Keith Gerein: Edmonton emergency rooms need their own life support system


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Here’s a tip, good many times over, but especially relevant right now.

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Beware of abdominal pain caused by excessive consumption of sweets. Stay very careful as the cold and snow hit our roads later this week.

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Don’t get sick. Don’t hurt yourself. Do your best to avoid any medical incident serious enough to require a visit to a hospital emergency department.

Because if you go there, chances are you will come to a traffic jam scene, with extremely long waits, overworked staff and a higher risk of adverse reactions.

I witnessed this myself recently when trying to help a sick family member through painful post-surgical complications. But you don’t have to take it from me. Take it from people who work in emergency services.

“Terrible. Disaster area. Overwhelmed. Lack of resources,” described Dr. Warren Thirsk, president-elect of the Alberta Medical Association’s emergency medicine section, who also works at the Royal Alexandra Hospital.

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“There is a growing sense of hopelessness and helplessness,” said Dr. Jarrod Anderson, an emergency physician at Misericordia Hospital. “Things are as bad as they have ever been and worse. Our ability to respond quickly to emergencies is not what it should be in a modern society.

And as serious as it is, we can expect the problem to get worse in the months to come. COVID cases are on the rise. We are just at the start of flu season.

As such, this seems like an insane time to pile on more risk and disruption with political decision-making like, say, firing a group of Alberta health service leaders or arbitrarily declaring a ban on wearing. mandatory mask in schools.

To be clear, if you become seriously ill or injured, you should always go to the emergency room. The most critical patients will always be treated quickly and skillfully, as they always have been.

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The problem, Thirsk and Anderson said, is not with patients who arrive in an obviously life-threatening condition. Rather, it is with patients whose symptoms are a little less clear – chest pain, abdominal pain, etc. – problems that can escalate into life-threatening situations the longer they are not treated.

In theory, think of someone who presents with diabetic complications that slowly escalate to the point that the patient goes into cardiac arrest.

Or a patient with partial paralysis who eventually develops breathing and swallowing problems after being immobile. Or patients with a faulty pacemaker, perforated intestines, or slow brain bleeding.

These are people who are initially assessed with reasonable vital signs and seem to hang on until all of a sudden they aren’t. During those endless hours of sitting in a waiting room chair or even lying on the floor before being thoroughly examined — sometimes up to 6 p.m., according to Anderson — bad things can start to happen.

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« Essentially, as long as you become the sickest person out of 100, we can see you quickly, » Anderson said.

Although AHS says it’s not aware of any such cases, Thirsk said emergency doctors have started tracking deaths in waiting rooms in Alberta and believe they’ve been happening since May on average once. per month. There has also been an average of at least one case per month of a near miss in which a patient nearly died or had to be resuscitated, they say.

As for how we got here, there seems to be a perfect storm of overlapping and interconnected calamities, some closely related to the pandemic and some less so.

This is largely linked to more very sick patients – many of whom are delaying care for heart disease, diabetes, etc. – encountering under-resourced and inexperienced staff.

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(AHS says daily emergency service traffic in the Edmonton area is up 10% this year compared to last year.)

You don’t have to have a medical degree to know that the pandemic has been tough on hospital staff, leading veternity of medical personnel, especially nurses, to retire early, take stress-related leave, or find positions with less potential for burnout. They have been replaced by younger employees, who lack experience and mentorship, and are more likely to make mistakes.

Problems or bottlenecks in other parts of the system also carry over to the emergency department, whether it’s cutbacks in some specialists, surgical backlogs, CT scans that are down, difficulties in accessing family doctors or ambulance teams so small that they increasingly have to leave (non-critical) patients in the waiting room.

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Add to that disputes over pay and overtime, and increasing incidents of patient assault and violence. Anecdotally at least, the whole thing has created such stress that nurses often call in sick, followed by struggles to find enough replacement staff.

In a statement, AHS said overall emergency services staffing has actually increased over the past year, mostly through casual workers, but the agency admits it also continues to see rates of vacation, sickness and overtime higher than usual.

« We recognize that our emergency services personnel are under significant pressure, » the statement said.

Some system issues will hopefully be resolved soon enough. The bad news is that the larger problems will likely take some time to stabilize, in part by strengthening emergency department personnel and in part by reducing other bottlenecks that will allow patients to move through the walls more quickly. emergency services or avoid them altogether.

AHS says they are actively recruiting, both nationally and internationally, but it’s not an overnight solution, especially when other jurisdictions are doing the same.

So in the meantime, it’s up to us to help. Take care of yourself as much as possible. Get minor issues fixed before they become major ones. Be nice to overworked staff.

Above all, our government must listen to front-line professionals and avoid policy choices that result in the worst medical choices about who lives and who dies in the waiting room.

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