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In Case of an Emergency: The Life Saving Triage Process
Dr. Kevin Hanson discusses the Triage Process in emergencies.
Featuring:
Learn more about Kevin Hanson, MD
Kevin Hanson, MD
Kevin Hanson, MD is the Executive Medical Director and Physician at EvergreenHealth Emergency Department.Learn more about Kevin Hanson, MD
Transcription:
Scott Webb: Hello and welcome to Checkup Chat with Evergreen Health. I'm Scott Webb and I'm here today with Executive Medical Director and physician at Evergreen Health Emergency Department, Kevin Hanson. Welcome Dr. Hanson. Emergencies can happen at all hours of the day and night. When you have a medical emergency, you want to be seen and diagnosed as quickly as possible. However, hospitals across the state are seeing higher volumes of people resulting in longer than normal wait times. So Dr. Hanson, the key takeaways for today's podcast is really to clarify what someone can expect from their care and how the triage process really works. Before we begin, maybe you could share a little bit about when someone should seek out emergency care?
Dr. Kevin Hanson: Someone should seek out care when they really are concerned about more life-threatening emergencies. So as example, someone who has chest pain, someone who is actively bleeding, someone who's short of breath, or having stroke symptoms. Those are the very appropriate times to be seeking out emergency care.
Scott Webb: Yeah, and some of the buzz. Sort of sayings, time is brain, time is heart. So those are important things. If it's heart related, you get there. If it's, stroke related brain related, get there. And I did one the other. Yeah. And I did one the other day about some other unusual condition and she was talking about if your hand ever turns blue and I said, doctor, I'm gonna add to that. Time is hand as well. So I kind of coined a new phrase, but in all seriousness, doctor, what can people expect? So they're having one of these conditions, some sort of emergent, alarming, emergenc y type conditions. So when they go to the emergency department, what can they expect?
Dr. Kevin Hanson: When someone arrives in the emergency department and comes in, , what we describe is through the front door, they'll end up in the triage process. And I think that's, a process that often is misunderstood. So it's a process where basically where we assess a patient, we will have a registrar and a nurse, and often one of our ed technicians work together as a team to really assess a patient when they come in. The registration personnel will get the person in our, electronic medical record, so we can see their past history easier.
While our tech and nurse really assess the patient. What's their medical condition today? What are their vital signs? There's a reason they're called vital signs as they are vital. They help us assess and, say how sick is a patient when they come in. You can have normal vital signs and be very sick, and you can have obviously abnormal, vital signs be quite sick as well. So really it's a matter of us sort of sorting through what are the conditions that someone presents with today. And then trying to see the sickest patients first in the emergency department.
That's one of the, misnomers. A lot of times you go to other type of venues and it's first come, first served in an emergency department. We really need to take the sickest patients first. Often we want to get everybody back quickly because obviously you wouldn't be in an emergency department unless you felt you were having an emergency. That being said, we have to triage and decide who is the sickest and get them back to the resources first.
Scott Webb: Yeah. And I'm sure there are times where you're thinking to yourself, maybe this wasn't an emergency. Maybe you didn't need to come straight here. But people are concerned and we'd rather they seek, medical attention than not, especially if it is something more serious. Wondering if the process is different at all. If someone calls 911 versus them sort of driving themselves in is the triage process the same?
Dr. Kevin Hanson: I would say the process is, slightly different if someone calls 911. So in the area where we live, If you call 911, oftentimes you will get the fire department or a private ambulance company that comes out and evaluates you. I would say the majority are the fire departments that will come out, or the medics will come out depending on what your complaint is. If you call 911 and your complaint is, you know, somebody collapsed and they're not breathing, the medics are gonna be dispatched immediately.
If you call 911 and you have abdominal pain and are vomiting, a fire department may come out first and assess you, and really the triage processes in the field as well. So, in other words, the fire department or medics will come out and do essentially what the, triage nurses are doing when someone drives into the emergency department, they're assessing the situation. What are the complaints? What are the vital signs? They're able to intervene with IVs and checking glucose levels and EKGs and, rescue things such as CPR if they need to, or intubate you if you need to.
