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Emergency healthcare: When the right actions can save lives

EMERGENCY CARE WEEK: Monday, July 26, to Saturday, July 31, 2021. An Irish Examiner and Cork University Hospital campaign to promote awareness of how an effective Emergency Department functions, a wealth of at-home healthcare tips, and insights on plans for a dedicated new Children's Emergency Department at CUH

Professor Conor Deasy, Clinical Lead at CUH Emergency Department, looks at plans for a new and improved Emergency Department at CUH, and advises patients on their first options before calling to the Emergency Department, which deals with nearly 70,000 patients per year

Staff Nurse Katie Mulcahy with her notes at the Emergency Department at CUH. Picture: Dan Linehan

Timely plans to upgrade children’s unit at CUH’s Emergency Department

f or as long as there have been humans, there have been emergencies; ailments or accidents that have befallen our people. It is a mark of society as to how it supports its people when such calamities occur.

Sometimes situations conspire against the outcomes we seek for our patients. Every frontline staff member holds images of certain patients and their families emblazoned in their mind's eye; situations and stories that cannot be forgotten; these influence how they care for the patient in front of them every day.

Each year, a growing number of people attend Cork University Hospital’s Emergency Department; close to 70,000 patients attended in 2020 of whom 70% were discharged home having completed their entire episode of care in the Emergency Department.

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Staff Nurse Aisling Ryan working at the Emergency Department at CUH. Picture: Dan Linehan

Emergency? Who to call first

 Could some of these patients have avoided the queue and the long wait and been treated elsewhere? Undoubtedly yes, but that is easier to say after a thorough assessment by emergency doctors, nurses and therapists, blood tests, X-Rays and CT scans and so on.

At various stages during the Pandemic, we asked patients to consider attending their GP, their Local Injury Units and Private Facilities; we do this to create capacity in the Emergency Department so we can deliver emergency care; we are grateful to patients and their doctors who retain the Emergency Department for patients who need it in emergency.

 
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Megan O'Brien, Rebecca Lyons and Emma Hurley, all Staff Nurses in the Emergency Department at CUH. Picture: Jim Coughlan

Restructuring for Covid


the Emergency Department at CUH underwent a huge physical transformation since the beginning of the Covid-19 pandemic in March 2020. All the while, it has continued to treat over 230 patients per day; in effect fixing the jet engines while the airplane was still flying at full throttle.

The Rapid Assessment Streaming Triage Treatment Area (RASTTA) is a purpose built space that allows us to efficiently manage large numbers of moderately unwell patients. We have built a Geriatric Emergency Multidisciplinary Service (GEMS) unit with physical infrastructure that is attuned for older adults to increase their dignity and safety while in our care.

 

CUH's Emergency Department team encourages patients attending to:

- Keep their mobile phones close at hand

- Nominate a liaison member of the family for regular updates

- Ensure that liaison person knows the patient's medical history

Patients - things to bring when attending the Emergency Department

- GP letter or preferably, your GP has sent through a Healthlink referral electronically.

- List of medications.

- Any letters/correspondence that relates to your medical conditions.

- Your health insurance or medical card details. CUH relies on the income generated from these sources to maintain services.

- Contact phone number for family liaison person.

- Mobile phone and charger.

- Reading materials/iPads with headphones.

Dr Adrian Murphy
 

Dr Adrian Murphy, Consultant in Emergency Medicine and Prehospital Emergency Care, CUH, suggests actions people can take when an emergency occurs at home

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Burns and scalds

Cool the burn or scald immediately in cool running water for approximately 20 minutes. Burn gels may be used only if running water is not nearby. If you cannot apply cool water immediately, do it as soon as possible after the injury. Remove any clothing or jewellery in the vicinity of the burn. Do not apply ointments or sprays to the burnt area. Apply a non-fluffy cloth or cling film to the area.

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Heart attack

Typical heart attack symptoms include central chest pain that may travel to the neck, jaw, back, or arms. Patients may also experience shortness of breath, light headedness, weakness, nausea, or experience a loss of consciousness. For patients having a heart attack, every minute counts. Stay calm and call 999/112 for an ambulance. Encourage the patient to rest, sit or lie down, and loosen tight clothing. Give an adult dose of aspirin if no previous allergies to taking aspirin have been experienced. If the patient has been prescribed a nitroglycerin spray, encourage them to take it.

