After a tragic event in the hallway of an ER, people are speculating on what an ER should really be used for.
It is an Emergency Department.
The problem is that what someone deems an emergency is subjective.
For most people who are healthy overall with few experiences with pain or illness, emergency to them might be just another day with a migraine to another. For people who play sports on a regular basis and get injured in some way fairly regularly, emergency might only mean anaphylaxis, a broken bone or severed limb, herniated discs in the back, or pain that is so severe Tylenol won't touch it and it won't subside. Someone who has never experienced heartburn who experiences it suddenly at age 45, might very well think that it could be a heart attack. Sure they might be embarrassed for going to an ER once they find out it was heartburn, but if they have never had it, how could they know? For people with chronic illness, unfortunately ANY pain that is new, severe, persistent, and does not fit the narrative of their illness could very well be an emergency. For someone with Cancer, like the poor man whose life was lost in the hallway of a crowded ER, people are questioning why he was there in the first place.
He was dying.
Emergency is exactly where he was supposed to be.
He was not in a hospice or long-term care facility. He was not given a concrete 'life expectancy' date. He did not have home care.
He knew he had Cancer and would likely die relatively soon... but when that day comes - when you wake up and realize you are about to die, where would you go? I don't care if you expected it or not - that panicked feeling hits you, and all you want to do is live. So where do you go to try and survive when you are about to die? The Emergency Room at the Hospital.
People go to the ER for all kinds of reasons. Panicked first-time parents whose child has a fever, parents with kids who are screaming and bawling and they cannot figure out what's wrong... At 3am do you really expect them to assume their kid is fine and screaming and burning up for no reason? Or for a flu? There is no walk-in clinics open at 3am, Urgent Care is the next best option, but how many people new to illness know about Urgent Care facilities? Should they wait until 8am when the clinic opens, go in and wait for another hour or longer? What if it IS something serious?
What about a migraine? If you have never had them before, how would you react to mind-splitting pain, an inability to even open your eyes, feeling compressed on all sides like a screwdriver is penetrating your skull, in a vice, with uncontrollable vomiting and complete intolerance to any sound, light, or movement? If you have never had one, then in that situation are you really going to automatically KNOW you are experiencing a migraine? Or are you going to have your spouse check symptoms online? Are you going to call Health Link, research, freak out, then freak yourself out more, and think of every possible terrifying reason to be in so much pain? Are you going to think of words like "aneurism", "blood clot", "stroke", "Cancer"?
Would you wait and wait and wait and see your family doc a few days later? Would you go to a busy walk-in clinic full of bright lights and a huge lineup of sniffles and coughs?
As someone with active and moderate to severe chronic illness, there are times I have gone into Urgent Care or Emergency when maybe I could have dealt with it in the morning, or the next day. But there are twice as many times I have stayed home when I SHOULD have gone to Emergency - for fear of scrutiny for over-reacting or seeming like I shouldn't be there.
There are times when I have been uncontrollably vomiting for 8-10 hours straight and was too stubborn to go in. There have been times when I have had throat swells and tightness in my chest and decided to go to Urgent Care first. When I herniated my discs I saw my gp, Urgent Care, then eventually Emergency. Why? Because Urgent Care did not have MRI or CT equipment. They couldn't diagnose it anyways!
There are other times - like when I was vomiting blood, heart rate and blood pressure were through the roof, taken in by ambulance, to be told that I should not have gone in. Made to wait just under 12 hours to see a specialist. Days before I had gone to my GP, then a Walk-In Clinic the next day, all for awful and intense chest pain... and my last resort was ER, but I was reprimanded anyhow. It eventually turned out that I had a severe case of Esophagitis and was told if I had had one more dose of the medication that caused it, my esophagus may have perforated. Yeah... that can be deadly. (That was the doc who suggested I go home and eat probiotic yogurt - to fix the pain).
With chronic illness, most of the time I expect to wait 6-7 hours. Although I am not always in *immediate* danger of dying, they are still situations that need to be dealt with in the hospital. Things like severe dehydration requiring IV fluids. Urgent Care is where I go for that. If I need emergency intervention in order to stop vomiting - because otherwise it will continue for hours and hours and hours and HOURS - then I have to go in. I am instructed to go in. If I experience a new, severe, uncontrollable pain that does not fit with my illnesses - sure I will go to my GP first, then try urgent care, but if I can't get a handle on it, Emergency is where I have to go. Unfortunately, because most of my chronic illness IS severe and can ALL be life-threatening, I can't take any chances. Nor should I be forced to.
Injuries like sprained ankles, cracked ribs, torn muscles - we are taught to go into some kind of Urgent Care. Why? To make sure nothing is broken, nothing is going to progress and damage organs, nothing requires casts or surgeries or slings. But sprains and strains, to me, are far less of an Emergency than a lot of other situations - but we have to go in just to make sure. Sometimes it is less understood simply if that kind of 'injury' or pain is coming from internal causes. It *should* be more frightening to have internal pain like a sprained ankle, but most people do not see it that way.
I would say that 70% of people in the ER waiting room are feeling HORRIBLE, are absolutely TERRIFIED, have likely tried other avenues, and need professional, immediate, relief before they can go home. Pain is subjective. 'Emergencies' are subjective.
And if you have Pancreatic Cancer and you feel you are about to die - the ER is exactly the place you should be going. And you should be met with compassion. And you should be able to know that the ER staff will do what they can to rule out other causes. And if it is the Cancer that is bringing you to your final breath - you should be able to say goodbye to your loved ones in privacy, in relative comfort, in as little pain as possible. Not in a hallway with people yelling at other healthcare staff NOT to help you live.
*As a side note, most of my experiences with staff in the ER have been exemplary. The few bad cases were SO bad that they stick out - and I am sure that is the case for most of us. ER staff are often understaffed, overworked, and see things that no other human should ever see. They are doing their best and they are trying to triage all of the time. People make mistakes and things happen. Sometimes they make a quick assessment based on how people look or if they are laughing at a stupid joke - and assume that their pain is less serious than the one screaming in pain in another chair. (My family tends to make jokes all the time in these situations to try and lighten the mood. So even when I was near death from severe pancreatitis, I was forced to wait longer because I was laughing at some stupid thing my dad said, and the adult who was mildly constipated was screaming bloody murder - he was moved to the back immediately for instant treatment).
They have to make quick decisions - and their decisions can mean suffering and even death if a mistake is made. That is a ton of pressure. I am incredibly thankful for hospital staff - even after some terrible experiences.
My humble opinion.