As Former ACEM President Dr Simon Judkins said, “The dam wall has well and truly broken.”

All of us working in emergency departments – nurses, cleaners, doctors – are under extraordinary pressure as we contend with providing business-as-usual emergency care over the busy summer period, as well as managing increasing COVID-19 presentations, while carrying higher than usual staff shortages.

I am in contact with Faculty Chairs and other FACEMs in each jurisdiction across Australia and in Aotearoa New Zealand and it’s the same story everywhere: workforce is the main problem. We simply do not have the people. Staff are isolating due to COVID exposure, or because their kids have become ill. Staff are on desperately needed leave. Staff are burnt out and are leaving. Staff cannot cross the borders. Staff have had childcare cancelled. Senior nurses have left as well as ED support staff. This leaves huge gaps that cannot be filled, and leaves many of us working below our scope of practice.

Right now, it is not uncommon for me to make beds, stock trolleys and answer phones. This would not be a problem – I don’t mind – except it prevents me doing my actual job. We need urgent measures to rebalance the ED workforce to ensure that the high-level skills of all health professionals are put to best use.

Frontline staff are reporting that while many COVID-positive patients being seen at EDs are requiring admission to hospital, many also – although requiring clinical assessment – are well enough to be discharged.

We are also aware that many people who have received positive COVID test results, either from self-administration of a rapid antigen test, or following formal PCR swab, have been presenting to EDs because they are unsure what they should do.

Although these issues are currently being experienced mostly in New South Wales and Victoria, where case numbers are highest, similar scenarios are occurring and emerging in other jurisdictions and must be responded to and planned for as cases continue to climb. We are grateful for the support of colleagues in primary and community care who have also been working hard to manage the increasing caseload.

There have been numerous communications to the public about saving the ED for emergencies – indeed, some have come from us at the College. 

While we continue to encourage people who are not experiencing a medical emergency to seek care via other pathways, we must also be careful that we don’t blame the general public for seeking inappropriate care in ED, especially when other care options are not accessible due to planning and system failures. 

Many people are frightened. For two years, they were told that COVID is a life-threatening disease and to seek care very early, with even minor symptoms. They are now being told that COVID is a mild disease that can be managed at home, which is a very sudden change in advice. 

We need clear and consistent communication about COVID. What is the strategy? What is the plan? Who should get tested? How should people seek care, and when? Messaging needs to be honest, empathetic and free of politics. Acknowledge the suffering and hardship, acknowledge the uncertainty – then show the community the way through. 

Health departments must engage with emergency clinicians. As the College has repeatedly said throughout this pandemic, the resources required to provide appropriate healthcare, across hospital and emergency department, as well as primary and community settings, must be factored into ongoing healthcare system planning and responses to COVID-19 by all governments. Reported numbers of admissions to hospital, or to intensive care units, do not adequately represent the pressures on emergency departments, or general practice, as increasing numbers of people infected with the Omicron strain seek medical care.

We know that the health system is fragmented and difficult to navigate and that this is not because of COVID – it has been like this for years. Out of pocket costs have increased dramatically. Timely access to healthcare is especially challenging for those who have chronic illness, low incomes, low levels of education, or are marginalised for other reasons. 

The pandemic has exposed the fault lines in our health system. We will all work hard to get through the current COVID wave, but we must remember how it feels now. We need to make sure health reform is on the political agenda. We need to build a new health system, one that is safer, fairer, and accessible for every member of our communities.

There are three important elections this year – the South Australian and Victorian state elections and the Australian federal election – and ACEM will be advocating fiercely for emergency medicine and public health systems in each. We have had enough of Governments who neglect the health systems they are tasked with supporting. We have had enough of access block. We have had enough of staffing issues. Australians, New Zealanders and healthcare workers deserve much more – better health systems, better governance, and better leadership.

Until next month, thank you, for all that you do. 

We will get through this together.

Dr Clare Skinner
ACEM President