Christmas at the A&E

While you will be busy doing your last-minute Christmas shopping or running to the supermarket hoping to find that crucial ingredient that you forgot to buy during the week, the staff at Mater Dei's accident and emergency department will be preparing to work at stretched capacity.

Every year, the Christmas and New Year season tend to increase the influx of patients. Additions to the influx include the routine daily patients who would have been admitted with chest related influenza symptoms due to the cold weather, the cardiac complaints and trauma cases. 

However, the majority of cases are due to excessive alcohol ingestion, drunkenness and the problems related to alcohol which lead to assault, trauma, social family problems, underage drinking and unconsciousness, where intoxication becomes a true emergency.

Consultant emergency physician Jonathan Joslin says that these days will definitely ensure that the emergency department will be working at stretched capacity, both with regards to patient numbers and also with the finite number of staff available to deal with the situation.

"All available doctors and nurses working the shift are assisted by further staff from the wards if there is an overload of patient numbers. In addition, there is close liaison with the various mass parties on the night where close communication is kept with medical and paramedical staff working within these parties," Joslin says.

This would ensure that patients with minor complaints can be redirected to the peripheral Health Centres and thus decrease the load on the A&E department, allowing them to concentrate on critical patient issues.

A complex department within Mater Dei Hospital, the A&E offers a 24-hour service to the emergency requirements of the general public in need. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.

A system of triage or sorting of the various complaint presentations will give prioritisation in deciding who should be treated first and foremost.

"It is imperative that life-and-limb threatening conditions are dealt with urgency. Due to the fact that over 300 casualties are admitted at the A&E on a daily basis, preferential treatment must be given to those who are most at risk."

Joslin explains that work is carried out as a team response. Led by a consultant, emergency physicians and nurses work together to alleviate the pain and suffering of the patients.

In addition to the main shop floor where all casualties are dealt with, the department is intricately related to the pre-hospital emergency response thanks to the emergency ambulance service on the island.

"This service is the first point of access to the National Health system for a wide variety of presenting conditions extending from life-threatening emergencies and major trauma through to chronic and recurrent illness and associated social problems," Joslin says.

In practice, all requests for an emergency ambulance response are passed through the Police and Civil Protection Department call centre through to the hospital ambulance dispatch unit located within the A&E.

"This means that all assistance for emergency services are initiated within this department. The first on site, the emergency nurse will initiate the front line care before the patient is brought back to the hospital for definitive management."

Response to major trauma and critical patients involves other paramedical staff with different roles: the radiologists, ECG technicians, plaster technicians, health care assistance, clerks and receptionists, ambulance support staff and the cleaners who maintain cleanliness and hygiene within the Department.

"At the department, we also run a short stay Observation Unit where patients may be admitted for urgent initial investigation and management for acute conditions which may not require long term in hospital admission," Joslin says.

Joslin admits that Christmas Eve and New Year's Eve are generally busier than the festive day itself due to the increased partying that goes on throughout the night; the increased amount of alcohol taken and the drive back home where both alcohol and tiredness are major recipes for disaster.

On Christmas Day and New Year's Day, an increase in patients is usually seen late in the morning and afternoon.

"One has to understand that the medical response to a single critical road traffic accident involves a team response which would mean that more doctors and nurses are required to address the needs of one critically injured patient.

"This may imply that the waiting time for other casualties whose needs are less urgent may increase," Joslin explains.

But while it is true that the festive season is the time for families and friends to get together, so does the drama. And an extra drink here, and an extra word there may easily spark into a fight... which ends with a trip to the hospital.

Joslin in fact admits that this period indeed has its "fair share" of assaults and fights that seem to overflow at the department.

"They are in general related to excessive alcohol, but we are noticing that road rage is on the increase."

But he adds that there is a zero tolerance policy to abuse and threats to the department's staff: "The police, a valued member of the team, assist us when we face difficult and abusive patients who still require our assistance."

Indeed, these days are associated with an increase in traffic incidents due to drinking and driving. Even though anti-drink driving awareness is on the rise, yet over the past five years the fatalities ran into double digits, with 17 fatalities occurring in 2011.

These mainly occurred during the summer months, and not the festive period. Official EU figures show that at least 30% of traffic accidents are related to excessive blood alcohol content.

"I believe that Malta is no different. One should break through the stereotypes which suggest that drink driving is a nighttime issue. One does not need to be drunk to be under the influence of alcohol, and since it takes over six hours to clear the body of alcohol, morning driving can still be affected after an all-night alcohol binge that often results in tragedy," Joslin says.

He warns that situation are made worse when the increased intake of drugs while drinking.

"Despite all the warnings, drink and drug driving continues to be a significant problem causing harm within our community. The strong presence of the police on the roads on New Year's Eve has in fact helped to decrease major accidents over the past two years," he says.

A reality among hospital staff, the worse situation doctors and nurses face is when they have to relate the death of a person to their relatives.

"It is always hard to break the news of the death of a loved one during this time of year when 'peace and goodwill' are the order of the day."

Joslin goes on to make a simple appeal to the public: "Don't drink and drive!"