How to be the emergency room frontline

Grey’s Anatomy it isn’t. And George Clooney has yet to darken the doorway. But give him time. Just about everything finds its way to the Wyoming Medical Center emergency room in Casper eventually.

And when it does, the two-person triage and intake team has to figure out what to do about it.

“Hello. How can I help?” is a good place to start. Kat Stewart, a certified nursing assistant, ER tech and veteran of the ER reception desk has the delivery down, just on the warm side of clinical.

Whether it’s a wild-eyed laborer howling through the metal detector and trailing blood from his sleeve (“Hydraulic press,” explained his visibly shaken coworker); a sick toddler, the same age as your own, struggling for breath; or an anxious young woman quietly confiding ”It really hurts when I pee,” your professionalism can not waver.

“You can’t get rattled, or show too much emotion,” Stewart explained. “And absolutely no judgement… . Everyone is seen, treated with dignity, and cared for,” regardless of medical urgency, or ability to pay.

‘Everyone’ is a big category, and growing as demand outpaces the supply of social services elsewhere. Arrestees enroute to jail, addicts needing to detox, drug abusers looking for a fix, the mentally ill in crisis, the destitute without any other access to care, absentee workers wanting doctor’s notes, the homeless looking to warm up, the elderly sliding into infirmity, the desperately overwhelmed, the simply confused and those who just couldn’t be bothered to make a doctor’s appointment — they all rely on ERs statewide, right alongside the car wreck victims, heart attack sufferers and flu patients.

At WMC alone, it comes to about 38,000 visits each year.

So you field each in turn — “I think she hit her head. She’s, well, not quite right.”…  “My baby has a fever!”… “Doc said to come back if my cellulitis spread.”…  “No, it’s not a rash. It’s a blister, one big blister with a thousand little blisters on it.” — hustle between desk and triage bays, take vital signs, order tests, collect samples, perform preliminary exams and initiate EKGs.

Keep an ear out, someone’s sure to appear at the desk as soon as you turn your back.

Do not fall behind on the data entry, ever.

Plan on attending to family and friends nearly as much as patients. They have questions, lots of them. Emotions will run hot. You control access to their loved ones. Sometimes you have to say no.

Harder still, sometimes you have to call for the chaplain and arrange for a private room.

But no matter what’s happening, maintain situational awareness.

Does that boy need a vomit bag? You’d better realize it before he does.

Was she that pale and clammy when she came in? There are no excuses for missing the signs of a stroke or cardiac arrest.

Is that man going to stop pacing, place a loaded .45 on the counter, and tell you he’s suicidal? If so, you’ve got to see that coming.

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Everyone needs you to see that coming, especially him. Because you can help. If you do, you may eventually send him back out the front door, like most of your patients, in better shape than when he walked in.

He may even get to hear your go-to farewell.

“Have a better day.”