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Yet another month punctuated by yet another snap COVID-19 lockdown. This tells us it will be some time before things begin to resemble normal for any extended period.

Thoughts go out to all affected by the latest restrictions in greater Brisbane: friends, colleagues and the broader community. While the most recent focus is Queensland, we all know another COVID lockdown could affect any of us, in any place, at any time.

Vaccines are our only hope of taking the next step towards COVID normalcy, and vaccinations must occur as quickly – and as equitably – as possible.

Already this year, there has been an immense public focus on the rollout of vaccines. This focus has included the various challenges in relation to supply, procedure and planning. It is, of course, welcome that vaccine rollouts have commenced, and are seemingly accelerating. However, there have clearly been some differences and inconsistencies in the way programs have proceeded within and across regions.

The College is continuing to seek ways to support and advance vaccine objectives. This requires consultation with relevant government agencies, and seeking to work as collaboratively as possible with healthcare colleagues and systems. The need for clear communication and co-ordination is ever more pronounced.

The vaccines currently approved for use in Australia and New Zealand are deemed safe and effective. As healthcare professionals, we have an important part to play in role-modelling, and promoting the uptake of vaccinations. We must also seek to address vaccine hesitancy, which we know is a factor in pockets of communities. We need to shoulder these roles and responsibilities for the sake of our families, and the patients, communities and healthcare systems we work for and in.

It is important to remember that, given the evolution of COVID-19, emerging strains will continue to appear. Therefore, vaccines available now are not likely to  be the last we receive. More vaccines will be developed in response to new COVID variants – variants we are already seeing emerging around the world.

It is going to be a long haul. Vaccine boosters and new developments are guaranteed to be part of our new normal. For now, it is  important  to gain as much protection as possible, with what is currently available.

Meanwhile, hospitals, health systems and governments must also maintain a focus on ensuring appropriate PPE remains available for frontline healthcare workers. There can be no room for complacency within the ongoing, multi-facted approach required to reaching a more COVID-normal existence.

We also need  to continue vaccine support to our Pacific neighbours, particularly Papua New Guinea, currently in the grips of a COVID-19 crisis. Right now, Australia and New Zealand remain in relatively fortunate positions, so  we need to look after our global community too.

Another very important component is ensuring vaccination hubs that have been established in our various jurisdictions are properly supported, supplied and resourced. This must include the necessary clinical support, to mitigate further pressure on already-struggling EDs.

This is crucial, particularly in the context of the other major issues we continue to grapple with in every jurisdiction in Australia and New Zealand; access block and crowded EDs.

Across our two countries, massive demand is resulting in many EDs experiencing their busiest months, ever. This has brought many to breaking point.

These are systemic issues, which manifest in the ED. The frustration of ED staff – including the very skilled ED nurses with whom we work so closely – in feeling we are time and time again left carrying the can is entirely justifiable.

Recently, we have had success in drawing attention to these issues in some jurisdictions. But there is more that must be done to secure the action needed from ministers, governments, health departments, and healthcare system and hospital leaders.

Some of the significant pressures may be attributable to some unmet healthcare need during COVID restrictions, and potentially some post-lockdown exuberance. However, the reality is that these issues are a continuation and an exacerbation of the trends we were seeing prior to the pandemic. It cannot be written off as a blip or an unexpected surge. We need to see the systemic support and planning that builds on solutions we continue to offer as a College.

There are a range of solutions to these problems, many of them resting outside the ED. We are talking more staffed and resourced beds on wards; greater flexibility from the wards to take on patients when the EDs are overcrowded; more access to diagnostics for ward patients; extended hours for clinical and diagnostic services; more operating theatre time to clear backlogs; and the understanding that elective and acute patients must be managed in tandem, with careful planning for acute presentations.

So the solutions are there. They just require buy-in from across the system.

There can be no more excuses or obfuscation. We will continue to counter the bogus narrative, so popular with politicians and administrators, that it is GP-type patients who are the predominant cause of access block.

We know this is untrue. We know that this untruth detracts and distracts from the real issues. And we know it is the real, systemic issues where we must channel action.

System leaders must listen and respond to the views and concerns of the staff at the coal face.
From my discussions with colleagues in recent weeks, it is clear that many of us are feeling immense pressure.

Workload pressure, certainly, but also the kind of pressure that comes from feeling not listened to. Instead, we are feeling ignored and unsupported. This is not acceptable, and it must change.

This is about respect and it is about kindness for our whole emergency medicine family; for ED doctors, for emergency nurses, and for all the emergency staff who give so much to provide the best possible care.

In finishing, I must acknowledge and thank the emergency medicine family for the incredible work you have done, and continue to do, across our two countries. Many of you are hurting and many of you are struggling. I appreciate each of you. I thank each of you for all your efforts.

I want to assure you that I, and your College, will continue to fight for the changes, the reset, and for the greater respect that we all need.

While we should always look for signs and optimism and hope, I appreciate that the challenges are significant right now. But as we have seen before, and as we will again, together we can get through.

Kia kaha,

Dr John Bonning
ACEM President