Emergency Room Crisis

An article in today's Winnipeg Free Press (Grace's ER in peril - March 3, 2007) once again speculates about a possible ER closure at the Grace hospital. Last year the province offered physicians $1,500.00 for every five shifts they covered at the Grace in an effort to offset a staffing shortage at the facility. Today that shortage remains, and it's not uncommon for patients to wait up to 10 hours to see a doctor. The government's solution as we move into 2007...cash incentives for physicians to pick up extra shifts. Am I missing something here?

Wait times in Winnipeg emergency rooms have been on the increase for years now. Not only are patients waiting longer to see physicians, but as you've undoubtedly experienced yourself, paramedics are often delayed far too long waiting to transfer care of their patients to hospital staff. In January of 2004 the provincial government undertook a formal review of the emergency care system in Winnipeg, and at that time we urged the Health Minister to encourage decision makers to "think outside the box" in efforts to find appropriate solutions to the problem. Among the recommendations we made at that time to help minimize ER problems:

• increasing the number of Urgent Care facilities available and enabling paramedics to transport or refer patients to these facilities in lieu of an ER when appropriate;
• developing appropriate paramedic treat and release protocols, resulting in fewer ER admissions;
• utilizing Advanced Care (and in future Critical Care) Paramedics in emergency care facilities to assist with triage, patient re-evaluation and high workload efforts including resuscitative measures.

The strain that is placed on our emergency rooms is only going to increase. The number of seniors in Canada has more than doubled in the past twenty years to almost 4 1/2 million. And it's projected that by the year 2026, that number will more than double again to 9.6 million. As the Emergency Medical Services Chiefs of Canada quite appropriately point out in their white paper on the future of EMS in this country (The Future of EMS in Canada: Defining the New Road Ahead)..."the status quo is clearly no longer a viable option".

As part of the effort to reduce the strain on Winnipeg ERs, Manitoba Health published an Emergency Room User Guide. In an effort to better educate the general public about proper emergency room use, they suggest there are certain conditions that are best dealt with "by a family doctor or local health clinic", and in fact recommend the use of Urgent Care facilities such as the Misericordia Health Centre and the Pan Am Minor Injury Clinic when appropriate. Yet paramedics are still required to transport to an emergency room.

In their white paper, the EMS Chiefs of Canada recommend that EMS become part of a "system" of health care that allows resources to be used more effectively and efficiently. They go on to say that it may "be clinically appropriate and beneficial to the health care system to assess, treat and release the patient or transfer them to another health care agency" (other than an emergency room). And yet provincial medical direction here in Manitoba refuses to consider the possibility of developing protocols to do just that.

Research suggests that only 10% of callers using 911 actually have a life threatening emergency. Many are in need of urgent or primary health care, and in fact could be dealt with through channels outside of the conventional emergency room. Innovative programs are underway in other Canadian jurisdictions to better integrate paramedics into the health care system and help minimize the increasing strain on emergency rooms and staff. Asking doctors, or for that matter any health professional, to pick up extra shifts is not the solution. We need to redefine the traditional model of pre-hospital emergency health care.

Money spent "bribing" practitioners to work longer and harder will only exacerbate the problem. Money spent on improving our EMS system can help address the real and increasing strain on our emergency facilities. Not only does it stand to reduce current pressures on our ER facilities and resources, but as pointed out in the EMS Chiefs white paper, "EMS high-level care can minimize time spent in the ICU, avoid additional complications and reduce the probability of on-going long term pressures on the health care system".

Again I ask...am I missing something here?