Thursday, August 27, 2020

What an Overrun ER really looks like

This article is NOT designed to create fear. (II Timothy 1:7 tells us that God did not give us a spirit of fear, but he did give us a spirit of power and love and a SOUND MIND. I believe understanding things helps create that SOUND MIND!)

This article is designed to share FACTS. I am NOT a medical person, but I have learned SO much by watching my husband in a crisis and understanding how things really work. When he tells me something that is going on, I often say: "But why don't they do ____." And then he explains why what I am proposing would not work. 

I purposefully wrote this WITHOUT his contribution so that it would be from ME not from HIM. This is not designed to be medical or "approved" by anyone. It is simply a general medical moron's (me!) observations.

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If I need an Emergency Room, I assume, when I arrive there, that there will be a spot for me. If I call 911, I assume, that an ambulance will come to help me. My brain has never thought: "What if I call 911 and no one can come?"

I am learning how "for granted" I take an ambulance arriving or a bed being available.

I want to offer you some things I have learned being married to the Director of Emergency Room. I think it is important to understand these "facts" so that you can understand why physicians/people in charge are worried about an ER being overrun.

FACT: An ER cannot afford to have doctors (and subsequently nurses and mid-levels (Nurse Practioners and Physician Assistants), paid per hour, sitting around doing nothing. However, physicians are the most "expensive" commodity and therefore they cannot afford to have more physicians present than will be utilized ... period.

AS A RESULT: An ER is therefore trying to very precisely have enough staff for an estimated amount of patients that they will be seeing.
No patient wants to pay more money than they already have to pay.

FACT: If an ER all of a sudden "blows up", physicians cannot be "created." I have often said to John "They need to call someone." His response is: "Who?"

AS A RESULT: In a big city, you may be able to have a physician available to come in at the last minute to help. But smaller towns simply do not have doctors available that are not being used. If a doctor isn't employed in a small town, they are not going to live there or be there.  They are going to be somewhere else where they are working.

FACT: An ER can only have a certain number of rooms.

HOWEVER: If more people come in then they have rooms for, there is a BIG problem. 

FACT: Sometimes an ER can put patients in the hallways and in "out-of-the-way" places.

HOWEVER: An ER canNOT do this with patients who are psychiatric/violent or contagious (COVID). These patients must have safe/secure spaces. A COVID patient, for example, can't just be plunked down in a hallway.

FACT: If an ER has patients that need to be admitted to the hospital, they must find a hospital for that patient to go to. Sometimes that is the hospital they are already at. However, if they are very sick, they may need to be transferred to a "bigger" hospital that has the resources they need.

HOWEVER: If the current hospital is full and other hospitals are full and don't have space, a patient who is very sick must simply "wait" in the ER. This means that they are taking up space/room but don't need to be there. Even if they could bring in more doctors, they cannot create space when there is none.

FACT: A very sick patient must go somewhere.

HOWEVER: Sometimes there is nowhere for them to go.

FACT: My asthmatic seven-year-old faced this a few years ago. He was very sick. He needed to be admitted. We were given a room within an hour. If there is not a room though, the only place for us to be is exactly where we are: In the ER taking up space. 

FACT: If an ER becomes too busy and has absolutely no place to put a patient, they must go on "diversion." This means that they have to tell ambulances: "Unless this patient is moments from dying, you must take them somewhere else."

HOWEVER: Small towns only have a small number of ambulances.

FACT: If there are, say, three ambulances in a county and those ambulances are forced to drive to other counties/cities to find space for a patient, that means there are fewer ambulances available for patients in the current county where the ambulance is supposed to be.

HOWEVER: If you call 911 and every single ambulance available in a county is driving a patient to a hospital that is farther away, someone (you!) could die.

FACT: Hospitals are always trying to be "mostly full" but not "completely full." They want to have enough people utilizing their services to pay the bills and to pay for the people working there. But they always want there to be space available for new sick people coming in. 

HOWEVER: Estimates can be thrown off by crazy things like a mass casualty, a natural disaster, a terrible flu season (although that can often be predicted) or a pandemic etc. 

FACT: July is usually a very slow month in Emergency Rooms. 

HOWEVER: July is completely not slow right now due to COVID.

FACT: COVID is not the chief problem. It is not all COVID coming in. But even if COVID is bringing in 25% more patients, that is hard to suddenly be able to handle. 

HOWEVER: Even with months to prepare for the possible onslaught that a pandemic might bring, there are things that cannot be fixed. A small town does not have physicians just chilling there and not working. There is a major nursing shortage already throughout our whole country. There are only a certain number of ambulances available. 

FACT: If ambulance drivers get sick or doctors get sick, the problem gets even more precarious because now they are down even more

AS A RESULT: These families of people in the medical field are required to be even more careful to keep their medical worker safer during this time. 

FACT: My husband is unable to think about, talk about, fathom, what would happen if he had someone come in that was dying and had no ability to help them. Or if they died because he didn't have the space to help him. As it is, he has already faced many precarious situations since all this COVID stuff began. For example: healthy teenager falls off his bike and has a brain bleed. Normally John can get him transferred within an hour. But now it is taking many hours. This is precious time that could cost a very healthy child their life. 

HOWEVER: He and those who help make decisions are constantly trying to come up with new ideas, new ways, new thoughts to make things better.

FACT: You can imagine how stressful an ER can be to work in already. Now imagine trying to do this with ambulance drivers unsure where to bring patients, nurses frustrated in trying to communicate that the hospital is on diversion, doctors not getting a single break or opportunity to regroup, etc. 

HOWEVER: Your prayers mean the WORLD to us. Keep supporting your medical personnel. It means SO MUCH.  

If you have other questions, please ask them and I will try to add them to my "Fact sheet" :)



 


1 comment:

Erlinda Kaes said...
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