Kiwi emergency doc’s prominent new role
‘‘You kind of know how many people are going to come in on any given day, but you’re not quite sure how sick they will be and what they’ll have.’’
Caring for the sickest patient? That’s not very stressful for Dr John Bonning.
‘‘Doing CPR, intubating – we train for that,’’ the Waikato emergency doctor said.
What does stress him is being confronted with 90 or 100 people in an emergency department, some angry about waiting hours, and knowing 30 need to be admitted to hospital and 40 haven’t been seen yet.
Bonning will soon advocate for thousands of colleagues who share similar challenges, as the president of the Australasian College for Emergency Medicine.
He’ll be the first Kiwi president elected in the college’s 35-year history.
Emergency medicine is chaotic and busy, Bonning said, but it’s interesting and the colleagues are great.
‘‘You kind of know how many people are going to come in on any given day, but you’re not quite sure how sick they will be and what they’ll have. And I just enjoy that challenge of finding order in the chaos,’’ he said.
‘‘And the tremendous variety – from the smallest children to people over the age of 100, women and men and psychiatry and trauma, but also medicine.’’
When he started in emergency medicine, around 1998, NZ had about six specialists, he said.
Bonning, 51, spent seven as director of Waikato Hospital ED, and will keep working there – with a slight trim in hours – during his president’s role.
He needs it for his sanity, credibility, and to keep up with issues on the clinical front line, he said.
Near the top of Bonning’s list of ED problems are the ones which leave patients around Australasia stuck – either in an ambulance, or waiting for a hospital bed.
For example, sometimes all 69 treatment spaces in Waikato ED are full, he said.
‘‘Then you can’t physically get somebody out of an ambulance, because there is no physical space in the emergency department’’ – they call that ambulance ramping.
Another problem, called access block, is when patients are stuck in ED because there’s no hospital bed for them.
Other aims for the college include better dealings with Ma¯ ori and with patients with mental illness, and getting more women into college leadership roles.
Bonning recently had a look at how emergency departments in Europe, the US, and Canada, deal with the flow of patients.
He also took in wider systems, including Glasgow’s helicopter retrieval system, ambulance services, and a National Health Service (NHS) call centre.
In Stockholm, Sweden, you need a referral or an ambulance to get into one emergency department.
European emergency departments often divert patients to a general practitioner based beside ED, or down the road.
But a UK hospital had tried that three different ways and all of them had fallen over, Bonning said, so it would need careful planning if we were to try it here.
The real pressure on ED is not ‘‘a bunch of people that should be seeing their GP’’, he said.
Rather, it’s increasing patient numbers and the more complex health conditions they show up with.
Bonning will spend a year as president-elect of the Australasian College for Emergency Medicine (ACEM), a kind of deputy role, before becoming president in late 2019.
He has been on the board of ACEM for four years already, chairs the New Zealand faculty, and is also the current chair of the New Zealand Council of Medical Colleges.