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Be Prepared for Emergencies in the Clinic/Office: I know I wasn’t

February 17, 2012

Be prepared, boy scout or not!

Most Family Practice (and Specialist) clinics are not prepared to deal with an Emergency walking in their door. Yet, patients will often turn to a nearby clinic for help instead of calling an ambulance.

I remember once, as a resident, seeing a patient who came in to the clinic for a schedule appointment and happened to be having some chest pain. He thought it was anxiety due to some recent stressors at home. He didn’t look unwell or uncomfortable so I asked him a few questions and examined him. In the back of my head, I figured this patient should have a cardiac workup, just to be safe. This means some blood tests and a heart tracing (EKG). There were a few red flags so while it could be done at the outpatient lab around the corner from clinic, it just didn’t make sense. Since I was worried enough to want this testing done, the safest thing was to recommend he go to the ER. I gave him some aspirin and his friend drove him to the hospital from our clinic on the outskirts of town, and it turned out yes, he was having a heart attack. His troponin – the chemical the heart leaches out in to the bloodstream when the heart tissue is angry, as when deprived of oxygen in a heart attack – was 2.41. That’s high! Definite heart-attack high.

In retrospect, I should have called the ambulance to take him in. Patients with heart attacks can suddenly go into dangerous heart rhythms, and a paramedic can detect and deal with this, whereas a friend driving a car cannot. Although the patient got timely and appropriate care, and nothing bad happened, it could have. Had he gone into such a rhythm in clinic, we would have been woefully unprepared to help him in a smooth and efficient manner. In an emergency, one needs to know their role in care-giving, where all the helpful equipment is, and how to get the patient to definitive care (i.e. the hospital). That makes it easy to stay calm and to ensure that everything the patient needs is done when and how it should be.

Dr Simon Moore, a friend and Resident Physician in the Nanaimo Family Practice program, has recognized that most clinics are like the one I was present in; staff are not prepared to deal with real emergencies and often fail to call 911. Equipment that can save a life may be present, but is scattered or hidden.

One of the graduation requirements of UBC’s Family Practice Residency Program is that residents participate in a research project in their final year. Simon has gone above and beyond with his project, a video that can make a difference. I encourage all health care practitioners to see his incredibly high-end video (and complete the brief survey for research purposes). It can help you prepare your staff and office for that day when you face an unexpected emergency.

Find it at http://www.officeemergencies.ca

5 Comments leave one →
  1. February 20, 2012 10:20 am

    There is something about going to the ER with vague symptoms that just feels wrong. I can sort of understand how patients decide to come to a clinic instead of a hospital emergency room.

    I sometimes wonder if the messaging around keeping trivial complaints out of the ER gets interpreted by the wrong people – the ones who wouldn’t bring trivial complaints in, and are scared to waste resources when all they feel is a little chest pain or tightness in the throat.

    • February 20, 2012 7:04 pm

      hah exactly Penelope!

      Given the “ERs are overcrowded, come if it is serious or call the nurses line” message, there are two schools. The tough people who hate going to the doctor and don’t want to burden anyone hear “don’t come to the ER at all.” The ones who regularly go with every little bitty thing hear “it could be serious!” There are of course the in-betweeners, but it is hard for anyone (including doctors-as-patients) to guess correctly if what they have is minor or the beginning of something serious.

      Sometimes the itty bitty things are serious, and sometimes the things that people are too stoic to get checked out end their life. Clinics should be prepared for emergencies, and the ER should have a system in place to deal with the CTAS 4 or 5 stuff (low priority, triaged as minor cases), anticipating that these non-emergencies will continue to make up a big part of their traffic.

      Most ERs have a ‘Fast Track’ for the minor things and that can really ease up the Acute side, but most clinics do not have much in the way of expectations and preparedness for Emergencies. That’s why I think Simon’s video is such a great thing!

  2. Prakash permalink
    February 23, 2012 12:15 pm

    Nice post, keep going

    Thanks
    Prakash
    http://medicalinformationforyou.blogspot.in/

  3. Simon-Pierre permalink
    February 27, 2012 4:44 pm

    This is great work, and the film puts the emphasis on how health care workers should be thorough designing their work environment. In so many different fields ex; road infrastructures, schools, CPE (Quebec’s centre petite enfance – kindergarden) working environment get audited for safety and quality. These audits are not expensive and don’t need to happen that frequently.

    MD offices, walk-in clinics and other out-of-hospital health care facility should not go under the radar with shady (questionable) design. Doctors, for too long, thought they did not need to take care of this stuff, or did not want to spend the money.

    These were the old days. Nowadays, clinics should get audited, and receive government’s subsidies to implement the changes required. Then fines should apply. This is a cheap way to better care.

    Then apply this to waste management and efficiency improvement. Utopia ?

    • February 28, 2012 1:10 am

      is there a “like” button?

      totally agree, SP!

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