Venita Currie (Host): This is Health Matters: Insights from WCH Medical Experts. Thanks for joining us. I'm Venita Currie. Ever wonder what really happens behind the doors of an emergency room? We're going to be talking with Dr. Ross McDermott as he breaks down what happens and why. First, Dr. McDermott, thank you so much for being with us today. We really appreciate it. I'd love for you to walk me through what an ordinary day is for an emergency room doctor.

Ross McDermott, MD: Well, first of all, thanks for having me. I don't know if I'm the best person to be talking to you about an ordinary day because I work just at night. So, I could tell you about what an ordinary night is like for me. Typically, our shifts at Wood County Hospital run from 7:00 to 7:00, so they're 12 hours. So, I'll come in around 7pm after eating dinner. That tends to be one of our busiest times there, kind of in the after dinner period. So usually, I'm running pretty quick to try and get caught up with everything when I first get there at 7:00, hoping to kind of get things a little more manageable by the time midnight or 1:00 rolls around. So, there's definitely kind of an ebb and flow to the night. There's certain times we're running fast, certain times where we got a moment to kind of stop and catch our breath.

Host: What are the most common reasons why people are in the emergency room? What typical injuries or health matters that you're checking on?

Ross McDermott, MD: We see a range of everything you can possibly imagine in the emergency department, which is one of the reasons that the specialty is interesting, but also that it's challenging because it truly is a little bit of everything. We see a fair number of people coming in with abdominal pain or chest pain or pains somewhere in the body. They're not entirely sure what is going on. They're concerned they might be having an emergency medical condition. And a lot of what we do is doing testing to rule out the emergent or dangerous causes of chest pain or abdominal pain when those people come in. As you said, we see all range of injuries going from minor to severe. We get people in after major car accidents. We get people who fall and break their wrist. We get people who cut their finger. So, I don't know that there is something that I would call the most typical. It's really a complete grab bag of what you're going to get in any typical night.

Host: When you're running like that and having so many emergencies happening in the emergency room, I know there's a lot of concern about your mental health and how the health staff are managing the stress of being in an emergency room, can you talk about anything that you do or your staff can do when they're in the emergency room to kind of manage that stress?

Ross McDermott, MD: I lean pretty heavily on my coworkers who all of whom I consider my friends. There's a lot of camaraderie in the emergency department. You know, we're all kind of in it together trying to do this hard thing together. So, it definitely is stressful, but you're with a group of people who understand and share that stress. And you can lean on each other both for emotional support, we all like to check in and have a good laugh when we have a moment, but also just in a technical sense, I rely very heavily on my nurses to be keeping the plate spinning while I might be occupied doing a procedure. So really, the best thing that we can do is kind of lean on each other and then that kind of keeps us all sane.

Host: Yeah, I imagine when people are there, they're very stressed out. They're very concerned, either about their own health or the health of a loved one. Can you explain to us why people sometimes have to wait in the emergency room while other people are being attended to? What is the process for getting people in and through the emergency room?

Ross McDermott, MD: So actually, one of the most difficult parts of emergency care happens right upfront. That's the triage process where we have to take everyone who's coming into the emergency department and make a determination of, okay, who's got to go back first. And the basic premise of it is we're trying to get people back if we think 10 or 15 or 20 minutes might make a significant difference in their outcome. For example, somebody who's having a major heart attack, they need to get attentive care as quickly as possible. We know that the longer you wait, the worse outcomes you are. So, people with chest pain who are concerned for heart attack are going to move right on back.

Other things, such as injuries, I want to see if you broke your wrist, I want you to come in see me so I can help you. But most situations, you can sit with a broken wrist for about 15 minutes without it ending up being a massive difference in your outcome versus somebody having a heart attack or a stroke. So, we certainly do try and get everyone back as fast as possible. We try and get people comfort as quickly as possible. You know, again, that's somewhere where I rely on my staff where if I'm occupied with a critical situation or gowned up doing a sterile procedure, my nurses can pop their heads in and say, "Hey, can I get pain medicine for room six? They just brought him back." So, we try and do everything as quickly as we can within the limitations of our resources and also trying to make sure that we are dealing with people who are at an imminent life threat immediately.

