I am pretty sure nobody enjoys being in the emergency room. You’re stressed because your pet is not feeling well, the lobby is full of other equally-stressed strangers, the chairs are uncomfortable, and you’re not familiar with any of the staff members. If you’re unlucky, it’s also probably late at night on Sunday, and you have an early meeting the next day.
The front desk staff hands you a clipboard with all sorts of information you have to fill out, and then pages the backroom staff that you’re here - how old is Fluffy again? Oh shoot, I didn’t bring any of her medications with me… does she get Revolution or Advantage for flea treatment? I hope my other dog isn’t tearing up the house while we’re here.
Someone who introduces herself as a veterinary nurse materializes from behind a door, asks you some quick questions about Fluffy before taking the leash from you, and then she disappears into the back room with your dog. You finish filling out the paperwork and hand it to the front desk, but then 30 minutes passes and you haven’t heard from anyone. Is she doing okay? I hope she’s not too anxious about being here.
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Triage
Triage (from the French word trier, or “to sort out”) is an old concept, dating back to World War I. With limited medical resources available, French doctors on the battlefield had to determine how to distribute medical supplies to the wounded so they could provide the most positive outcome for as many people as possible. In emergency veterinary medicine, we use the term triage to refer to rapid assessment of patients that present to the ER to determine which patients are the sickest, so that intervention and stabilization can be provided as necessary to ensure the best outcome. Frequently, there are more patients in the ER than there are nurses or doctors, so triage is necessary to make sure that doctor/nurse time is distributed most equitably to all patients. In most hospitals, patient vitals are obtained immediately upon presentation - weight, temperature, pulse rate, and respiratory rate and effort and neurologic status are assessed (blood pressure if possible/appropriate). In terms of priority where organ systems are concerned, patients with abnormal cardiovascular, respiratory, or neurologic status are deemed most emergent, and abnormalities with the urogenital systems are generally considered second-tier.
What do we mean by “abnormal cardiovascular, respiratory, or neurologic status”? If a patient presents to the ER with a severely elevated or decreased heart rate, respiratory distress, or abnormal mental state (e.g. having seizures or behaving abnormally), these can be potentially life-threatening and signs of imminent death, so immediate intervention may be necessary. These patients jump to the top of the priority list, no matter where they are in the overall client queue, because we have to formulate a diagnostic and treatment plan as soon as possible, or start CPR if the patient has indeed experienced respiratory/cardiac arrest.
It may be upsetting to witness someone else rush their pet in, after you have been waiting for an hour or more, and have them be seen first. I would argue that you never really want to be the person who gets to jump to the front of the queue in an ER. If you’re waiting longer, it’s because your pet is not as ill.
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Wait Times
Lately, emergency medicine has been very busy. Some hospitals have to shut down intake of patients through the ER because there simply isn’t enough staff to manage more sick animals, which means the remaining ERs experience additional strain of having patients redirected to open facilities. In many cases, the wait time is hours long. This may be the new normal for emergency care, so pack some snacks and water and a book if you’re headed to the ER!
If you want to be prepared, call ahead. The front desk staff can get your information and give you an expected wait time (which may change by the time you get there), and can also give the nurses and doctors a heads-up if your animal seems more critically ill and may need emergency stabilization when it gets to us. It helps us know what to expect, so we can be ready.
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The Client’s Role
How can you make the ER visit easier for everyone involved? If your animal is on medications, bring the bottles with you to the ER so we can confirm the dosages, or take pictures of the medication labels to save on your phone. If the medications are specially-ordered, it may be helpful to bring them with you so that we can administer them in hospital if Fluffy has to stay for in-hospital care.
If you come to the ER during daytime working hours, call your primary veterinarian to let them know, and have them send records for your pet to our facility, so that we can have access to those records and know a little bit more about Fluffy’s history. It can be helpful to know what her bloodwork looked like 6 months ago, to see if anything has changed.
When the veterinarian asks you about Fluffy’s history, it’s because they want to hear your side of the story! I sometimes have people tell me “it’s all in the record”, which is probably true, but owners and veterinarians see two different sides of the pet’s life, and we want to know how you feel the treatment plan is going. Does Fluffy hate taking her liquid medications? Is she eating normally? What is her energy level like? Are you happy with how things are going?
Most of all, be patient. Veterinary hospitals are busy places, and just like human ERs, there is going to be a wait. If you’re waiting to be seen, it is because there is a lot being done in the treatment area that you just can’t see. We probably don’t know each other, and I’m probably meeting you on a bad day, but the same is true for every other client that I’ve seen that day. It is my honor to be there for you and your animal, and I hope you see that.