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26 June 2005 @ 04:36 pm
Emergency care break down?  
You hear a lot these days about our emergency care services being strained to the breaking point, overburdened with treating uninsured patients as their only primary care, dealing with drunks clogging up their rooms, doctors refusing to be on call any more, nursing shortages, and a host of other problems related to funding.

Last night my daughter, Ramya, got to bear the brunt of those problems.

She was driving her family to get dinner when a car pulled out of a driveway and struck the passenger side of her car in the rear. After assessing the minor damage to the car, exchanging insurance information, and deciding not to bother with the police for such a minor and clear cut accident, they all went to get their neck, back and head pain checked out. Her pain was the most severe of the four of them, 7 out of 10. She had looked back, realizing that the car was moving towards them, just as the impact happened.

The E.R. was busy as they arrived. None of them were given neck braces, normally standard operating procedure. She didn't have her cell phone with my number. So she and her husband Juan tried to corral their two young sons while dealing with their own neck and back pain. She also took on translating duty whenever the nurse was talking to her husband, who is not always sure of his English skills. Medical language is especially not part of his vocabulary yet. Strangely, my daughter was last on their list to be seen, even though she reminded them that her pain was the most severe. By the time they got to her, she was so exhausted and in so much pain she just wanted to go home and lie down, and she couldn't see how she was going to be examined with her sons clamoring for her attention. Juan wasn't dealing with them well on his own. So she decided to go home. While the nurse and doctor said, "Are you sure?" they didn't point out that if she had an injury she might aggravate it by caring for her children or other normal activities.

I felt that someone should have suggested she call a relative or friend to care for the children while in the E.R. so she could be examined and so she wouldn't injure herself picking them up or restraining them. (They are ages 4 and 2 1/2.) They could have pointed out that they had my number in their database and offered to call me. If she'd had her cell phone with her she would have called me, but she'd left it at home.

In any event, she left, went home, and called me. I insisted on driving her back so that we could make sure she did not have an injury that needed further attention. We arrived back at the E.R. at 1:30. (She'd already been there from 9 to almost midnight.) We left the E.R. after her X-Ray and treatment at 5:30 A.M. While there I told them what I thought should have happened, complained that she had not been seen first, pointed out that they could have suggested to her that someone ought to come to help with the kids, complained that no one had immobilized her neck prior to her examination to insure no further injurty, and insisted that she should be billed for one visit rather than two. Along the way I insisted they find her some food as she had not eaten the dinner they originally went to get. (Since I'm an old hand by now at E.R. visits I knew that they had stashes of crackers, yogurts, jello, and juices.)

They were much better the second time around and apologized for their deficiencies in the previous visit. They were filled and overflowing. In the last year or so the local E.R. has had to close to patients several times as they had no beds, and the next town over with a hospital has often done the same--whereupon both hospitals have to reopen to the ambulence patients and they end up putting patients where ever they can fit them. It's reached a crisis point, and care is compromised. We are all lucky that Ramya did not have any structural damage to her disks or spinal cord from either the accident or the lack of protection while caring for her children last night. Other patients with life threatening injuries might not be so lucky.

We have to do something to insure that our emergency rooms across the nation are no longer clogged with patients who really need regular doctor's visits and preventive care, coming to the E.R. as their last resort when a minor problems has deteriorated into a major one. We need to accept the idea of government involvement in basic health care, with private insurance providing the frills like plastic surgery or elective, non-emergency surgeries. What will it take before we do this? More closed emergency rooms? Deaths? How many deaths will it take? I suspect we've already had deaths related to our overworked, overcrowded system and frayed, overextended health care workers. We just don't gather statistics on such causes.

I'm just glad she's ok, although very sore and she may need physical therapy. But she should recover.
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