I want to tell you what happens behind the scenes at an emergency department. I am currently working at a kids emergency department and in the last couple of weeks, we have been absolutely flooded with patients. People have been flocking to us in record numbers and as a consequence, our waiting room has been a symphony of wailing, crying, coughing, sneezing, vomiting and yelling. That’s a lot of cranky kids and their parents in one room, 24/7.
The key to all of this however, is that the people in the waiting room are merely the tip of the iceberg. For every patient in the waiting room, there is another two if not three that are brought straight into the department (usually brought by ambulance) because they are so unwell and will most likely need to be admitted to hospital. These are the kids that need oxygen, immediate antibiotics or fluids through a drip or who have broken their limbs so badly that they need intravenous morphine and are eventually taken to an operating theatre.
The call we all dread however is the call to attend a category one patient – patients whose lives are in immediate danger. These are the ‘lights and sirens’ patients that pass you on the freeway in an ambulance, the cases that require the attention of many doctors and nurses all at once, not just emergency doctors but surgeons, intensive care specialists and paediatricians. This happens in the resuscitation rooms, away from the eyes of the general public and without fanfare. You can imagine that if there are several of these resuscitation cases in a day, other patients may end up waiting a little longer to be seen.
This is what the triage system is based on and it is the same for all patients regardless of age. They are given a number between 1 and 5 – the smaller the number, the sicker the patient and the faster they need to be assessed and treated.
So you can understand the frustration I experience sometimes when I hear parents (or in an adult emergency department, the patient’s themselves) complaining about how long it has taken them to be seen after I have spent an hour or so assisting in the resuscitation of a child who has been involved in a horrific car accident. Don’t get me wrong, I know its equally as frustrating for them to be waiting indefinitely but for the most part, the patients that are kept in the waiting room are suffering from ‘minor’ illnesses. That doesn’t mean that these patients don’t feel just as miserable or as sick, it just means that they are well enough to wait. Truthfully, in ‘normal hours’ at least half of the patients in the waiting room of any emergency department could be reviewed by a GP.
I guess what I am trying to say is this – if you come to an emergency department, please be patient. The system is not perfect but for the most part it does what it is designed to – we see and treat the sickest first yes, but eventually we will see everyone. So the next time you are asked to sit in the waiting room with your mother/brother/child, spare a thought for the relative sitting by themselves in a quiet room of the emergency department, waiting for us to finish resuscitating their loved one. Which room would you rather be waiting in?
Rowena Lalji is a doctor based in Brisbane who fuels both her career in medicine and her passion for writing using the nectar of the gods – espresso coffee.
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Top Comments
Commenting on an old story, but.... Part of this is also hospital management and funding. There are a number of excellent initiatives that have worked wonders in the past. Acute Observation wards coupled with a "4 hour ward" provide an escape valve to deal with patients who arent necessarily "emergency", but are potentially too unwell to send home, ie people with Asthma and the flu. Other things like a non emergency GP service for people with non threatening wounds or colds or whatever certainly dont harm patient turnover either.
First comment so be kind. I think nurses and doctors do a wonderful job so I don't think my gripe is with them but there is certainly a problem. I'm in country Victoria and our local ED is quite frankly a joke. There can be no one in our department but your wait is 2 hours reguardless, they actually have a note up saying that. I've been unlucky enough to need to go to the ED on a few occasions and most of the time I have been willing to wait my turn, however one time I was so sick that even my was muttering 'please don't die' as he was driving me to the hospital. I went in with what I thought may have been an accidental overdose on medication and was made to feel like a drug addict and left crying and screaming in pain on the waiting room floor with someone else's fecies on the floor beside me. A kind stranger lent me their jacket so I could rest my head for a moment and I wasn't even seen for a bp/temp check until my father stormed in and asked why I was on the floor. Miraculously a bed was available instantly, however I was left sitting in a room for 3 hours with no treatment so I walked out. The next morning I begged a gp to see me and I had a spasm in my bowel and and dehydration and a fluctuating bp. All this in mind, if we had a gp open more than 9-5 I would have tried them first and we only have 3 clinics here that tend to rush you through, that's even if you can get in as my gp frequently has a week plus wait. Sorry for the rant I guess I just wanted some to know how lucky they have it having 24 gp's and fully staffed ED's. We have lots of overcrowding from matters that could be dealt with from GP's if you were able to see one! And there are no services for the elderly, they're taking up beds everywhere which just seems wrong for all concerned. Give me a good place in Vic with healthcare and I'll move there :)