Strict 30-Minute Rule Imposed At Mumbai Hospitals: BMC Issues Tough Casualty Protocol After Patient Neglect Reports

Mumbai: Taking serious note of incidents where patients referred to higher centres were left unattended for hours and specialist doctors failed to report to the casualty ward, the health department of the Brihanmumbai Municipal Corporation (BMC) has issued a circular introducing a strict casualty protocol. The directive makes it mandatory for doctors to attend to patients within 30 minutes of their arrival.

The Directive

The instructions, issued by Dr Chandrakant Pawar, Chief Medical Superintendent and Head of Department (Secondary Healthcare Services), lay down clear guidelines for the management of patients in casualty departments, with special focus on medico-legal cases (MLC) and patient transfers.

According to the circular, every patient arriving managing patients in casualty departments, with a special focus on medico-legal cases (MLCsat casualty must be examined immediately by the Medical Officer (MO) on duty and subsequently by the concerned registrar or PG bonded Assistant Medical Officer. Patients should not be made to wait in casualty for more than 30 minutes under any circumstances, and interns cannot treat patients without supervision.

Triggering the Crackdown

In the past two months, The Free Press Journal has repeatedly reported cases of casualty patients being referred to higher centres due to non-functional CT scan machines and the unavailability of specialist doctors. In February, a 62-year-old woman with a severe head injury was shifted from Balasaheb Thackeray Trauma Care Municipal Hospital to Dr R N Cooper Hospital after the CT scan facility was found non-functional.

The guidelines also stress strict documentation for medico-legal cases. Casualty Medical Officers must record their duty timings and handover details in the MLC register. Patient details including name, age, sex, address, MLC number and whether the patient was brought by relatives or the police must be clearly documented.

Admission Protocol

For seriously ill patients, the Casualty Medical Officer must admit the patient to the appropriate department based on the chief complaint and stabilise the condition before sending the patient for investigations such as X-ray, ultrasound, CT scan or MRI. Indoor case papers must be prepared immediately and treatment started as for admitted patients.

Doctors are also required to record the patient’s medical history, general condition and clinical signs. The circular also outlines procedures for transferring patients to higher centres. Patients must first be registered as indoor patients and provided initial treatment before transfer. A detailed transfer memo — including medical history, vital signs, investigations, provisional diagnosis, treatment given and reason for transfer — must accompany the patient.

Transfers must be carried out only by ambulance equipped with oxygen, resuscitation equipment and essential medicines, and must be accompanied by a House Officer, Registrar or PG bonded AMO.

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