Dr Simon Walsh Consultant in Emergency and Retrieval Medicine
It’s 2pm on a Saturday. A call comes through that there’s been a 2 car collision in North Cork. A helicopter is en route and due in 15 minutes. The patient is unconscious with vital signs that are markedly abnormal, with a maximum blood pressure of 70mmHg (Normal roughly >100mmHg).
The Nurse in Charge informs the Consultant who gathers a medical team in the Emergency Department. Roles are allocated by the Consultant Team Leader – Airway, Circulation, Procedures doctors and nurses, a radiographer, a porter make all their way to the resuscitation room in anticipation of the patient’s arrival.
A trauma call is put out to Anaesthetic and Surgical teams because of the degree of abnormal vital signs.
Predicted and potential injuries are discussed, and individuals mentally rehearse the procedures required and algorithms to follow: the placement of the patient on a life support machine; the placements of chest drains; fluid resuscitation; massive blood transfusion; focused abdominal, cardiac and lung ultrasound.
The patient arrives, the Resus Room quietens as a structured handover is taken from the Helicopter Advanced Paramedics. The Team Leader thanks them and then refocuses the team on individual tasks that are then rapidly, skillfully performed, and once done, this information is clearly fed back to the Team Leader who absorbs, acknowledges and utilises this information to deliver optimum, expert care to the patient.
The patient is successfully resuscitated and is stable to go for CT scans; care is taken over by the Surgical teams and the patient is transferred directly to Intensive Care.
The Team breathes, briefly discusses the intricacies of the case, makes detailed notes, and then prepares for the second patient who will be arriving by road ambulance in the next 10 minutes.
The Resuscitation Room is where the sickest patients in the Emergency Department go. It is designed to provide space and equipment for performing life-saving interventions, and for carrying out investigations.
The senior staff in the Emergency Department move patients in and out of the Resuscitation Room depending on clinical need; having Resuscitation Room capacity is vital as when a patient is unstable they require life-saving interventions immediately.
Physiological parameters (heart rate, blood pressure, respiratory rate, conscious state) are used to determine if someone is too sick for the waiting room or a cubicle, and those patients who are most unwell, or who have the potential to deteriorate rapidly, will go to the Resuscitation Room.
Resuscitation nurses and doctors in the Emergency Department at CUH are highly trained, and will provide initial Intensive Care for those patients that need that level of support until a bed becomes available in Intensive Care or elsewhere in the hospital. They are trained to deal with the worst case scenarios, and will prepare for that when they get information from the pre-hospital environment.
Emergency Staff are also trained and equipped to recognise those patients who need to get to other areas of the hospital for their life-saving interventions e.g. the Operating Room, the ‘Cath-lab’, Radiology. Colleagues across specialties in the hospital understand the significance of “Resus”, and respond promptly when asked for help in treating the sickest patients.
