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OP-ED: Are we prepared for what is coming?

['Dr. Robert Martel – Guest Shot']
['Dr. Robert Martel – Guest Shot']

Annual crisis that will face our emergency rooms and its over-worked personnel is just around the corner

‘The better you are prepared, the better chance you will have of staying on top of everything that is coming your way’ has been advice that most parents have tried to pass on to their children from time immemorial. Another well-worn phrase goes like this: ‘preparation through education is less costly than learning through tragedy.’

For those of us who have spent many years in emergency departments in this province, we have observed that each year at roughly the same time (Dec. 20 to April 15) the wheels barely stay on the bus. There is evidence that people suffer increased morbidity and mortality because of the system’s inability to cope with people presenting for care at this time. Each year health workers run around with their hair on fire trying to address the needs of their patients.

This was well articulated by the emergency room physicians at Valley Regional Hospital in Kentville last winter when they were asked by their Nova Scotia Health Authority (NSHA) supervisors to see sick patients on stretchers in hallways and then had to ask those same patients (many of whom were elderly and frail) to get off the warm stretcher to make room for someone presumably sicker than they were. Why? Because the emergency room was at 110 per cent capacity and because admitted patients had no place to go but, more significantly, primary heath care was simply not meeting the most basic demand of its constituents: access to timely care within their own communities.

We have also known, for the better part of two decades, that there are easily identified reasons for the Emergency Department (ED) surge:

1) health care staff and administrators scheduled holiday time so that regular services are adjusted accordingly, resulting in back-ups in clinics and even Operating Rooms

2) decision makers (especially in the hierarchical system we have created) are not anywhere near the front lines

3) family physicians and other community based health-care workers are not as available, resulting in people seeking other venues and personnel to address their problems resulting in an increased demand on emergency department services

4) the desire to delay seeking advice or intervention until the holidays are over

5) the predictable tsunami of sick people who present with the annual flu

6) the lack of health human resource planning for the gray wave that has both increased the number of those seeking health-care interventions and simultaneously reduced the number of workers to provide care.

On Aug. 24, 2019, Hurricane Dorian struck the Bahamas a devastating blow. Immediately, Nova Scotia EMO officials, private corporations like Nova Scotia Power, Bell Aliant and Telus, municipal and provincial governments and private citizens started preparation for what was predicated to be a direct hit on Nova Scotia. Each of these groups would know what can happen with hurricanes and other natural disasters (Hurricane Juan and White Juan).

As a result they asked their people to suspend their leaves, staff from other jurisdictions were marshalled (ahead of the event) to bolster home forces, budgets were adjusted to assure adequate resources were available and, most importantly, leadership was focused on the end game: restoring normal and timely services to their clients.

How is the annual ED over-crowding phenomenon different from hurricane preparedness? The former has a longer lead time than most hurricanes, the outcomes are more predictable, the location is easily identifiable and the need to return to normalcy is a life threatening imperative. Yet every year we end up with the same wringing of hands and familiar phrases from managers of the health system claiming that the surge is a blip that will soon pass. After Hurricane Dorian, Nova Scotia Power was criticized for not being proactive enough with respect to tree clearing under power lines, communication companies were admonished for their lack of preparedness and politicians and business leaders were quick to point fingers. Why isn’t the health system held to the same level of scrutiny or outcome metrics?

The annual flu will hospitalize approximately 12,000 people and kill approximately 3,500 across Canada. These data are irrefutable. Therefore health managers know that at the very least 10,000 hospital beds will be required to address the surge that the flu will cause, to say nothing of increased health human resources to cope with the PREDICTABLE load. Yet each year we are told that we do not have enough resources, both capital and human, to address this recurring and predictable event. Why do we accept this?

In less than nine weeks we will begin the annual struggle with an increase number sick people seeking care in our over-crowded emergency rooms. Is that enough time to prepare? A recent report to the NSHA board on ambulance off-load delays indicated that improving turn-around times (ambulances’ ability to return to active duty) improved but the consequence was to increase the burden on other parts of the system; another entirely predictable outcome.

How prepared is the NSHA for the recurring crisis that will face our emergency rooms and its over-worked personnel? In May 2019, it was reported that nurses at the QE II in Halifax pleaded with management to call a Code Orange (ED is unsafe at current work loads) when the Halifax Infirmary emergency room was understaffed and overcrowded but they were denied. How has the NSHA prepared for the upcoming predictable workload that will face these same nurses this winter?

Is there a plan to increase capacity within the nursing home environment, move patients to alternate venues like hotels, hire more heath workers to help, educate people on preventative strategies (akin to having bottled water, candles and food at the ready)? Will front-line managers be given decision making powers and have discretionary spending authority? And, finally, will the NSHA share with Nova Scotians how the infrastructure will be modified to address the recurrent problem, akin to building better dikes and moving people away from threatening shorelines.

Who should be held accountable for the failure to recognize that repeated warnings about recurrent events have been ignored? Who will be held to account for the increase in morbidity and mortality that is associated with overcrowded EDs?

A wise man said: ‘There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.

Robert Martel, MD, is a retired emergency room physician/palliative care physician. He lives in West Arichat, Richmond Co. and can be contacted at rmartel@eastlink.ca.

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