Sharon

Those who work in an emergency department refer to it as controlled chaos. Even when Washington County Hospital’s twenty-one bed Emergency Department (ED) is at full bed capacity, they still find room for more patients. “Everything funnels into the ED,” said Sharon, an emergency room nurse of forty years. She explained that staff have no way of predicting the type or severity of injury they'll see. Washington County Hospital is a trauma center, stroke center, and maintains a state-of-the-art catheterization lab, resulting in more critically injured, stroke, and heart attack patients coming to the hospital. “We are busier now than we’ve ever been,” said Sharon.

With their strong stomachs, analytical minds, calmness, and versatility, ED nurses see a variety of conditions ranging from toothaches and flu symptoms to chest pain and hallucinations. As more people rely on the emergency room for life-threatening conditions, after-hours care, and even general healthcare, rush hour can be every hour. According to Blake, an emergency nurse of seven years, there is a misconception that the ED is busiest only on the weekends. Washington County Hospital’s ED is generally busy from 10:30 am to 1:00 am every day of the week—treating an average of 70,000 patients annually.

For those of us who are fortunate to enter the ED through its front doors, it is easy to forget that ambulances bring patients in the back door. “In ten minutes, we could have ten ambulance calls,” explained Sharon. People waiting out front often have no idea what is going on in the back. As emergency departments become busier, these veteran nurses offer sage advice for anyone entering the hospital’s ED.

Don’t Expect First Come, First Served
The ED does not operate on a first-come-first-served basis. Your position on the ED waiting list depends upon the severity of your condition. A triage nurse listens to a patient’s complaints, and assesses vital signs and medical history. “If patient A arrives at 10:00 pm with a lacerated finger and patient B arrives at 10:05 pm with shortness of breath, patient B will be seen first,” said Blake. The number of resources the patient will need in the ED (lab, x-ray, CT scan, IVs, catheterization lab, surgery) also determines how soon the patient will be seen.

Use Good Judgment
“A person will drive himself to the ED and the last thing he considers is that he’s having a heart attack,” said Blake. If you are experiencing chest pains and have a cardiac history, high blood pressure, or high cholesterol, do not drive to the ED—call 911. Some local ambulance providers can send the patient’s EKG results while in transit to the hospital so everyone is at the ready when the patient arrives. ED nurses caution not to delay care for chest pain or stroke symptoms. During a heart attack, heart muscle cells die—prolonging treatment can mean more damage to your heart or even death. During a stroke, blood flow to the brain is interrupted, causing brain cells to die. The more brain cells affected, the more devastating the impact of the stroke.

Staci

Use Your Options before Coming to the ED
Given the ED’s continuous stream of patients, nurses urge people to use Urgent Care for minor injuries, or call their primary care physician or a nurse line before coming to the ED. These resources can best tell people whether their condition is life threatening. Staci sees many patients with cold and flu symptoms in the ED. “Unless you have cold and flu symptoms with a condition like COPD, emphysema, or an infant with a high fever, you’re better off recovering at home,” said Staci. If you are not sure whether you need to be seen by a doctor right away, call Urgent Care’s advice line at 1-800-274-0499.

Expect the Once (or Twice) Over
A triage nurse typically has three years of ED experience and passes a rigorous test before assuming the role of ED detective. “A triage nurse can look at a person and know what’s going on,” said Staci. Blake warns that if a patient answers a question about her medical history with “nothing lately or nothing much,” expect the triage nurse to probe for more information. “I’ve heard nurses ask, do you have all of your parts?” said Blake.

	Blake

Give Us the Down and Dirty
“Give us the down and dirty as to why you’re in the ED,” advised Staci. “Tell us everything—not just bits and pieces.” According to Staci, patients often convey some medical history to the triage nurse, but not all. “Don’t think that after a period of time, parts of your medical history can drop off the radar screen,” warned Blake. She asks that patients take time to write down their past medical history (surgeries, hospitalizations, medications, allergies). “If you’re on heart or blood pressure medication, we need to know the name of your medication—not just that it’s a blue pill,” she said.

Remember that if you arrive in the ED and are admitted to the hospital, you’ll have a physician who does not know you as well as your primary care physician. “We have great hospitalists, but there’s always a risk when we don’t know your complete health picture,” explained Blake.

Avoid Bringing the Family
While being treated in the ED, Washington County Hospital allows two visitors per patient. Blake urges people not to bring their children to the ED. The hectic pace, serious patient conditions, and airborne germs make the ED a not-so-friendly place for children.

Don’t Ask Us about the Patient on the Stretcher
Patients often ask Staci about the condition of other ED patients (is that guy going to make it?). “We can’t tell you what’s going on due to HIPPA laws,” said Staci. She asks patients to use a little empathy. Would you want people inquiring about your serious condition?

Walk in Our Shoes
“There’s an expectation that you’ll be seen quicker in the ED,” said Staci. When patients’ minor injuries are not addressed right away, they perceive nurses as indifferent. The ED nurses are simply busy. “When we get to you, we may have just come from a ‘life or limb’ situation,” said Staci. It is a job where changing gears, multi-tasking, and caring for over 200 patients a day is the norm in a twelve-hour shift.