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Cuts, wounds and bleeding

The primary goals in wound management are to stop bleeding, prevent wound infection, and promote healing. For minor cuts, wash your hands (or wear clean sterile gloves), clean the wound with lukewarm water to gently remove any  debris or dirt, stop the bleeding by applying direct pressure with a piece of gauze or clean cloth for a few minutes. If possible apply some petroleum jelly (from a tube, not a jar) to keep the wound moist and act as a barrier to bacteria. Cover the cut with a sterile bandage. Consider taking some over-the counter pain medication such as paracetamol or ibuprofen.

What to do when someone is collapsed and not responsive:

- Take a breath and stay calm

- Check for danger to yourself, others, and the casualty – do not put yourself in harm’s way and risk becoming a casualty yourself

- Call 999/112 for help early. Know your Eircode or closest landmarks to your location (e.g. Schools, churches, sports pitch etc). At night, turn house lights on and open your front gate and door. Consider putting hazards lights on in your car. This to help the Ambulance Service locate you quicker

- In places where you spend a lot of time, familiarise yourself with the location of the nearest Automated External Defibrillator (AED)

 
Dr Rory O’Brien
 

 
Don’t panic if your child has a fever, there is no need to treat a fever. But if they have a fever for over 48 hours with no clear explanation, then call your doctor.

 

What to do if your child is running a fever

Dr Rory O’Brien, Clinical Lead in Paediatric Emergency Medicine, details a calm and careful response for parents of children with a fever

if your child is under 6 months give them their usual amount of formula or if breastfed offer them more breastfeeds. If over 6 months you can give them their usual milk or breastmilk or you can try a rehydration solution. Your child might need to drink smaller amounts more frequently.

There is no need to treat a fever, however if your child is miserable you can give them paracetamol or ibuprofen. Do not give ibuprofen if your child is under 3 months or if they are dehydrated. Never give your child aspirin. Be sure to follow the recommended dosing regime supplied on the bottle. Dress your child so that they are not too hot or too cold. Cold showers and baths are not recommended.

 
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If your child is running a fever and has no wet nappy or urination for over 12 hours, then call your doctor.

When to come to see your doctor:

- If your child is < 3 months old, even if they look well

- If your child has any underlying serious health condition

Come to the ED If they have any of the following:

- a stiff neck or the light is hurting their eyes.

- a rash that is purplish/red and not blanching.

- Difficulty breathing.

- No wet nappy or urination for >12 hours.

- Lethargic or inconsolable

Please see a doctor if:

- fever for >48 hours with no clear explanation electronically.

- They have a rash

- Increasing or a new pain

- Symptoms not improving after a further 72 hours

- Seem to be getting more unwell

 
proposed CUH children's emergency

A view of what the new Children's Unit at CUH may look once completed after a drive to raise funds.

 

cUH is determined to create a welcoming space within its Emergency Department for children and their families. Children represent 20% of all patients who attend the Emergency Department at CUH.

The creation of a Children’s ED in Cork University Hospital is long overdue and in light of Covid 19, more essential than ever.
CUH is committed to making this happen as soon as possible, co funded by the State and through charitable donations by the public. The new Children's ED will have capacity to answer the needs of these young patients whatever their emergency.

The NEW Children’s Emergency Department will include:

- Audio-visual separation from adults

- Infection control compliant treatment spaces (to avoid COVID and other
infections spreading)

- Child-friendly (toys, decorations etc)

- Bottle warmers / fresh water

- Baby change area

- Family Room

- Separate waiting area

 
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CUH are determined to create a calm and relaxed environment in their children's emergency department. Picture: iStock

 

Rory O’Brien, Consultant in Paediatric Emergency Medicine at CUH, said: “When a parent brings a child to the Emergency Department we want to remove as much stress as possible – for the parent and the child. This safer, calmer, child-friendly environment will benefit any family that walks through our doors. And also give our staff tools to help distract or entertain children during medical procedures or assessments.”

The Emergency Department is a bustling, busy environment. It can be stressful for an adult when they come through our doors for care – so for children, this can be amplified.

Some 20% of all Emergency Department patients are children.

