In The ER: Fatal Overcrowding
June 1, 2005
ecently, I told my patient, ‘Mr. A’, that he was likely to die in front of me within the next few hours. Not
because I, an emergency physician in downtown Toronto, didn’t know what was wrong with him. Not because there
was nothing that we, as doctors, could do for him, but simply because at that moment the Canadian health care
system could not summon the resources to fix ‘Mr. A’.
I didn’t say it quite like that.
I told ‘Mr. A’ that the largest artery in his body was bleeding into his abdomen, that this carried a fifty percent mortality
with surgery; a certainty of death without surgery, and I could not find a vascular surgeon for him.
Both of our hospital’s vascular surgeons were operating, we had no Intensive Care beds free to take care of ‘Mr. A’
after an operation, even if we could get him one, and the provincial emergency transfer service, Criticall, searched
desperately but found no available surgeon and bed for my patient in Ontario. The Criticall coordinator told me, “I’ve
got nothing. You’re on your own.”
Nowadays we, front-line Emergency Medicine providers, are often on our own with nothing to give a patient. In front
of our triage desk, where patients explain why they have come to hospital, there was once one chair. Then two, then
five, and now there are ten chairs in two rows, filled with those waiting to be triaged. This is not the waiting room. The
waiting room, burst to overflowing, is where people go to endure their pain along with fifteen to thirty other members
of the public for six, eight, twelve hours with no medical attention after triage. Next to the triage desk, there are three
to six ambulance crews waiting for hours to deliver their orange-wrapped patients. The Toronto District Ambulance
Service has announced that this ‘offload delay’ problem is a crisis. They are frequently unable to respond to
emergency calls because they are marooned in hospital ER’s.
It would be nice if we could point to one issue, such as ambulance offload delays, or packed ER waiting rooms, and
say ‘that’s the problem – fix that!’ The reality is not so simple. These problems are only the highly visible tip of the
iceberg which is health care’s now-dysfunctional lack of capacity. During the past decade, there has been a 40%