PROLOGUE - Written 2012

Most hospital Emergency Departments in Australia are chaotic places run by over-worked and  poorly supported  orderlies, nurses, clerical staff and doctors.

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The “Floor” of the Emergency Department is that area in which the hard stuff is looked after. The heart attacks, strokes, leaking aortic aneurisms, the severe trauma due to road smashes, violence, industrial injuries, fires, explosions and so on ad-nauseum. And there is no shortage of it believe you me! The central area of The Floor, where the doctors and nurses work is coordinated, and all the computers lurk, is known as “The Flight Deck”.Conversely, the “Fast Track” is that area of the department dedicated to diagnosing and treating those conditions that can be sorted out without too much fuss and a minimum, if any, of x-rays and laboratory tests.  I spent the first two years of my time in ED working The Floor mainly because the Fast Track concept had not been introduced.The efficiency and effectiveness of the Fast Track is dependent upon many factors not the least being the effectiveness of the Triage system. Triage is usually performed by nurses whose function is to assess each new patient as soon as possible after they present to the Emergency Department. The nurse decides if the patient can be properly treated in Fast Track or must go into the main department – The Floor.

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Fast Track patients will spend much less time than Floor patients waiting and being treated. It seems a bit incongruous at first and can result in a patient with a minor laceration arriving after someone with a broken leg yet being treated and discharged before the broken leg  is even seen by a doctor. However, the department is not clogged up with both minor stuff and serious stuff all waiting ages for attention. Hence, an efficient Fast Track has a high patient turnover and there are few “Did not wait” patients. 

 

I loved working in Fast Track. My skills, knowledge and experience are better suited to Fast Track than to The Floor. I can communicate better with the patients and establish rapport; I can teach nurses and medical students to diagnose and treat the simple stuff – the stuff they will see every day in general practice. I knock off after each ten hour shift exhausted but feeling I have achieved something worthwhile.

And now the time has come for me to leave it behind – to retire.  I consider these five years to have been among  the best years of the fifty I have spent in the medical orientation. I am deeply indebted to the bright, young Emergency Medicine specialists who taught me so much. I am no less indebted to the support staff – the orderlies, clerks, nurses and non-specialist doctors with whom I worked. And to the staff of the radiology department and the pharmacy with whom I had daily contact and who guided me through much of the new, innovative stuff in their respective fields.                       

                                   

I have hung up my stethoscope and already - I miss it all.