In emergency rooms the patient numbers are increasing – an increasing burden for the staff. FOCUS-Online-editor Anika, Jonas accompanied the everyday life in a Munich emergency room. There showed, what is the real challenge for Doctors and nurses – and why it is a good sign, when a Patient has to wait longer.
Monday, 20.29 PM: At the reception of the emergency Department in Großhadern suddenly happens all at once: A 60-Year-old comes in hobbling, in the Wake of his wife and son. His leg was between two cars crushed. Another man rushes excitedly into the room: His girlfriend has become in front of the toilets passed out. At the same time a rescue comes in the back entrance of the emergency room cart. He brings a patient with a suspected stroke.
I sit together with an emergency nurse Nele Schmid* on the so-called Triage counter, where she takes new arrivals in reception, the Severity of their injuries, evaluates and acquires data. Schmid has the late shift. A few minutes has passed, your colleague from the next room, where the rescue will arrive the car, in the evening. Schmid is now responsible for both areas.
If she could, she would now probably three parts. But she remains calm. After more than five years in the emergency room she does not know to distinguish the urgent cases from the non-critical, will take care of everything at the same time, but each patient in the appropriate order.
The emergency room at Klinikum Großhadern
In the emergency room at the Klinikum Grosshadern (Munich) to be handled annually about 40,000 patients. More than 100 people a day. Round-the-clock Doctors from different subject areas in this interdisciplinary emergency Department, neurology, trauma surgery, Internal medicine and abdominal surgery. More Doctors are available on call in the house. Per shift, five to six nurses to come also.
Those who have to wait may be lucky
So you can be the man with the trapped leg, despite the pain, his face twisted in time to sit and search for a free treatment room for the patient in the ambulance. How the victim feels, I can well understand. I remember my first visit to an emergency room. That was eight years ago. I had cut the little Finger on a tin can. He got three stitches. At the time, I was shocked to some extent, that upon my arrival in the emergency room, not at once all life support measures were taken. Instead, I should put me in the waiting area – with a blood Finger?!
Today I know: That was a good sign. If it takes a little longer, that means in an emergency room, you will survive the day. Worse it would be if Doctors and nurses are provided with a deck, slips, syringes. As it is in the patient of the case that has probably suffered a stroke. With him, every Minute can make the difference between life and death.
20.39 PM: Nele Schmid is back at the Triage counter. It takes a short time to fill up water bottle. This is their second break since the start of the Shift four hours ago. Meanwhile, the Stroke Team takes the patient from the ambulance, the blood. Thereafter, in the computer tomography images of the brain are created.
“The true face of the company”
21.33 clock: All treatment rooms are occupied. In one of the rooms, a 40-year-old woman with systemic scleroderma, a connective tissue disease is seated. At the time of their arrival in the emergency room they prayed continuously to God, he was barely responsive.
In the waiting area of ten patients were able to talk to any doctor, sit. Including a mathematics student who is feeling burned out, a woman with stomach pain, a cancer patient who has lost the car, the orientation to short-term, a woman who cut herself while cooking in the Finger.
“In the emergency room, you will see the true face of the society, the entire range, starting from people needs, about asylum-seekers to the Upper Class with their own set of problems,” tells me emergency nurse Sandra’s reputation*. You experience dramatic stories, as a result, the work was very stressful, she says.
The work takes energy
Tuesday, 7.22 PM: Outside it’s cold, over night it snowed. In such weather, the emergency room is often visited in the morning. A man fell down in the snow slide. A woman is caught with your car on the slippery road and hit the collision with another car the Arm. These are the most typical accidents in this weather, explains Matthias Klein, senior physician and head of the emergency room Großhadern.
12.38 PM: The lunch break falls short today. Because a colleague moves to another Department, there is the farewell to sandwiches and pastries. Most of the employees take just ten minutes to refuel shortly. A 59-year-old woman with a suspected brain haemorrhage is the arrival of the wagon at any Moment with the rescue. As time to enjoy lunch.
