Forewarned is fore-armed, or is it?

Sometimes in the Emergency Department we get warning that a seriously unwell person is arriving, and this allows us to prepare the resuscittation room.  Other times, we get little or no warning.  Does this mean we’re not ready for the patient?  At first glance it would seem so, but in reality it doesn’t make any real difference.  I think this is because we always have the resuscitation room ready, even when we don’t have anyone expected to use it.  Sure the drugs aren’t drawn up and the chest drain pack hasn’t been laid out.  But it only takes a few seconds to do that anyway.

During my career in emergency healthcare, I have noticed that the main effect of a long prior warning time before receiving a seriously injured or unwell patient is that some staff have time to have nightmares.  They get anxious about what to expect, and try to second-guess everything. My own approach is to be prepared for the worst at all times, so that whatever comes in the door I can deal with it.  Doesn’t always work, but I don’t often ‘lose the plot’.

I remember one shift in a busy regional ED where I was Team Leader.  We had more patients coming through the door than we had spaces to put them, so I had to allocate staff and cubicles to deal with the most urgent.  If I had stopped to think about it, I don’t think it would have gone very well, but at then end of the shift, we had coped pretty well with the workload.  Because I kept calm and seemed in control, the rest of the team were able to cope with the pressure.  Contrast this with a similar shift where a colleague was Team Leader, who had a tendency to second-guess decisions.  By the end of the shift we were all frazzled and fed-up.  And we didn’t even have a patient in the resuscitation area!

So why am I going on about this?  Well, a colleague was recently overheard complaining that the ambulance service hadn’t phoned through that they were bringing a fitting patient to our ED.  My opinion, for what it’s worth, is that when you are Team Leader, you always have a contingency plan in the back of your head.  Then you don’t need to be forewarned.  In fact, if you rely on being forewarned, there’s a risk that you become complacent until the phone rings.

It’s a bit like relying on the oil pressure warning light to come on before you get your car serviced.  Far better to plan some preventive maintenance.  OK, OK so it’s not a perfect analogy, but hopefully you get the point.

That’s it for now.

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