*ECHS EMERGENCY TREATMENT*
Para 16. *Treatment in Emergency.*
(a) If in 'emergency', patients can go directly to any empanelled / non
empanelled hosp. 'Emergency' in ECHS is defined as life threatening conditions
to include the following :-
(i) Acute Cardiac Conditions/ Syndromes including Myocardial
Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal
Superventricular Tachyccardia, Cardiac Tamponade, Acute Left Ventricular
Failure/ Severe Congestive Cardiac Failure, Accelerated Hypertension,
Complete dissection.
(ii) Vascular Catastrophies including medical and surgical shock and
peripheral circulatory failure, Acute limb ischaemia, Rupture of aneurysms.
(iii) Cerebro-Vascular Accidents including Strokes; Neurological
Emergencies including coma, cerebro meningeal infections, convulsions,
acute paralysis, acute visual loss.
(iv) Acute Respiratory Emergencies including respiratory failure and
decompensated lung diseases.
(v) Acute abdomen including acute obstertrical and gynaecological
emergencies.
(vi) Life threatening injuries including road traffic accidents, Head
injuries, Multiple injuries, Crush injuries and thermal injuries.
(vii) Acute poisonings and snake bite.
(viii) Heat stroke and cold injuries of life threatening nature.
(ix) Acute endocrine emergencies like Diabetic Ketoacidosis.
(x) Acute Renal Failure.
(xi) Severe infections leading to life threatening sequelae including
Septicaemia disseminated/ miliary tuberculosis.
(xii) Any other condition in which delay could result in loss of life or limb.
(b) 'Emergency' provision should not be misused. It is related to medical
condition of the patient and not with closing hour of PC/ holidays.
(c) This provision should not be used as a 'short cut' to avoid going
through PC.
(d) In life threatening conditions, moving to one of the closest hospital is
the natural response and therefore all emergency admissions will be viewed
from this perspective as well. Hospital should also be careful while treating
such cases. Intimation within 24 hr by empanelled hospital for ER and
within 48 hr from non empanelled hosp by individual (EIR) is mandatory.
(e) All empanelled hospitals must allow treatment/ admissions in case of
genuine emergencies only. 'Benefit of doubt' should be given to the patient. After
stabilisation, patient should be discharged viz a patient may come to empanelled
hosp feeling chest pain but on examination, he/she may be suffering from gastric
problem and all tests done don't indicate heart problem, such patients after
stabilisation and basic medication, should be discharged and charges raised on
day care basis to ECHS. Empanelled hospital will indicate date and time of
reporting and discharge on discharge summary/ bills (Auth: Para 4(b)(iv) of GoI
(MoD) letter No 24(8)/03/US(WE)/D(Res) dt 19 Dec 2003) to the nearest as well as parent PC. The bills under emergency clause will be raised with specified
documents as under:-
(i) Copy of ECHS Card.
(ii) Emergency room case sheet/ discharge summary indicating time of
reporting / discharge.
(iii) Copy of ER.
(iv) The applicable charges will be as under :-
(aa) Consultation Charges (max two) as per CGHS rates. Second
consultation is allowed if a specialist attends in addition to MO.
(ab) Emergency investigation charges.
(ac) Medicines & consumables used for stabilisation including
POP charges etc.
(ad) No room rent will be paid.
(f) Those misutilising the provision be it ECHS beneficiaries/empanelled
hospitals will be strongly penalised.
(g) Emergency Treatment in Non Empanelled Hosp and Reimbursement.
All beneficiaries are allowed to get themselves treated in any hospital in case of
emergency, though empanelled hospitals will submit their bills online, patients
who have treated themselves in non empanelled hosp to process their
reimbursement bills through parent PC. Mandatory documents are as under :-
(i) Copy of ECHS Card.
(ii) Emergency certificate issued by the hosp.
(iii) Discharge summary (must include admission date & discharge
date correctly with details of disease & treatment provided).
(iv) Emergency room case sheet.
(v) Copy of EIR.
(vi) Bill in detail with summary.
(vii) All images, pouches, barcode, invoices etc.