No Rest for Emergency Rooms During Holidays

Dec. 25--Even on their best days, emergency rooms aren't exactly festive.

They don't liven up during the holidays, when Thanksgiving, Christmas and the birth of a new year are on everybody's minds.

There's no bauble-laden Christmas tree. Mistletoe doesn't hang from the ceiling.

This is no place for a party.

"Anyone who comes to the ER is in a crisis," said Laura Rogers, director of emergency services at Memorial Hospital Central/North. "You don't come here to hang out."

For emergency rooms, the holidays are a busy time, not necessarily by the numbers, but by the seriousness of injuries. There are more suicides, family violence escalates and free-flowing alcohol leads to all kinds of accidents.

Like the time a man in Seattle got drunk, shot his own leg off with a cannon and ended up in Seattle's Harborview Medical Center emergency room, said Bill Needham, clinical manager of the emergency departments at Memorial Central/North. He was there that night.

"The whole emergency room smelled like gunpowder the rest of the night," Needham said.

On Christmas Eve at Memorial central, the morning started slow.

About 9 a.m., the calls started, including one for a young child with cardiac arrest. The mood changed.

As the ambulance rolled in, nurses, radiologists, the ER doctor, a pharmacist, forensic nurse and specialists gathered in and near the Resuscitation Room. Within minutes, they were ready.

"They practice this all the time," said Ivey McCune, operations manager for the emergency department. "It's called STAT training. Everybody knows exactly where to be."

A second cardiac arrest call comes in. Other patients are rolled into other rooms. By the time the child is brought in, there are roughly 25 medical personnel waiting. The room goes quiet. The team goes to work.

"It's quiet so everybody in there can hear, so everybody knows exactly what everybody else is doing," McCune said. "This will be a long day for them."

Upstairs the atmosphere is not as charged. Labor and Delivery has not had any calls, but they know it won't be long.

"We haven't seen anything," said Janine Wellborn, a staff nurse.

Stockings with employee names hang from the counters and though it's quiet, there's an air of expectation. Pregnant women who come to Colorado for the holidays often have their water break because of the altitude. On top of that, a winter storm is expected to hit later in the day.

"It's a little scary because you know any minute ... it's that day and tomorrow is that day, too," said Jen Leach, an RN and member of the flight team.

Welcome to the holidays in the ER. On Christmas day somebody will be shot. Another person will be stabbed. Cars will crash, someone will try to kill himself and a family gathering will explode into violence.

Drinking, Rogers said, "can drive risky behavior, such as fighting. You put families together that shouldn't be together, they think they can get along and then fuel it with alcohol. There's always increased violence."

Memorial Central's emergency room serves between 280-300 patients a day. In a year, it sees about 110,000 patients. On a typical day, it's staffed with about 25 nurses and 14 technicians, and peak hours run from 11 a.m. to 1 a.m.

While the number of patients on Thanksgiving and Christmas usually decline, their conditions are almost always more serious.

"Their acuity is higher, so it's harder on the staff," Needham said. "Their only source of medical care is going to be the ER."

The busiest ER day during the holidays is Black Friday. There were 275 patients on Black Friday 2011 and 280 this year at Memorial. The department adds two RNs, but otherwise staffing stays the same on Christmas and Thanksgiving, Needham said,

Another high-volume day is the day after Christmas. Needham figures that's because people don't want to ruin that special day for the family and hope whatever is bothering them will fade.

The trend is similar at Penrose Hospital.

"The day after is historically is always busier than the holiday itself," said Dr. Jack Sharon, medical director of emergency services at Penrose. "People don't necessarily want to go to the doctor on the holidays."

Sharon, who worked 1 p.m. to 10 p.m. on Christmas Eve, said emergency rooms can see a 30 percent or higher spike the day after holidays.

The holiday atmosphere also is low key at Penrose, Sharon said.

"I think you will see people with more subtle Christmas things, like a sweater or Christmas pin," he said. "Our business is pretty serious, although we certainly don't hesitate to wish people a Merry Christmas. That's a good thing and hope is a good thing."

The high altitude can be tough for people from sea level visiting family, he said.

"We see lots of altitude issues with older folks visiting family from out of town," Sharon said. "That's sad. They came to see family and they end up in the ER. That's not why they came to Colorado Springs."

Typically Penrose has a staff of about a dozen nurses and five technicians with doctors and nurses on call 24 hours.

"We always have on-call folks and nine out of 10 patients who come in see a provider within 30 minutes of hitting the door," Sharon said. "We get them back to the family as quickly as possible so they don't have to eat hospital turkey."

Even though they get paid time and a half, most prefer not to work on Christmas and Thanksgiving, Rogers said. They miss family and it's a high pressure day. Most are upbeat and positive, even though they are working the holidays, Sharon said.

But too many Christmas' in emergency and the day can lose its family feel. Just about anything can roll in.

Rogers remembers a Christmas Eve night when four kids aged 14 to 17 came in at the same time with cut wounds on their hands that had to be stitched up. They had received knives for Christmas.

"I will never forget it," she said. "The knives were new, and they were sharp."

McCune remembers nurses referring to Christmas as "nursing home dump day" because family members who visited elders who they hadn't seen for awhile thought they looked worse than the last visit.

The view from inside the ER, Rogers said, is vastly different from the view from the outside.

"It is the world of emergency medicine, which is really interesting," she said. "It's an emotionally charged place to work."

On holidays, it's even more emotionally charged.

"What happens at Christmas, a very happy holiday ... we're going to see something that has a bad outcome," Rogers said. "When you see that, it impacts you and when you go home, you hug your kids a little tighter."

NOTE: Because of privacy issues, the hospital could not say what happened to the patients who arrived in the ER Monday morning.

Memorial Hospital Central's holiday patient numbers

Thanksgiving 2011: 247

Thanksgiving 2012: 224

Black Friday 2011: 275

Black Friday 2012: 280

Christmas 2011: 272

Penrose Hospital holiday patient numbers

Thanksgiving 2010: 97

Thanksgiving 2011: 89

Black Friday 2010: 116

Black Friday 2011: 116

Christmas 2010: 95

Christmas 2011: 102

Dec. 26, 2010: 143

Dec. 26, 2011: 147

Copyright 2012 - The Gazette (Colorado Springs, Colo.)