AAEM NEWS
COVID-19 and the Bursting Bubble of ER Management Terrence M. Mulligan, DO MPH FAAEM
My name is Terry Mulligan. I’m on the Board of Directors of the American Academy of Emergency Medicine (AAEM), and I’m currently the Vice President of the International Federation of Emergency Medicine (IFEM). Over the last 20-25 years or so, I have been deeply involved in emergency medicine, international emergency medicine, and global emergency medicine development. I think all of us are up to our ears with working in the ER and taking care of all of our emergency patients – a job that’s been increased and intensified especially the last six or eight months because of the unfortunate COVID-19 pandemic. I say this is unfortunate because a lot of this overwork and high stress for emergency physicians and for the health care system potentially could have been avoided. I think over the last weeks and months, this pandemic and its crippling impact on our emergency care system within the health care system has pulled the curtain aside and laid bare the already overwhelming, overworked, overstressed state of emergency medicine, the emergency departments of hospital care, and the health care system in general. I think it’s obvious that this pandemic has had a huge effect on almost every aspect of our society – not just health care. It’s also shown how many of these different systems previously looked at as standalone or disconnected are deeply connected. For example, the economic impact of the pandemic is directly affecting the health care system and its proper functioning because so
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much of the United States’ health care system depends on the state of the general economy, the state of people’s employment, and the insurance that often comes with the people’s employment (or the lack thereof. I think this pandemic has the chance to pull the curtain aside on a crisis we’ve been facing in emergency medicine for probably 15 or 20 years. The crisis is that in lots of areas of medicine and in health care in general, but in the emergency department specifically, the current business and economic structure of the health care system forces us to run health care on a very thin margin. Now, it is being laid bare and made obvious to almost anybody who wants to or cares to look at it.
problem even before the COVID-19 crisis, but I think the pandemic really put this into the forefront of our minds. The pandemic has served as a stress test for the health care system. It shows the system was already running in the red. Under standard circumstances, it is not safe to keep an engine running in the red, and we are running at 7000-8000 RPM. Then, when a crisis such as the pandemic comes along, it becomes clear there is not any extra capacity in the system left over to take care of even a small surge, much less a giant surge like what has happened here. Maybe one of the only good things to come out of this is the giant spotlight now shining on how the health care system and the emergency system has been running on very low resources. Hopefully, people outside the field of Emergency medicine will see how the system can really improve itself after we get through the current crisis.
The health care system is looking to the emergency department as a cleanup crew the emergency department serves a multiple layered safety net.
This pandemic has hit the emergency department in a multitude of ways. In a material sense, the effects include shortages of personal protective equipment (PPE), of ventilators and medications, and other emergency care resources. Interpersonally, effects include staffing problems with physicians and other health care workers becoming sick and risking their lives along with those of their family, and risking being fired for speaking out against patient safety issues or PPE issues. Being fired or transferred for this is unfortunately common for us. It is important to show how the corporate practice of medicine has crippled emergency services in the USA. This was an obvious
In the next 6 to 12 months, we will probably have some sort of vaccine. Within the next 12 to 18 months, we could potentially be out on the other side of this crisis. Between now and then, I hope we will continue to shine the spotlight on the emergency care system’s vital role in hospitals, the greater health care system, and the general economy. Training people to take care of acute unscheduled emergencies is a relatively new concept.
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