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CoVid19, Emergency Medicine & Emergency Departments

While facing the undeniable challenge of the COVID19 pandemic, we can reassure the Irish public that Consultants in Emergency Medicine, doctors training to be Consultants in Emergency Medicine, other doctors working in Emergency Departments (EDs), our ED nursing colleagues and other staff working in Irish EDs will continue to deliver care to the sick and injured as best they can. 

Those working in hospitals have come together to develop contingency plans to best manage the expected onslaught of sick patients infected with CoVid19 and their impact on the healthcare system. The professional links with Emergency Medicine colleagues in other countries and links we have within Ireland (with the HSE, through the Emergency Medicine Programme; Department of Health and with our Intensive Care and Primary Care colleagues) have been useful in our preparations. Notwithstanding these preparations, attendances at Ireland’s EDs by patients with respiratory symptoms can be expected to increase rapidly over the coming days and weeks and many will arrive over short periods of time. With our nursing colleagues we will endeavour to triage (assess) and treat according to clinical need; identify those who can go home, those who need to stay in hospital and, alongside our Intensive Care colleagues, those who need critical care support. Other patients needing emergency care will continue to attend EDs and while we will aim to care for everyone, the experience of colleagues in other countries and public health predictions indicate that demands on EDs will be enormous and we will have to use the available resources in a way that ensures the best outcomes for the greatest number of patients. 

The past week has seen a massive reduction in the number of admitted patients waiting in EDs for inpatient beds (inpatient boarders) manifested in reductions in the trolley count. This confirms what can be done if the political and management system prioritises doing it. The personal commitment of the Director General of the HSE has been key and the input from the National Clinical Advisor, Acute Operations has been really useful; over the past week there has been significant work done by many to create the hospital capacity for the large numbers of patients that will need care over the coming months.  

IAEM has long flagged the lack of bed capacity, infrastructure and staffing in public EDs in Ireland and, even before this pandemic, delivering care in EDs in Ireland has often required heroic efforts.  The coming months will stretch us further and the public need to bear with us as we try to provide the best possible care in very trying circumstances. We need to ensure EDs are supported as well as possible with appropriate Personal Protective Equipment, adequate staffing numbers and bed capacity on an ongoing basis. 

IAEM strongly supports the work done by our colleagues in Public Health over the past number of weeks and the contribution this weekend from the President of the Irish Medical Council has been hugely important. It is imperative that the public follow the sensible advice provided by the HSE & Department of Health which gives us the greatest chance of reducing the numbers that will become significantly unwell and or die from this pandemic. The important messages about the need for regular hand washing, social distancing and the avoidance of contact with those who are at the greatest risk should they contract CoVid19 infection need to be understood by all those in society. All of us need to take responsibility for ourselves as individuals. 

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