and health promoters. This can be used to:

Support the emergency health services by developing a national standard treatment protocol in all health institutions.
Ensure that all the necessary equipment’s and resources are available.

The STP is proposed to be used at the following levels of health service as endorsed recently by the Government of Nepal, depending on the resources available:

1. Basic Health Service Centers (BHSC)

2. Primary hospitals (up to 5-15 bedded hospitals)

3. General hospitals (up to 50 bedded hospitals

Download Standard Treatment Protocol of emergency Health Service Package .pdf

Standard Treatment Protocol of emergency Health Service Package | MoHP

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