Triage assesses patients who need immediate care
Hospital television shows don’t always get their dramatizations about medicine and medical care correct, but the usual depiction of a hospital emergency department is generally spot on: They are busy places full of urgency and immediacy.
“The motto of emergency medicine is, ‘Anything, anyplace, anytime.” –Dr. Eric Rushman
“It all comes down to the basics, like the way the emergency department’s run,” said Dr. Eric Rushman, one of the attending physicians in the emergency department at Baptist Health in Lexington. “There’s triage, so the people who are the sickest and have the most urgent injuries come back first and are attended to first. The process of triage hopefully lets you see if somebody has a condition that requires very prompt care. The people with the more minor things have to wait a little bit longer. That’s the way the emergency department works.”
Rushman said patients come to the emergency department in a variety of ways.
“There are people that walk in, people that are brought in by ambulance and people that are flown in by helicopter,” he said. “Sometimes there’s advance notice [about a patient’s condition]. Sometimes there’s not.”
The emergency department staff has to be on their toes at all time, Rushman said. “Somebody may come in and say, ‘I’ve got a little bit of chest pain’ and look OK. In reality, they may be having a heart attack.”
An initial assessment of a patient’s condition is made by a nurse. Then the patient is seen by the attending physician or a physician extender such as a nurse practitioner or a physician’s assistant. Rushman said the most important assessment tool used in the emergency department is the “eyeball test.”
“If somebody comes in and looks like they’re dying, chances are they’re dying,” he said. “You make sure those people are brought back and promptly cared for.”
All emergency medicine physicians must be board certified in emergency medicine. They are trained to handle cases from the simplest – such as a splinter in a finger or a minor laceration – to the more complicated, such as an amputated limb, stroke, miscarriage or overdose.
“The motto of emergency medicine is, ‘Anything, anyplace, anytime,’” Rushman said. “A lot of people still don’t have health insurance or access to primary care doctors. The emergency department many times is the doctor of last resort and first resort for them. We see all comers. And I’m happy to see everybody. Being able to help people is a wonderful thing.”
Although his training was in internal medicine, Rushman enjoys the pace and the challenge of working in the emergency department.
“The only thing I’ve ever done since residency is emergency medicine,” he said. “No day is ever like the day before, and that’s one of the things that make it very interesting. In the emergency department, no day is ever predictable.”
By Tanya J. Tyler, Associate Editor