IAEM Warns of Implications of Emergency Department Overcrowding for outbreaks of Infectious Diseases including Influenza
Spread of infection is greatly increased in overcrowded environments. In any situation where a large number of people are in close proximity, the potential for a contagious disease to spread is greatly enhanced. Where these people are already unwell and are vulnerable to infection the problem is greatly magnified. This applies to the common cold but also applies to more serious conditions such as Tuberculosis, Norovirus (Winter Vomiting Bug) and to potentially serious respiratory viral illnesses such as Influenza.
Ireland’s currently overcrowded Emergency Department (EDs) are an example of this environment. A large number of vulnerable patients, particularly elderly patients, many of whom have a variety of underlying medical illnesses, are crowded together for extended periods in cramped conditions while being forced to wait for an inpatient bed. Inevitably should any serious contagious infection be introduced into this environment many will be infected, some of whom may ultimately die and many may have adverse medical outcomes. (This phenomenon was most dramatically seen in Toronto in 2003 when a Canadian national returned from Hong Kong with SARS and infected adjacent patients as well as staff in an overcrowded ED resulting in an outbreak which ultimately saw 251 patients infected around Canada with 41 deaths).
To date, Ireland has not had such a dramatic outbreak. However there have been many examples of patient-to-patient transmission of infectious conditions, particularly during periods of greater ED overcrowding. The ongoing failure to address ED overcrowding, in spite of multiple promises, has left Ireland’s ED patients very vulnerable to an outbreak of infectious disease. Influenza is of particular concern at present as it has begun to affect the country again.