So they're able to intervene in the field. And subsequently they're communicating with us in the emergency department. Either with a nurse or with a physician, and communicating with us what is coming in from an ambulance, essentially in the field. So a lot of that process is happening the same. It's just happening when you're at home or when you're in your car, if you got in a car wreck, those sorts of things. And then the patient comes in almost directly to a room, I would say the vast majority of the time, occasionally a patient will be triaged back out to the waiting room if their only mechanism into the facility was via ambulance.
An example of that would be when someone gets in a car wreck that's not severe, but they can't drive their car. They're sick enough to need assessed, but they're medically stable, so they will sometimes go to our waiting room, but that is the exception, not the rule.
Scott Webb: Yeah, I see what you mean. the. The rule for sure. So then besides the triage system, because I know at least speaking only for me, both of my kids have been into the emergency room many times over the years and sometimes wait times are high. So besides the triage system, is there any other reasons you can tell us or explain why ED wait times can be so high?
Dr. Kevin Hanson: It's really a, function of the acuity and the volume of patients often, I would tell you it is not as frequent that it is around staffing. I think the perception is that we don't have enough nurses or physicians or those sorts of things, but the reality is it's a matter of volume that comes in the door. There is some consistency to an emergency department, and I think that if you don't live in that world every day, people don't know that there is predictable volumes. Certain days of the week are always busier.
Certain times of the day are always busier and we attempt to staff for those sort of busier days and busier times, but there's always the unpredictable event. A good example is the ice storm that happened a few weeks ago where you wouldn't have predicted that there was an ice storm on a certain day of the week, and all of a sudden you're gonna have 200 people show up that fell on the ice and injured and broke their extremities. So it's those sorts of things that can really affect sort of the wait times as well.
Scott Webb: Yeah, I see what you mean. Is there anything we should do before we go to the ED? I mean, I sometimes, obviously in the case of an emergency, we're not thinking about, oh, I better bring this, I better bring that. Or, how does my hair look? Or whatever. But generally speaking, what should we do? If we have time to plan, what should we do before we go?
Dr. Kevin Hanson: If folks have time to plan, which oftentimes they don't and we understand that, but if they do have time to plan, some of the things that are more helpful to expedite your care and to make your care better are to make sure you understand your medical history. If you don't know your medications, if you don't know who your physicians are, if you don't know which surgeries have you had? Those are things that are extremely helpful. And I would say if I had to focus on one thing, it's, really understanding the medications. It's really, surprising how many times we see patients and we ask them, what's your history?
And they'll tell me, I have high blood pressure, or I've had a stroke in the past. What medications do you take for that? And they're like the little white pill. And I take it twice a day and the reality is knowing the medications, is that little white pill a blood pressure medicine or is it a blood thinner, but immensely changes the workup and sort of your evaluation. So if you can't understand the pills or you don't necessarily have them written down, bring the actual bottles. That's extremely helpful for us. And I think it's really understanding someone's history is probably the most important thing that oftentimes can delay their care.
Scott Webb: For sure. We were talking about wait time, so knowing your history, being familiar with your family history, grabbing your meds before you go. Then you don't have to try to pronounce those names and remember all them the little pill. It's about this big. It's white. Yeah. this has been really helpful today. As we wrap up here, what would you be, your final thoughts and takeaways, when we think about people listening to this and when they should call 911? When they can drive themselves what they should do before they go, what they can expect once they get there? Wrap it up for us, Doctor.
Dr. Kevin Hanson: Yeah. I would say no one ever intends to come into the emergency department. No one ever wakes up thinking, today's the day I'm gonna go to the er. I would want people to know that it's appropriate if you're concerned about a medical emergency, that we are there for you 24/7, 365 days a year. It's one of the reasons that emergency physicians go into emergency medicine. We will take care of anybody, anywhere, anytime, and that's really important to know that we're there for the community and we're there for our patients. And so, we hope that we don't have to cross paths with someone, but when we do, we are there to take care of them.
Scott Webb: Yeah, that's perfect. That's well said. And as you say, by definition, you really can't plan for an emergency, but it's good to know, , if we're having one, some things we could think about or someone else who's helping us could think about before we go. And then what to expect when we get there. And as you gave us some great suggestions, how to maybe, speed up our wait times would be to have some of the answers the doctors are gonna want to know, like what's your family history, what's your history? What meds are you on? And so on. So, great stuff today, doctor. Thanks so much. You stay well.
Dr. Kevin Hanson: All right. Thank you very much for your time.