Host: You know, when I think about some of my friends who have been to the emergency room, you know, it's because they've been on a scooter and they've fallen off or something that that could have been preventable on their end. Can you tell us what are some things that we should or should not be doing to avoid having to see you and having to come to the emergency room? Are there any kind of typical things that happen in the emergency that bring people to the emergency room, that if they had thought about it or were safer about it, they wouldn't have to go to the emergency room?

Ross McDermott, MD: Yeah, I mean, I don't know that I have any special insight beyond typical safety advice. Those electric scooters are becoming more and more popular, and we are seeing a number of injuries from those. So, just being careful while riding on those kinds of things. And definitely, anytime you're riding a scooter or a bicycle, wear a helmet. It can make such a huge difference between an accident being a minor issue to being a life-changing event. The same goes for if you're driving the car, wear your seatbelt, make sure that your airbags are functioning appropriately, make sure that children are secured in an appropriate car seat, because again, you know, a car accident can be a minor stress point in your life, or it can be a major life-changing event. And some of that is under our control, making sure that we're following those basic safety measures. So, there's no secrets that I have. All of the stuff that your mom and your teachers told you about being safe, you should follow that advice. And then, hopefully, you won't end up in with me at 2:00 in the morning.

Host: You know, one of the things I know that happens for me is I sit and I ask myself questions like, "Should I really go to the emergency room? Am I really in that much pain?" My husband, he'll go any second that he feels like he's uncomfortable, but are there any questions we should be asking ourselves to determine if we really need to go to the emergency room?

Ross McDermott, MD: The most important thing that we want to do is make sure that we are not dissuading anyone who needs emergency care from getting emergency care. So, the first thing I want to say here is we are here to serve our community 24 hours a day, seven days a week. So, anyone who believes that they're having a medical emergency can come in and see us at any time. No one will be turned away.

That being said, I was referencing earlier, it's difficult for us to manage high volumes of patients to determine who goes back first, get everyone's care going at the same time. I kind of look at the emergency department as kind of a community resource. And you got to ask yourself, "Okay, is this an appropriate use of this community resource? Is what's going on with me, has this raised to the level where I need to take advantage of this thing that is available for me?" again, if you feel that your life is in danger, if you feel scared, or if you have major concerns, come in and see us.

Things that we're not as good at dealing with, your typical, you know, sick symptoms like your cough and cold congestion, things like that, it is not something that we like to be dealing with in the emergency department. And also, kind of as I said before, I don't have secret stuff in the back. I don't have, you know, fancy medicine that's going to get your cough and cold symptoms to go away any more than, you know, what you could get at the store. It's a different situation if you're having trouble breathing and think you have pneumonia, but everybody's kind of got to judge for themselves, okay? Am I just sick or is this something where I think something more is going on?

Host: Thank you for that. And one more question, is there a big difference between urgent care and the emergency room?

Ross McDermott, MD: I would say that the differences in resource availability, my emergency department is based in a hospital where I have access to all kinds of specialty consultations. We have CT scanners, we have MRIs, we have x-rays, we have all of the equipment that a hospital has to offer that an urgent care might not necessarily have. Different urgent cares have different levels of equipment, some have x-rays, some do not. So, you got to kind of think out in your head, "Okay, what is it that I think that I need when I'm going in?" Because if you think your child's got an ear infection, well, that's pretty straightforward. You need a prescription for some antibiotics, which, you know, is not a resource-intensive thing, can be handled at an urgent care. If you think that you're going to need something, if you're having severe belly pain and think you have appendicitis and might need a CT scan, it might be better to go straight to the emergency room if you foresee labs and things like that being part of your care.

Host: Thank you so much, Dr. McDermott. It's been really insightful talking with you, and I hope our listeners got something out of the conversation. So, thank you so much.

Ross McDermott, MD: Absolutely.

Host: If you found this podcast helpful, please visit woodcountyhospital.org. And please share it on your social media. I'm your host, Venita Currie. Thanks for being a part of Health Matters: Insights from WCH Medical Experts.