Emergency rooms need help — now

Triage. It’s an interesting, necessary, and bluntly pragmatic concept, but it’s not for the faint of heart.

It’s a method of determining how and when to treat the injured and the sick, and it has a long (and disputed) history. Many historians credit French army surgeon Dominique-Jean Larrey, who, in Napoleonic France, came up with a classification system to help evacuate and treat injured soldiers by quickly dividing their injuries into three different classifications.

“In the Battle of Jena in 1806, the French army used the triage system developed by Larrey. The system involved categorization into three grades based on the severity of the wounds irrespective of the soldier’s rank: dangerously wounded, less dangerously wounded, and slightly wounded,” wrote researchers Hiroyuki Nakao, Isao Ukai and Joji Kotani in the medical journal Acute Medicine and Surgery.

Triage, in fact, means “breaking into threes,” and there’s a dispute over whether it was originally used to classify coffee beans or wool — but we’re not going any further down that particular rabbit hole today.

In current English usage, triage saves lives because it classifies patients not based on who they are or when they arrive at emergency rooms, but on the basis of which patient needs the most urgent treatment.

And doing triage is far from easy: patients don’t like to be told they have to wait, and triage nurses have a heavy burden of responsibility to make the right decisions quickly — decisions that have life and death consequences.

And the burden on triage providers is growing.

On Thursday at 10:01 a.m., the wait time at the Health Sciences Centre’s emergency room for adults was 15 hours. The wait at St. Boniface Hospital’s emergency room was 10-and-a-half hours; at Grace Hospital it was nine hours. And the website tracking those wait times warned the numbers might not necessarily be accurate.

“Due to rapidly changing demands and the need to see the sickest patients first, your own wait time may be more or less than the time displayed here,” the website says.

Wait times are so significant in Winnipeg that a sort of emergency room shopping has begun: 40 nurses at Bethesda Regional Health Centre in Steinbach are calling for an additional triage nurse in their emergency room because more and more patients from Winnipeg are making the 60-kilometre drive to take advantage of shorter wait times.

The nurses wrote to Health Minister Uzoma Asagwara saying the increased numbers mean the emergency room’s single triage nurse can’t safely manage the number of patients. That means patients can wait an hour for triage, and as long as eight hours before they have their conditions reassessed to see if they’re getting sicker and need to see a doctor immediately.

The nurses wrote that patients see “excessive and unacceptable safety risks on a daily basis” in the emergency room.

Meanwhile, on the same day the Free Press reported on the Steinbach issue (Steinbach ER under siege by frustrated Winnipeggers, Aug. 5), we also reported on the Brandon hospital often operating with just one of the two emergency room doctors it’s mandated to have working (Emergency room in Brandon short staffed, Aug. 5).

Now, let’s consider the area most in need of care in the health-care system — and if we’re going to do that particular triage, emergency rooms should be on their way into treatment already.

The places that provide the most urgent care need urgent care of their own. Period.

Dominique-Jean Larrey, by the way, received the Legion of Honour from Napoleon for his success in reducing battlefield mortality.

The person who can finally deliver the same kind of improvement for our emergency rooms deserves the same sort of recognition.