In the Emergency Department, the Paediatric Emergency Medicine team see children for any number of reasons:

major trauma

broken bones

high temperatures

mental health issues

acute illness etc.

 
CUH gallery 1

Intern Murray Linn, staff nurse Tara Ivri, intern Kate Ryan with Prof Conor Deasy and Dr. Simon Walsh in the Clinical Desicion Unit at the Emergency department at CUH. Picture Dan Linehan

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The Covid screening area with Katie O'Donovan, health care assistant and Ian Morey, security department at the Emergency department at CUH. Picture Dan Linehan

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Staff nurse Aisling Ryan working at the Emergency department at              CUH. Picture Dan Linehan

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Mary Coen, nurse planner with Kieran Twomey, engineer, HSE Estates outside the new entrance at the Emergency department at CUH. Picture Dan Linehan

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Dr Ciara McGlade, Consultant in Acute Medicine at CUH. Picture Dan Linehan

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Mark Butler, chief medical Scientist with the point of care PCR covid testing machines at the Emergency department at  CUH. Picture Dan Linehan

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Staff Nurse Rebecca Lyons carefully recording progress in the patient’s notes at the Emergency Department at CUH. Picture Dan Linehan

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Nadia Strugacz providing meals to patients in the Emergency Department at CUH. Picture Dan Linehan

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Laura O'Callaghan, Critical Care Paramedic. Picture: Jim Coughlan.

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Avril Corcoran, Clerical Officer Emergency Department and Mick Aherne, Paramedic National Ambulance Service. Picture: Jim Coughlan

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Annmarie Dineen, ICT Support and Aideen O'Riordan, Unshedueled Care Manager. Picture: Jim Coughlan.

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Mark Guinnane, House Keeping Emergency Department and Saoirse O'Shaughnessy, Healthcare Assistant Emergency Department. Jim Coughlan

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Isabel Dermody, House Keeping Emergency Department. Picture: Jim Coughlan

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Denise McCarthy, Staff Nurse, Dr. Tesna Haas, Registrar, Carol Murphy, Staff Nurse in the resuscitation room in the Emergency Department of Cork University Hospital. Picture: Jim Coughlan.

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Sean O'Sullivan, Paramedic National Ambulance Service and Jessica Graham, CNM2 Emergency Department. Picture: Jim Coughlan

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Jane Desmond, Healthcare Assistant and Frank Higgins, Portering Service carefully assist patient home from Emergency Department at CUH. Picture: Jim Coughlan

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Alvaro Rubio Morilla, Staff Nurse with Ruth Mulcahy, Senior Phlebotomist in Emergency Department. Picture: Jim Coughlan

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PJ Whooley, Consultant Emergency Medicine, Ruth Butler, Staff Nurse, Coleen Sweeney, Clinical Nurse Manager and Henrietta Sabbagha, Emergency Medicine Registrar, at the Rapid Assessment Streaming Triage Treatment Area (RASTTA) in the Emergency Dept. Picture: Jim Coughlan

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Helen Cahalane,Director of Nursing, Rory O'Brien, Paediatric Emergency Medicine Consultant, Conor Deasy, Prof of Emergency Medicine, Gerry O’ Dwyer CEO South/Southwest Hospital Group, Siobhan Scanlon, Assistant Director of Nursing, Kieran Twomey, engineer, HSE Estates, Ger O'Callaghan, CEO, CUH, Mary Coen, nurse planner, HSE Estates and Sheila Leopold, head of bed management, the Emergency department at CUH. Picture Dan Linehan

 

Ireland’s busiest Children’s Emergency Department

Cork University Hospital is the busiest paediatric major trauma receiving hospital in Ireland. These are kids who sustain life threatening or life changing injury due to major trauma. The NEW Children’s Emergency Department will help ensure we give the best chance possible for these kids to survive and survive well.

For more information or to make a donation, click below.

 
 
 
 
 

This report on Emergency Care was also produced as an information booklet by the Irish Examiner in association with Cork University Hospital, entitled 'Let's Talk Emergency Healthcare'. It features contributions from CUH teams spread across a range of departments, working to deliver emergency and unscheduled healthcare services to people right across Munster.

CUH Charity is currently raising funds for a new Children's Emergency Department that will support CUH's Emergency team deliver the best care possible to our children and their families in their emergency. Click HERE to learn more.

 

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