The current CoVid19 impact on Emergency Departments

This week has seen the continuation of on-going intensive and detailed inter-agency working, co-operation and contingency planning throughout Ireland to manage the spread of CoVid 19 infection in our community in a way that minimises its effects on individual health, population health and our economy. This has inevitably led to a flood of information in many different media, informing everyone how best to stay safe and work together to ‘flatten the curve’. The Association cannot emphasise too much just how important it is to lessen the impact on the finite capacity of our healthcare system by reducing the number of patients requiring acute hospital care simultaneously and reiterates strongly the need for the public to follow the clear guidance on social distancing, cough etiquette and the importance of repeated, prolonged hand washing to help achieve this goal.

There has also been much speculation and some ill-informed commentary on the impact that the presence of CoVid 19 in the community and the measures taken to combat it are having on Ireland’s Emergency Departments (EDs) and the reasons for this. Our view as the experts in Emergency Medicine is that the flow of patients through EDs has improved greatly as a result of a number of main factors. These include: i) a reduced number of ED attendances due to there being fewer episodes of injury, infection and the exacerbations of chronic conditions in the community as a result of the cancellation of mass gatherings, the closure of venues and social distancing; ii) the cancellation of scheduled non-emergency work in the healthcare system resulting in the dedication of the entire bed stock to emergency care, and iii) the hard work of staff in all areas of the health system to concentrate on and optimise patient flow. Many of those whose acute hospital care had been completed but who remained in an acute hospital pending the provision of services or resources in the community (the so called delayed discharges) have now been moved to where they should have been.

While these reduced rates of attendance have allowed time for staff to concentrate on the extra training required to ensure optimum preparedness, the Association is keen to reassure the public that the management of all time critical emergency presentations e.g. stroke, heart attack, severe breathing difficulties and injury requiring hospital attendance etc continues without interruption. Optimum preparedness in many EDs has included early diversion of patients into separate streams of those with suspected CoVid 19 infection and all other ED patients. We have some concerns that patients, in particular the elderly, may be minded not to seek medical attention for conditions which genuinely require urgent medical intervention so it is important to emphasise that while facing the undeniable challenge of the CoVid 19 pandemic, 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 on an on-going basis.

The enormous efforts being made by colleagues in very many other medical specialties and by hospital management to ensure that hospitals are as well prepared as they can be to deal with the expected onslaught must also be acknowledged. Ironically however, it will be the actions of the public at large that will ultimately determine whether these preparations have been successful or not.