Scott Webb: Evergreen Health offers three emergency department locations in Redmond, Kirkland in Monroe. If you're unsure of what level of care you need, call the Evergreen Health Nurse Health Line at 425-899-3000.
Dr. Jessica Dai: Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.
Scott Webb: Hello and welcome to Checkup Chat with Evergreen Health. I'm Scott Webb and I'm here today with Executive Medical Director and physician at Evergreen Health Emergency Department, Kevin Hanson. Welcome Dr. Hanson. Emergencies can happen at all hours of the day and night. When you have a medical emergency, you want to be seen and diagnosed as quickly as possible. However, hospitals across the state are seeing higher volumes of people resulting in longer than normal wait times. So Dr. Hanson, the key takeaways for today's podcast is really to clarify what someone can expect from their care and how the triage process really works. Before we begin, maybe you could share a little bit about when someone should seek out emergency care?
Dr. Kevin Hanson: Someone should seek out care when they really are concerned about more life-threatening emergencies. So as example, someone who has chest pain, someone who is actively bleeding, someone who's short of breath, or having stroke symptoms. Those are the very appropriate times to be seeking out emergency care.
Scott Webb: Yeah, and some of the buzz. Sort of sayings, time is brain, time is heart. So those are important things. If it's heart related, you get there. If it's, stroke related brain related, get there. And I did one the other. Yeah. And I did one the other day about some other unusual condition and she was talking about if your hand ever turns blue and I said, doctor, I'm gonna add to that. Time is hand as well. So I kind of coined a new phrase, but in all seriousness, doctor, what can people expect? So they're having one of these conditions, some sort of emergent, alarming, emergenc y type conditions. So when they go to the emergency department, what can they expect?
Dr. Kevin Hanson: When someone arrives in the emergency department and comes in, , what we describe is through the front door, they'll end up in the triage process. And I think that's, a process that often is misunderstood. So it's a process where basically where we assess a patient, we will have a registrar and a nurse, and often one of our ed technicians work together as a team to really assess a patient when they come in. The registration personnel will get the person in our, electronic medical record, so we can see their past history easier.
While our tech and nurse really assess the patient. What's their medical condition today? What are their vital signs? There's a reason they're called vital signs as they are vital. They help us assess and, say how sick is a patient when they come in. You can have normal vital signs and be very sick, and you can have obviously abnormal, vital signs be quite sick as well. So really it's a matter of us sort of sorting through what are the conditions that someone presents with today. And then trying to see the sickest patients first in the emergency department.
That's one of the, misnomers. A lot of times you go to other type of venues and it's first come, first served in an emergency department. We really need to take the sickest patients first. Often we want to get everybody back quickly because obviously you wouldn't be in an emergency department unless you felt you were having an emergency. That being said, we have to triage and decide who is the sickest and get them back to the resources first.
Scott Webb: Yeah. And I'm sure there are times where you're thinking to yourself, maybe this wasn't an emergency. Maybe you didn't need to come straight here. But people are concerned and we'd rather they seek, medical attention than not, especially if it is something more serious. Wondering if the process is different at all. If someone calls 911 versus them sort of driving themselves in is the triage process the same?
Dr. Kevin Hanson: I would say the process is, slightly different if someone calls 911. So in the area where we live, If you call 911, oftentimes you will get the fire department or a private ambulance company that comes out and evaluates you. I would say the majority are the fire departments that will come out, or the medics will come out depending on what your complaint is. If you call 911 and your complaint is, you know, somebody collapsed and they're not breathing, the medics are gonna be dispatched immediately.
If you call 911 and you have abdominal pain and are vomiting, a fire department may come out first and assess you, and really the triage processes in the field as well. So, in other words, the fire department or medics will come out and do essentially what the, triage nurses are doing when someone drives into the emergency department, they're assessing the situation. What are the complaints? What are the vital signs? They're able to intervene with IVs and checking glucose levels and EKGs and, rescue things such as CPR if they need to, or intubate you if you need to.
So they're able to intervene in the field. And subsequently they're communicating with us in the emergency department. Either with a nurse or with a physician, and communicating with us what is coming in from an ambulance, essentially in the field. So a lot of that process is happening the same. It's just happening when you're at home or when you're in your car, if you got in a car wreck, those sorts of things. And then the patient comes in almost directly to a room, I would say the vast majority of the time, occasionally a patient will be triaged back out to the waiting room if their only mechanism into the facility was via ambulance.
