Thread by @ghbledsoe

1/x As I skim the #COVID19 #coronavirus headlines tonight I realize that here in the United States this story is primarily playing out in a venue that is very near to my heart: the Emergency Departments (EDs) of our nation. #arpx #ARnews

2/x While all of health care will be affected by this pandemic, it goes without saying that the EDs of our country will be the primary recipients of the majority of these #coronavirus patients, especially those who are the most ill. #arpx #ARnews

3/x And so, because this is the backdrop of this unbelievable #coronavirus story, it would behoove us all to consider the ED, and consider what goes on there, because you truly cannot understand the #COVID19 story in the United States without at least a cursory ... #arpx #ARnews

4/x understanding of the place into which all of this tragedy will funnel. The ED in the US is unlike any other environment in health care, so let’s take a moment to set the stage so we can better explain the later acts. #arpx #ARnews

5/x EDs in the US are a chaotic place— this is obvious to anyone who visits. What is less obvious is that they are chaotic by design. Sure, administrators attempt to corral what goes on there, and visitors sometimes assume it’s simply a disorganized madness, but #arpx #ARnews

6/x make no mistake, EDs are built to absorb all the chaotic mess of our health care system— even our entire society— and condense it into a singular location. Wreck your car? To the ED. Overdose? To the ED. Heart attack or stroke? To the ED. Contemplating suicide? #arpx #ARnews

7/x To the ED. Out of meds, can’t sleep, lonely, homeless, need a work note, victim of assault, psychotic break, your baby crying? You guessed it— to the ED. The Emergency Department is the one place in the US where an individual can come any time, for any reason, #arpx #ARnews

8/x however often they want and they’ll be evaluated by the medical professionals there. In addition, everything goes to the ED and often all at once— there are no appointments and there is no schedule. Only 1 doc working and 20 patients arrive? Well, someone’s #arpx #ARnews

9/x gonna have a busy morning. This chaos is what causes many health professionals to avoid working in EDs. It’s smelly. It’s sweaty. It’s frenetic. It’s unpredictable and it’s an unimaginable morass of craziness to the uninitiated. In the US, the ED #arpx #ARnews

10/x is the extremely hyperactive & unmanageable kid everyone is trying to put on Ritalin and put into time out. It’s also the medical specialty with the highest burnout rate, and the profession with the highest burnout rate of any profession requiring a grad degree. #ARnews

11/x EDs is the US are staffed with some of the most dedicated and unusual people in health care. They work weekends, holidays, and 12-hour shifts that flip-flop between nights and days. They chose this specialty because it offers something #arpx #ARnews

12/x they can’t find anywhere else. They’re an amazing bunch, these dedicated ED workers, highly skilled and self-sufficient, but they’re also exhausted. Because in the midst of all this chaos they signed up for, are all the stressors they didn’t— the frustrated #arpx #ARnews

13/x patients, the angry family members, the impatient administrators, the dismissive colleagues. The feeling that the system has abandoned them and then condemned them for the abandonment. It’s incredibly demoralizing for these folks in the ED, and it’s why these #arpx #ARnews

14/x eccentric idealists have begun to make an exit. Almost every region of the US lacks sufficient ED physicians & nurses. And its into this environment that we drop the #COVID19 #coronavirus pandemic. #arpx #ARnews

15/x The story in the media is a story of being able to handle the stress of #COVID19 patients, and the workload, etc... but this isn’t my main concern. In the ED, most nurses and doctors could resuscitate a patient while they eat a sandwich— handling the critically #ARnews

16/ ill is routine. The real story is whether our friends in the ED will be supported. Will they have enough PPE? Will they have the support of colleagues and administrators? Will their concerns/fears/recommendations be considered or ignored? This is the big #ARnews #arpx

17/x story. The medical professionals in the ED will walk through walls to fulfill their duty and will gladly treat any #COVID19 #coronavirus patient that comes their way. They live for this. They’re actually really, really good at it. I am confident #arpx #ARnews

18/x they won’t falter. But if we as a society abandon them. If we ignore them. If we dismiss their concerns as this pandemic rolls on, they will not complain, but they will later leave in droves and never come back. Never. This is a great moment for our #arpx #ARnews

19/19 country. #COVID19 will show the world the amazing talent and unflinching commitment of those in our nation’s Emergency Departments. I hope we use this crisis to also demonstrate our commitment to them. #arpx #ARnews @EmergencyDocs