On popular TV shows, emergency room physicians run from one obvious crisis to the next, but in the real world, while some
days have more twists and turns than a roller coaster, there’s no typical day in the ER, especially during a pandemic.
“We see everything from surgical emergencies, strokes and heart attacks to minor bumps and scrapes. Sometimes, patients
have vague symptoms. My job is to listen, understand and identify what’s going on, because, for anyone who comes to the
Emergency Department, it feels like a crisis to them,” explains Doylestown Health Emergency Medicine physician Brenda Foley,
From Calm to Chaotic
“Slow days are certainly not as exciting as fast-paced days, but the ER is never dull,” says Dr. Foley, who enjoys the
unpredictable nature of her work, which challenges her to think outside of the box to come up with solutions when seconds
Predicting the Unpredictable
Some ER providers have come up with their own ideas about what makes a shift calm, chaotic or just right. For example:
The ER is calm during Eagles games:
Although the evidence is unscientific, Dr. Foley agrees that Doylestown Health’s ER tends to be quieter during
televised Eagles games.
A Full Moon Equals Mayhem: Some speculate that a full moon leads to chaos and a busy night in the ER, though
Dr. Foley does not believe this common superstition. Studies back her up, finding no relationship between a full moon and
increased ER traffic.
Monday is the busiest day: This is true and reflected in ER staffing at Doylestown Health, which is more
robust on Mondays and between 11 am and 11 pm when volume and acuity are highest.
Some Days are Tough
Mondays are busier, especially after a holiday, but the first Monday of 2021 was unusually busy. “We were fully staffed
and anticipating a higher than normal volume of patients, yet despite that, the ER was packed and patients we had already seen
were waiting for an inpatient bed to open,” says Dr. Foley.
Bucks County Emergency Health Services has a temporary designation called Divert status that informs pre-hospital personnel
when a hospital is at capacity. “We went on Divert, but other area hospitals were also on Divert, so the ambulances continued
to bring patients to the ER. Our team never stopped. The entire ED team was exceptional in coordinating care and placing
patients. We did everything we could to absorb this surge, and yet with that, some patients waited for hours and a few left,”
says Dr. Foley.
COVID-19 and the ER
“The physical and emotional burden of COVID-19 has a domino effect on the health of our patients. Patients that present to
the ED are generally sicker than in the past, I suspect because they are receiving less preventive care. In addition, we are
seeing increasingly more people in crisis with mental health issues,” says Dr. Foley.
Ironically, while the first wave of COVID-19 hit Bucks County and many health care providers worked around the clock,
Doylestown Health ER visits dropped to 50 percent of pre-pandemic volumes. “The reduction in accidents made sense, because
people were quarantining and restricting activities; however, a drop in chest pain and other illnesses led us to believe that
COVID-19 fears were keeping some patients from coming to the ER in a timely manner,” says Dr. Foley. “Fortunately, as Bucks
County progressed to the green phase and people became more comfortable, ER visits gradually increased to 85 percent of
Don’t Delay Emergency Care – Call 9-1-1
To anyone hesitant about coming to the ER during the pandemic, Dr. Foley says, “Do not delay emergency care for any
Stroke symptoms and
are medical emergencies that require immediate treatment. Call 9-1-1, and do not drive to the hospital, because ambulances
are equipped to send critical information to the Emergency Department before you arrive to expedite care and improve
“Left unchecked at home, a stroke may progress irreversibly,” explains Dr. Foley. “We can literally save a life or
prevent disability with clot-busting medications and advanced treatments for stroke patients who qualify, but we need to see
you in the ER within 4.5 hours from the onset of symptoms.”
To recognize stroke symptoms, BE FAST*:
Trouble with balance or coordination
Eyes: Blurred vision or sudden loss of vision in one or both eyes
Face: Does the face look uneven? Ask the person to smile
Arm: Does one arm drift down? Ask the person to raise both arms
Speech: Does their speech sound strange? Ask the person to repeat a simple phrase, for example "The sky
Time: If you observe any of these signs, then it's time to call 9-1-1
The sooner you call 9-1-1 after chest pain begins, the more likely you are to have a better outcome, and paramedics can
begin treatment on the way to the hospital.
Heart attack symptoms include:
- Burning, aching or tightness in the chest
- Pain that travels down one or both arms
- Jaw pain
- Chest pressure, squeezing or discomfort (feeling of fullness)
- Back pain
- Shortness of breath
Keeping the ER Safe
“We’re eager to take care of our community, we’re protected and we will protect our patients,” says Dr. Foley. In
addition to standard universal precautions and repeated handwashing, protections include:
- Most Emergency Department staff already fully vaccinated against COVID-19
- Masks, verbal screening and temperature checks are required for every patient, family member and visitor
- Visitors are prohibited at this time, in an effort to minimize risk to patients and family members. However, staff will
keep in contact with family members via telephone as requested.
- Health care providers wear personal protective equipment (PPE)--masks, gowns, shields, gloves, etc.
- Patients are separated based on risk/suspicion of COVID-19. A 15-minute test helps identify those who are positive.
- Limited transport of patients at risk/suspicion for COVID-19. For example, x-rays performed in ER, rather than traveling
through hallways to Radiology
- Special, negative pressure rooms engineered to limit aerosol transmission of virus particles
cleaning measures throughout the hospital including:
- Patient rooms and public areas sanitized with EPA approved high-level disinfectant
- Diagnostic equipment cleaned before and after every use with germicidal disposable wipes that kill coronavirus in
- Disinfection in isolation, discharge and procedural areas with pulsed xenon machines that emit an ultraviolet (UV)
light found to reduce the risk of hospital-acquired infections
of Physical Space with social distancing and safety in mind