The past few weeks have certainly provided a reminder of the complex and fast-moving times in which we are living, with June seeing the world total COVID-19 cases swell from 6 million to well over 10 million in a month.
From a position of relatively well-flattened coronavirus curves across both of our countries in May and at the start of June, we have now seen some concerning increases in cases in Victoria and a smattering of cases in New Zealand, and in some other Australian jurisdictions in returned travellers.
Such upticks highlight the ongoing complexities presented by the pandemic and the pressures our hospitals, healthcare systems and workplaces will continue to come under in the weeks and months ahead, as this pandemic continues to fluctuate in our corner of the world. We are all acutely aware of the enormous ongoing impact to every other continent in the world (except Antarctica).
With COVID-19 remaining a threat, the associated infection control measures we must continue to employ in emergency departments, likely to be in place for 12 or more months, all require additional time, space and resources. Combining these with ongoing systemic and capacity issues contributing to challenges in admitting patients from emergency departments to inpatient beds or other definitive care; and presentation numbers returning to ‘normal’ levels post COVID-19 lockdowns; some most-unwanted and seriously dangerous issues have returned to our hospital EDs.
ED crowding and access block are back with a vengeance, perhaps worse than before, exacerbated by our institutions’ necessary but complicated infection control measures.
In times of COVID-19 it is unethical and unsustainable to allow this access block and physical crowding in EDs to continue, and finding fixes must be a priority for hospital and healthcare system leaders and governments.
It is well known that crowded EDs increase the risks to patients, including greater risks of morbidity and death, and the added infection risks posed by COVID-19 mean it is all the more unacceptable to have large numbers of people crammed in to enclosed waiting rooms, languishing in beds in corridors of EDs or worse still, in ramped ambulances, where tragically we have seen lives lost.
These are not just ED issues. They are threats to our communities and entire healthcare systems. Finding solutions requires understanding and buy in from everyone involved in our healthcare systems.
Working at the frontline, emergency doctors are eager to bring solutions to the table. To that end, following a period of consultation, the College expects to present new recommendations in relation to revised time-based targets and other systemic improvements, to raise with key decision makers, leaders and funders as part of our ongoing advocacy work.
COVID-19 has seen unprecedented inter-speciality and inter-sector collaboration and consideration of major healthcare challenges and systemic issues. It is that spirit of collaboration which we must capitalise on, to secure lasting and meaningful improvements. If there is to be a silver lining to this pandemic, it must be that it is the catalyst for genuine systemic change for the better.
As the short and longer term impacts of the coronavirus continue to be felt, be it through increasing numbers of acutely sick and injured patients presenting to our EDs, or the increasing numbers and complexity of mental health patients and issues presenting, we must act now.
On the issue of mental health, improving long-standing systemic issues to ensure some of the most vulnerable patients in our communities have access to the timely and definitive care they require is another ongoing area of advocacy for our College.
The problems of systemic failures and inadequacies leading to mental health patients facing dangerously long waits in the EDs, as well as possible solutions, are issues we have raised for some time.
Therefore, it was somewhat disappointing to learn of the recent intervention by South Australia’s Chief Psychiatrist in the Royal Adelaide Hospital in relation to the treatment of mental health patients via media reports.
While we of course welcome the Chief Psychiatrist focussing on improving the situation for mental health patients, and hope the intervention finally results in genuine change for the better, the official response cannot be to charge EDs and ED staff with the blame for longstanding, systemic issues which have been allowed to worsen over many years. We look forward to continuing to engage and address this issue in South Australia, and across our two countries.
Another current priority for our College, is the proposal to formally embed in the ACEM Constitution the commitment to improving the health outcomes of Aboriginal, Torres Strait Islander and Māori communities.
To help achieve this, all FACEMS are being asked to vote for the inclusion of a new object in the College’s Constitution which affirms that we will:
Strive for excellence and equity in emergency care for Aboriginal, Torres Strait Islander and Māori communities in Australia and Aotearoa New Zealand, through a commitment to the principles of Te Tiriti o Waitangi in Aotearoa New Zealand, the process of Reconciliation in Australia and the intent of the United Nations Declaration on the Rights of Indigenous Peoples.
While this may seem like a logical and common sense addition to our core document, our Constitution, to promote equity as a core business of our College, it requires support in the form of a formal vote from our Fellows.
I encourage all of you to help us take this important step, building on work undertaken over the past decade to improve cultural safety and foster partnerships with Aboriginal and Torres Strait Islander Peoples and Māori to address health inequities.
You can find out more and lodge your vote here before Monday 20 July 2020.
There is certainly no shortage of other work going on at the College and other areas I’m focussed on include looking at workforce issues both short term (access for overseas Resident Medical Officers) and longer term (the training pipeline and maldistribution), as well as the ongoing focus on College examinations and how best to run them in the current environment.
We’ll continue to provide timely updates on these matters as we work through them and they come to hand.
Finally, I’d encourage you to keep an eye out for the next edition the EMA journal and an opinion piece entitled Safer coalmines, happier, healthier and more engaged canaries, which I’ve co-authored with FACEMS and College staff, in response to an article in the previous edition suggesting that solution to burnout is not stronger canaries.
In these current trying times it’s more important than ever that we maintain a focus on our wellbeing and seek to address issues of burnout with all of the tools and resources at our disposal.
Without question, the first half of 2020 has thrown us more than its share of challenges and surprises, twists and turns and bad news. Throughout, I have been left repeatedly impressed by the innovation, commitment, compassion and hard work emergency doctors have shown, in meeting the challenges and performing their crucial work in service to our communities.
It would be brave, or foolish, to try and predict precisely what the second half of the year holds. Our colleagues elsewhere in the world are still struggling. Something I do know, however, is that we remain up to the task, and for that I am extremely grateful.
Please look after, and be kind to yourselves, your patients, colleagues and loved ones. There are persisting challenges, but we’ll keep getting through them together.
Be well and kia kaha
Dr John Bonning