An example of that would be when someone gets in a car wreck that's not severe, but they can't drive their car. They're sick enough to need assessed, but they're medically stable, so they will sometimes go to our waiting room, but that is the exception, not the rule.
Scott Webb: Yeah, I see what you mean. the. The rule for sure. So then besides the triage system, because I know at least speaking only for me, both of my kids have been into the emergency room many times over the years and sometimes wait times are high. So besides the triage system, is there any other reasons you can tell us or explain why ED wait times can be so high?
Dr. Kevin Hanson: It's really a, function of the acuity and the volume of patients often, I would tell you it is not as frequent that it is around staffing. I think the perception is that we don't have enough nurses or physicians or those sorts of things, but the reality is it's a matter of volume that comes in the door. There is some consistency to an emergency department, and I think that if you don't live in that world every day, people don't know that there is predictable volumes. Certain days of the week are always busier.
Certain times of the day are always busier and we attempt to staff for those sort of busier days and busier times, but there's always the unpredictable event. A good example is the ice storm that happened a few weeks ago where you wouldn't have predicted that there was an ice storm on a certain day of the week, and all of a sudden you're gonna have 200 people show up that fell on the ice and injured and broke their extremities. So it's those sorts of things that can really affect sort of the wait times as well.
Scott Webb: Yeah, I see what you mean. Is there anything we should do before we go to the ED? I mean, I sometimes, obviously in the case of an emergency, we're not thinking about, oh, I better bring this, I better bring that. Or, how does my hair look? Or whatever. But generally speaking, what should we do? If we have time to plan, what should we do before we go?
Dr. Kevin Hanson: If folks have time to plan, which oftentimes they don't and we understand that, but if they do have time to plan, some of the things that are more helpful to expedite your care and to make your care better are to make sure you understand your medical history. If you don't know your medications, if you don't know who your physicians are, if you don't know which surgeries have you had? Those are things that are extremely helpful. And I would say if I had to focus on one thing, it's, really understanding the medications. It's really, surprising how many times we see patients and we ask them, what's your history?
And they'll tell me, I have high blood pressure, or I've had a stroke in the past. What medications do you take for that? And they're like the little white pill. And I take it twice a day and the reality is knowing the medications, is that little white pill a blood pressure medicine or is it a blood thinner, but immensely changes the workup and sort of your evaluation. So if you can't understand the pills or you don't necessarily have them written down, bring the actual bottles. That's extremely helpful for us. And I think it's really understanding someone's history is probably the most important thing that oftentimes can delay their care.
Scott Webb: For sure. We were talking about wait time, so knowing your history, being familiar with your family history, grabbing your meds before you go. Then you don't have to try to pronounce those names and remember all them the little pill. It's about this big. It's white. Yeah. this has been really helpful today. As we wrap up here, what would you be, your final thoughts and takeaways, when we think about people listening to this and when they should call 911? When they can drive themselves what they should do before they go, what they can expect once they get there? Wrap it up for us, Doctor.
Dr. Kevin Hanson: Yeah. I would say no one ever intends to come into the emergency department. No one ever wakes up thinking, today's the day I'm gonna go to the er. I would want people to know that it's appropriate if you're concerned about a medical emergency, that we are there for you 24/7, 365 days a year. It's one of the reasons that emergency physicians go into emergency medicine. We will take care of anybody, anywhere, anytime, and that's really important to know that we're there for the community and we're there for our patients. And so, we hope that we don't have to cross paths with someone, but when we do, we are there to take care of them.
Scott Webb: Yeah, that's perfect. That's well said. And as you say, by definition, you really can't plan for an emergency, but it's good to know, , if we're having one, some things we could think about or someone else who's helping us could think about before we go. And then what to expect when we get there. And as you gave us some great suggestions, how to maybe, speed up our wait times would be to have some of the answers the doctors are gonna want to know, like what's your family history, what's your history? What meds are you on? And so on. So, great stuff today, doctor. Thanks so much. You stay well.
Dr. Kevin Hanson: All right. Thank you very much for your time.
Scott Webb: Evergreen Health offers three emergency department locations in Redmond, Kirkland in Monroe. If you're unsure of what level of care you need, call the Evergreen Health Nurse Health Line at 425-899-3000.
Dr. Jessica Dai: Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.