ER expectations

Every year, local emergency rooms brace for a surge in cases. Medical staff share how they cope and offer essential advice on how to stay healthy during the holiday season

THE CHRISTMAS TREE is up and decorated, the gifts are wrapped and the cookies are baked. You are all ready to celebrate the holidays when suddenly, instead of spending time with family, you end up in the hospital emergency department.

Unfortunately, it’s an all-too-common scenario that plays out in local hospitals across Kitchener, Waterloo and Cambridge.

“We always see a spike in people coming to the ER during the holidays,” says Jill Schitka, program director, emergency department at Grand River Hospital. “It’s a busy time of year for us.”

We are not trying to prevent people from coming to the emergency room. We are trying to make sure they get the best care. No one wants to be stuck in the emergency room on Christmas.”

Jill Schitka, program director, emergency department, Grand River Hospital

On average, about 180 to 190 people visit the Waterloo emergency department each day, but that number jumps every year between Dec. 21 and Jan. 4.

“We actually see our highest volumes on Dec. 26,” says Schitka. “Last year on Boxing Day, we saw 217 patients.”

The second busiest day at the hospital during the holiday season is Jan. 2, with 202 people visiting Grand River’s emergency department on that day last year, she adds.

Schitka, who has been working in the local emergency department for the past 15 years, says there are a number of factors driving this surge in emergency room visits at a time when people are supposed to be celebrating with family and friends.

One of the biggest reasons is there might be no other place for them to go for medical care.

“There is more limited access during the holidays, particularly on Boxing Day, because most family doctors’ offices are closed,” she says.

Not only are there fewer medical services open, but more people tend to get sick. During the holidays, there are often higher incidents of influenza and stomach flu. When you combine the typical rise in illness during the winter months with an increase in social gatherings, you get a recipe for spreading germs, says Schitka.

“We will end up seeing clusters of families at the emergency department. The mother, father and kids will all come in sick rather than just one of them,” she says.

Although people might get sick before Christmas, they will often hold off until after the big day to seek treatment, which might also explain the spike on Dec. 26.

“The first part of the holidays is still relatively quiet because people are busy with their plans,” says Dr. Mark Shafir, chief of the department of emergency medicine at Cambridge Memorial Hospital.

“People want to make sure the kids

have a wonderful Christmas so they will put off going to the hospital. But after Christmas Day, the emergency room just gets busier and busier until the holidays are over. It can be a stressful time.”

While Shafir agrees holiday gatherings can be germ-filled, he says the alcohol consumed at these gatherings can also play a role in why more people show up at the emergency department between Christmas and New Year’s Day.

“With an increased use of alcohol, you get an increase in injuries associated with intoxication,” says Shafir, who has been an emergency room doctor at the Cambridge hospital for 17 years.

“Alcohol can also have a negative effect on other systems in the body and any medications a person is taking. For example, a patient with a bad heart may drink and get what we call ‘holiday heart.’ They will show up at the ER with a heart arrhythmia or congestive heart failure.”

Another cause of the spike in emergency room visits are car accidents. More people are out travelling at this time of year and are also more likely to risk driving in bad weather, says Schitka.

“During the holidays, people tend to make plans with family and the weather doesn’t seem to stop them. They will just push through and drive in weather that they wouldn’t normally drive in.”

As a result, the hospitals also often see an increase in the number of people suffering from injuries caused by fender benders and more serious car crashes.

Michelle Flanagan, who has worked as a nurse practitioner in the emergency room at Grand River Hospital for 22 years, has experienced many difficult Christmases as a result of having to treat people injured in serious, sometimes fatal, car crashes.

She says working in the emergency room during the holidays can definitely put a damper on what is supposed to be a festive time of year.

“I don’t see the holiday season as a

holiday because, in my world, I can’t celebrate and kick back and enjoy it,” says Flanagan. “For me, the holidays are a frenzy. I never look forward to them. But you know when you go into this field that it’s 24-7. You get used to it and you adjust.”

Hospital staff typically work either Christmas Day or New Year’s Day and will alternate each year which of those holidays they are scheduled to work. As a result, many doctors and nurses working in the emergency department do not have typical celebrations during the season.

“I remember when I had young kids, there was one Christmas morning when I worked until five in the morning,” says Flanagan. “We celebrated as soon as I got home and then I went to bed.”

Depending on her shift, Flanagan will show up late for Christmas dinner or celebrate over breakfast. She says her husband and three children, now in their 20s, have become accustomed to working around her hectic schedule over the holidays and have accepted that she can’t always be there.

Schitka, who also has three grown children, remembers having to find creative ways to celebrate Christmas with her kids when they were young because she was often absent.

“There was one year when my kids were three, four and six years old that we told them Christmas was on Boxing Day,” she says. “They had no idea that it wasn’t actually Christmas Day. It went off without a hitch.”

Despite often missing out on family gatherings during the holidays, Schitka says staff try to make the best of it by bringing some festive cheer into the emergency room, whether it’s organizing a potluck or decorating the department.

“You may be missing your family, but you have your emergency room family,” she says. “They become really important to you and you get used to spending a lot of the holidays together. We do our best to keep it happy and festive.”

Shafir remembers one Christmas Day in particular where he was glad to have his colleagues with him. A four-year-old girl in critical condition showed up at Cambridge hospital’s emergency department.

“She had been at a hospital in London and was released Christmas Eve day because they were hoping she could spend Christmas at home,” he says.

Unfortunately, she wasn’t doing well and had to be rushed back to London on

Christmas Day. Since it was the holidays, there wasn’t enough staff in London to travel to Cambridge and transport the girl by ambulance, so Shafir and a team of medical staff had to.

“We felt terrible for this young girl, but we were glad we got her there safely,” he says. “On the way back, we stopped at McDonald’s and had our holiday meal on the side of the highway. It was 10 or 15 years ago, but that Christmas still sticks out in my memory.”

Shafir will be working Christmas Day again this year and he is among a number of hospital staff who began preparing for the upcoming holiday surge back in October.

Every autumn, members of the Waterloo Wellington Local Health Integration Network (LHIN) meet to discuss strategies on how to deal with the increase in visits to the emergency room during the holidays, says Shafir.

While emergency room staffing typically remains the same, other services within the hospital that aren’t vital and draw on resources are shut down. For example, the number of functioning operating rooms is reduced because elective procedures aren’t scheduled during the holiday season, he says.

“During the holidays, we keep one operating room open for emergency procedures. If there is a patient that needs an emergency surgery, we can get them in quickly because there isn’t anything else scheduled.”

At Grand River Hospital, the staff puts out pamphlets in the emergency room with tips on how to avoid ending up in the hospital during the holiday season.

“We usually put it out about two weeks before the holidays,” says Schitka.

The pamphlet advises people to prepare for the holidays by filling up prescriptions in advance and visiting your family doctor before the holidays begin if you have an ongoing health problem. It also provides information on the location of local walk-in and after-hours clinics and the hours they are open.

The pamphlet also recommends ways to stay healthy during the holidays, such as frequently washing hands, not visiting family or friends when you are sick and getting your flu shot. It also suggests ways to avoid injury by drinking responsibly and not driving in weather that is unsafe.

“We are here if anyone needs us,” says Schitka. “We are not trying to prevent people from coming to the emergency room. We are trying to make sure they get the best care. No one wants to be stuck in the emergency room on Christmas.”