Definitions
The current literature is often inconsistent in the use and interpretation of terminology. Accordingly, the specific terms used in this chapter are defined as follows:
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Emergency care. Emergency medical care is that care delivered in the first few hours after the onset of an acute medical or obstetric problem or the occurrence of an injury, including care delivered inside a fixed facility.
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Paramedical personnel. Paramedical personnel refers to all persons with medical training who are involved in the care and transportation of patients in need of emergency medical care. The length and quality of training vary, from highly specialized personnel with capabilities for advanced life support to those with simple first-aid training and limited field experience.
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Hospital. A hospital is a geographically fixed facility in which personnel with some acceptable level of training deliver emergency medical care. The distinctions between a clinic, health center, and hospital are unclear, and the presence or absence of a doctor is not a determining factor in this distinction. A range of facilities from small, basic units up to tertiary care hospitals provides an increasing level of capability for emergency and other care.
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Triage. Triage is the screening of patients in the field or in the receiving area of a fixed facility to determine their relative priority for treatment. Triage, which is usually necessary in the occurrence of mass casualties, may be necessary whenever a large number of patients requiring emergency care present at the same time. It typically entails categorizing patients into three groups: those very unlikely to survive, even with treatment; those whose conditions are minor and who will recover without emergency care; and those with potentially lethal conditions who are likely to survive if they receive timely emergency care. Patients in the last category form the highest priority for emergency care.
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Stabilization. A distinction is often made between initial emergency care and stabilization on one hand and definitive medical care on the other. Initial emergency care and stabilization are usually considered the domain of mobile EMS; lower levels of the health care system (for example, clinics and smaller hospitals); and the emergency departments of any fixed facility. Definitive care is usually considered the domain of the hospital and of larger facilities and implies the resolution of the condition needing treatment. However, the distinction is somewhat arbitrary; a more accurate approach is to view care as a continuum. Many of the elements of early care delivered in the course of emergency treatment, whether in the field or in fixed facilities, can be considered definitive (McCord and Chowdhury 2003; McCord and others 2001).
