The COVID-19 situation continues to evolve and change daily, dominating much of the global news agenda with much hyperbole. While coronavirus certainly remains cause for concern, and cause not to be complacent, it is not cause for panic or public hysteria. Whilst we must continue to plan for the surge, be careful, and listen to government and travel advisories, it is important to retain perspective and ensure community and emergency department responses remain proportionate, and based on the latest available evidence. We will continue to provide updates as appropriate.
As the situation evolves, emergency doctors and our emergency departments will continue to feel the impacts on the front line. As always, we will rise to the challenge and continue contributing productively to the whole-of-system response.
To support the ongoing response, all governments in Australia and Aotearoa New Zealand must provide the resources, policies and measures necessary to mitigate risks to the community and healthcare staff, and ensure frontline efforts are safe and sustainable.
Amid the significant challenges there are also opportunities for collaboration and improved lines of communication with other skilled healthcare clinicians and governance bodies in our hospitals and health systems. The whole of our healthcare systems from primary care through to and beyond hospitals will have to rise to this challenge, with all healthcare professionals working within their scope to mitigate the surge. All hospitals, both public and private, pathology labs, and general and private practice must be part of the solution.
As the impact of COVID-19 increases in Australia and Aotearoa New Zealand, it will not be business as usual, and measures to address any increase in the current state of demand on EDs such as the cancellation, or moving to the private sector, of non-urgent elective surgeries are rightly being factored in to emergency planning discussions.
There is talk of a need to double ICU capacities, as well as the need for additional capacity across our entire healthcare and hospital systems; and we all know this won’t happen overnight. Respiratory/fever clinics, both in the community and co-located with EDs, will need to happen and these must be appropriately resourced as they become necessary. Separate testing facilities in the community for otherwise well patients will be very important to safeguard the health of the many vulnerable patients who attend EDs every day.
We also know there will be patients coming in with complex co-morbidities with the coronavirus co-infection. While emergency medicine is well placed with the skills to deal with these critical patients, it is important that measures are in place to keep the community and healthcare workers safe.
The COVID-19 situation has also starkly highlighted the everyday stressors we face in the emergency department.
We know from daily experience that beds within most public hospitals are full most of the time and staff and patients in EDs are experiencing overcrowding and long waits already, even before the ‘flu season’ has hit the Southern Hemisphere.
Within planning, considerations and discussions, there needs to be acknowledgment that pandemics will happen again; and even when we aren’t in the midst of emergency situation such as coronavirus, major systemic issues must be addressed to improve health system sustainability and ensure there is capacity to keep the community and medical staff safe, every day.
On the issue of information, while plenty has been made available, some have raised concerns, particularly in relation to consistency and co-ordination of updates from state and federal jurisdiction within Australia. This will be conveyed to the relevant authorities in ongoing communications, as will our concerns about capacity and other areas of need.
In February, the College also issued a statement calling for a unified and respectful approach to coronavirus following concerning instances of xenophobia and racial profiling from some patients or families in the ED. It was disappointing to see reports of further incidents later in the month, and we once again condemn racism and xenophobia, and reiterate the need for calm and unity.
With so much happening, we often hear about ‘busy-ness’; how busy we all are. I don’t think many would dispute that in emergency medicine everybody is busy, and perhaps more so than most. Given busy-ness is a near constant, it can be helpful to consider this notion in different terms. With that in mind, my wife and I have recently made a commitment to discuss our days, not in term of being ‘busy’ but rather in terms of being ‘productive’.
That’s not to disregard that busy-ness is there; it exists and places us under pressure. However, the term ‘busy’ tends to have negative connotations and create the impression of being overwhelmed, whereas being productive echoes that we are all striving towards something, aiming to better ourselves, our workplaces and our patients’ lives; putting some reward, a sense of achievement and positivity into the descriptor.
To be productive we need, of course, to acknowledge and address the many issues facing EDs, staff and health and hospital systems. We can do this in a productive way, looking for the light at the end of the tunnel.
The 2019 Sustainable Workforce Survey report, which will shortly be available on the ACEM website reiterates the stressors we face due to access block, overcrowding and relations with inpatient teams.
Key to addressing these issues is sustainability, and the vital role it plays in productivity. We must find ways to reduce high levels of burnout, to improve career longevity and reduce stress. And we must keep looking out for each other – reach out if you need to.
An important part of this is being mindful of and maintaining our wellness. I am pleased to confirm that the College will again be supporting 2020 Emergency Medicine Wellness Week from 6-12 April, the focus this year being the health of emergency physicians and its impact on patient care.
This aligns with the ACEM, ACEP, CAEP and RCEM joint statement, calling for action to address the impacts clinician burnout can have on patients, colleagues and health providers. It’s an acknowledgement that individual and system factors contribute to burnout in physicians, highlighting the need for action from emergency and healthcare organisations, governments, hospital systems and networks and ED leaders. I encourage you all to consider how you can contribute to Emergency Medicine Wellness Week 2020, from both an individual and ED perspective. #EMWW2020.
One vehicle for positive change available to you is the College, and its array of engagement and networking opportunities. Along those lines, it’s pleasing to see that we are shortly set to confirm our new Faculty Boards and Chairs, as we continue our advocacy and representative work at the jurisdictional level. I encourage you to familiarise yourself and engage with your local Faculty Board; get involved with events and activities. They are an important avenue for involvement in the College, and a means of advocating for the change you would like to see.
A recent example is the appearance of representatives from ACEM’s New Zealand faculty before Parliament’s Mental Health and Wellbeing Commission in Wellington on 12 February.
I am constantly in awe at the vital, impressive and committed work emergency department staff perform every day, and what we can achieve. While we are all contending with past, current and ongoing challenges, I am positive about a productive rest of 2020 and beyond. I wish you one as well.
Kia hora te marino
Kia Whakapapa pounamu te moana
Hei haurahi mā tātou i te rangi nei
Aroha atu, aroha mai
Tātou i a tātou i nga wā katoa
Hui ē. tāiki ē.
May peace be widespread
May the sea be smooth like greenstone
A pathway for us all today
Give love, receive love
Let us show respect for each other
Hui ē. Tāiki ē.