Shifting the Borders of PHYSIOTHERAPIST in ACCIDENT & EMERGENCY DEPARTMENTS

INTRODUCTION:
As a Medical practioner, how many of us know the Emergency ambulance number to call ? Probably 95% would not know.
Accidents can occur at any times and any places usually at Odd times and at Places where a doctor would not be expected to be.
Injuries are a common cause of Death, Most of the Deaths due to injuries may be unavoidable, but prompt care saves life.1
Early skilled care can reduce the extend & duration of damage and return the patient into his community in earlier period.2
Emergency medical service is a life saving service, it is a chain of human & Physical resources, brought together to provide total patient care. 3, 4
Emergency triage is a process of sorting or classifying patients according to the need for Emergency treatment & potential for further injury. Triage comes from French. 5.
The health care industry is becoming more complex, there are considerable personal shortages in many of the professional disciplines.
Physiotherapists are responsible for providing quality services and care for patients. Still they can provide more services if they extend their area.
This article focuses role of physiotherapist in Accident & Emergency situations through Available literatures. The available literatures for the Role of Physiotherapist practioners in Emergency department are severely limited.
There are Major Benefits for employing Physiotherapist practioner in Emergency Department. 6, 7.
Ø Enhance the ability of department
Ø Reduce the Waiting time for patients.
Ø Reduce Hospital admissions
Ø Treatment applied on the site of injury
Ø Help to manage the increasing load
Ø Being a part of flexible & responsive work force
Ø Giving timely & Quality care
Ø Improving access to most appropriate emergency practioner.

The Major Disadvantage for not applying physiotherapist in Accident & Emergency situations are. 6
Ø Lack of Communication Skills
Ø Deficient in Hands on approach on First Aid.
Ø Insufficient knowledge in Emergency Code/ Colour.
Ø Not knowing to apply POP
Ø Poor Knowledge on Monitors.

Physiotherapist can reduce the number of admission in hospital. A study on COPD patients’ states that Exercises delivered in the Community will reduce the number of hospital admission and ease the burden on waiting list. 8
Physiotherapist work successful in all areas in U.K, Physiotherapy Triage was successfully trialed in the Emergency department of Royal Melbourne Hospital in 2004, where a Physiotherapist found vital in reducing waiting time and total treatment time for emergency patients with Musculoskeletal injuries.
Jibuike et al., conducted a study on “ Acute Knee screening service” shows that Physiotherapist can reduce number of patients in Trauma & Accident & Emergency clinics.
Jibuike et al., also found that Physiotherapy practioners could diagnose knee conditions better than Accident & Emergency Senior house officers. 9
The Role of the Accident and Emergency extend scope of Physiotherapy practioners with the ability to treat patients autonomously can be challenging for both the practioners & other health care providers whose professional boundaries have been crossed. 10
Conclusion:
There are clear advantages in having Accident & Emergency extend scope Physiotherapy practioner in emergency departments particularly for patients with Musculoskeletal injuries.
Physiotherapy practioner are already providing a valuable resources for the A& E team members and their role fits in with the ‘See and Treat’ and minor injury streaming systems that the department of Health. 12
Suitably trained and Qualified physiotherapy practioner can lead Accident & Emergency soft tissue injury review clinics, thereby freeing up senior doctors for other duties. 11

Bibliography:
1) John Norman (1978) “Management of injured patients” Mc Milan journal limited, USA.
2) Easton. K (1970) “The general practioner and the rescue services” community health. Bristol.
3) Herbert J. Proctor MD( 1979) “Management of Acute trauma” Year Book Medical publishers, USA.
4) Gene Weatherall. (1983) “Instructors guide for emergency care” Prentice—Hall Publishing, Mary land.
5) Jean H Roger.(1989) “Emergency Nursing—A Practical guide” William & Willikins, USA.
6) Bethel J (2005) “The role of the Physiotherapist practioner in Emergency departments: A critical appraisal, Emergency Nurse.
7) Department of Health (2003). “Work force matters: A guide to role redesign in emergency care. The stationary Offices, London.
8) Kathleen Philip (2006), “Physiotherapy can reduce Hospital admission” Australian journal of Physiotherapy.
9) Jibuike et al (2003). “Management of soft tissue knee injuries in an Accident & Emergency department.
10) Mike smith ( 2004). “Collaborative working” Emergency nurse.
11) Boyce S ( 2003) “ The Physiotherapist practioner: Extending the role of the physiotherapist. Emergency medicine journal.

Author: B. Arun., MPT, CMPT,