In the meantime, I’ve found: The biggest challenge in a emergency room, the serious illnesses and injuries with which patients arrive. The violence is not the willingness of some patients under the influence of alcohol or drugs. For Doctors and nurses to be trained in their training, learning certain operations and handles, applying them routinely in their everyday work.
What is the training not prepared for the many: The work robs immense energy that is missing in your private life. Doctors and nurses to sacrifice their own quality of life, so that other people get a better quality of life.
“The work is exhausting, and you often feel exhausted”, tells me Sandra’s reputation. It is every second weekend on duty, Early, Late and night shifts. So it is with people in many Professions – but not everyone is in his Job for the lives of other people. “If we miss something, is the life in the worst case, a threat to the patient,” says the sister. At night around three o’clock, she often leaves the force. Your shift lasts five hours.
12.47 PM: The 59-year-old patient has arrived. She is barely responsive. Your sister-in-law has not elected to the emergency, because they responded to calls and messages. The emergency doctor and his assistant found the woman unconscious in her living room, she had slipped from the Sofa.
Now the 59-Year-old surrounded by a ten-member Team of Doctors in the so-called shock room. Because it is not able itself to take off, cut nurses her pink T-Shirt and grey Jogging pants. The patient is connected to monitors to observe your heart rate and the oxygen saturation in the blood. A blood sample comes to the evaluation to the laboratory.
13.07 PM: The patient is in the computer tomograph pushed. It is still unclear exactly what is wrong with her. Senior physician Matthias Klein comes to me now a little like Sherlock Holmes. Together with a neurosurgeon, neurologist and radiologist, he is puzzled on the basis of the previous findings, what the woman might be sick.
13.22 PM: Small lays: The patient probably has an infection of the sinuses taken. The infection had eaten through the skull plate and now they are attacking the brain. She comes back in the shock room. A doctor picks her brain fluid from the back to secure the diagnosis.
The patient needs to be on this day in surgery and is in need of a bed on the intensive care unit of neurology. However, the is full. No bed during the day, you need to deal with the nurses on the ward to a patient’s more – an additional, unplanned burden for the staff.
More and more patients come to the emergency room
Around 1600 euros net a care worthy of power. In a city like Munich, where rents are rising steadily, is for many too little to live on. Consequently, there is a lack of hospitals to care staff. If at the same time, the number of patients increases, attributed to the more pressure and responsibility on the shoulders of the existing forces. Some drag themselves to work sick, so that colleagues do not need to fill in.
The growth in patient numbers, not necessarily the fact that people get hurt more often, or more often become ill. “Patients nowadays are demanding a fast diagnostic classification,” says Matthias Klein. A violation of the patient take today is not easy. You want round-the-clock best possible care.
21.13 PM: In one of the treatment rooms sits a 22-year-old woman for a few days, a strange feeling in the chest. As if she had swallowed an object, she says. In the room next door, an elderly lady accompanied by her husband. Your foot is numb. Now she is afraid to plunge.
Many patients in the emergency room are not “true emergencies,” says a senior physician Matthias Klein. “You feel but all as an emergency. Of the patients, we can’t expect that you consider yourself to be.“ So the emergency room treated both patients with epileptic seizures or a stroke, as well as the retiree who decides after twenty years of back pain one Night, to come to the emergency room, because he has the time.
“I am looking forward to the slowness”
Performance pressure and Stress, the loads on the personnel, are not felt in the emergency room. Everyone is working quietly and patiently. Nele Schmid kids counter with the new patient at Triage, to take you to the fear. However, one learns of the immense pressure in conversations: “When I retire, will I get back my life”, tells me Sandra’s reputation. She has no husband, no children.
After so many years in the service, you will be happy to work on the little things. On a relaxing Sunday on the couch, take a walk, to a concert that you missed, because she has a late service, and the colleagues not to change. “I’m most looking forward to the slowness,” she says. Many of your colleagues will not even consider it until retirement in your profession. You switch after a few years in other hospital areas, or a completely different Job.
*Name changed by the editors