Surviving the Accident and Emergency Department

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If you are suddenly taken ill or have an accident you are likely to be taken to the Accident and Emergency Department at your nearest large NHS hospital (also known as the Casualty Department.) With a few exceptions private hospitals do not have A&E departments and are not equipped to deal with sudden emergencies.

The paramedics who stabilise you when they arrive at your side and accompany you in the ambulance will hand-over basic information such as vital signs and a brief account of events to the Casualty team.

The A&E department is run by a team of professionals under the leadership of a team of consultant doctors who specialise in acute care and dealing with trauma such as road traffic accidents, falls, abdominal pain, heart attacks and strokes as well as asthma or diabetic emergencies and serious infections.

Often this department appears pretty chaotic. Most A&E departments are extremely busy, and staff are pretty hard pressed. The departments are often noisy and crowded. You will almost inevitably have to wait for attention unless your condition is critical. (Take a book with you!) Many people with a wide range of problems need to seek help in the A&E department so you are likely to see a huge variety of people some in a state of some distress. Again, it is an enormous advantage if you can take a friend or family member with you. They can keep an eye on what is happening and alert staff if you become more unwell or anything changes. They can make a note of times and what the plans are and do their best to ensure that things keep moving along and that your case is not overlooked.

On arrival you are likely to be registered and then be seen as soon as can be arranged by what is called a Triage nurse. His or her job is to assess your condition, how sick are you, do you have a condition such as heart attack or stroke (bleeding in the head) which needs immediate attention, what is your level of discomfort or pain?

Some basic tests are done: temperature, blood pressure, pulse rate, breathing rate. These give an indication of how acute (i.e., serious) your immediate condition is. The term ‘acute’ refers to medical problems of sudden and serious onset. ‘Chronic’ conditions are those which simmer on for long periods such as diabetes or asthma but can have ‘acute’ phases needing urgent attention too.

You will then probably have to wait until a Casualty doctor is free to see you and decide what investigations are needed, what treatment you might need and what happens next. Make a note of the name of the doctor you see and refer back to him or her (or the doctor who takes over from them) if you are kept waiting too long without any information. Try and find out your hospital registration number and note it down. This can be very helpful later if you are referred elsewhere and need to ensure that information travels with you. Until a bed is found for you, and you are admitted to a named ward you are the responsibility of the A and E department. Any queries need to be raised there. Always go to the most senior person you can find if matters are serious. Lesser problems can be dealt with by the junior staff. While waiting for a bed to become available you may be placed in a waiting area with a name such as ‘Admissions ward’, or ‘Investigations unit’. They will do their best to get you into hospital swiftly but the problems the NHS are having with finding a bed for you are well known.

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