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Emergency Care

According to the Centers for Disease Control & Prevention (CDC), Emergency Room visits declined more than 42 percent during the early stages of the COVID-19 pandemic.

Dr. Susan Tout shares the symptoms that need immediate attention to avoid a life-threatening situation and hospital safety protocols in place for patients.
Emergency Care
Featured Speaker:
Susan Tout, MD
Susan Tout, MD is a Board-certified emergency medicine physician on the Medical Staff at Southwest General.

Alyne Ellis (Host):   According to the Center for Disease Control and Prevention, emergency room visits declined more than 42% during the early stages of the COVID-19 pandemic. However, timing is particularly critical for many healthcare issues such as heart attacks, stroke, abdominal pain, and trauma. Early treatment is critical in minimizing damage and for improving patient survival. Joining me to discuss why it is essentially to never delay emergency care when needed and the symptoms one should never ignore is Dr. Susan Tout. Dr. Tout is the director of the emergency department at Southwest General, and she’s the medical director for the local EMS area. This is Southwest General Healthtalk. I'm Alyne Ellis. Welcome Dr. Tout.

Susan Tout, MD (Guest):   Well thank you for having me.

Host:   So what are some of the symptoms that need immediate attention to avoid a life threatening situation?

Dr. Tout:   In the emergency department, we always like to make sure we’re dealing with time sensitive conditions as a priority. So I would say the most important things are where you can lose recovery, you can lose prognosis by waiting. Again, that always translates to our chest pain patients where we always say time is heart muscle; our stroke patients, because a delay in care of a stroke leads to brain cell loss. Obviously, there are other conditions. Anything that’s obstetric related, severe infections where a delay causes instability in the body systems, and obviously anything that’s a major traumatic injury, although those normally do come by 911 and EMS. Time sensitive conditions, very, very important to seek care and seek it promptly.

Host:   So for example if you were to have a heart attack, the sooner the better. Are we talking 20 minutes? What kind of time frame?

Dr. Tout:   There's no set time frame, but again obviously the sooner the better because with each minute there’s potential loss of heart muscle and the recovery for the heart. Heart attacks happen because of blockages in blood vessels. The sooner we open those open, the more likely the heart’s going to get the oxygen and the nutrient supply it needs to survive.

Host:   So I've heard that a lot of people aren’t going to the emergency room at all or they're hesitant. I know in the beginning they were hesitant about this, but now we resurge again. Do you find that’s still true? That a lot of people are hesitant to go?

Dr. Tout:   My perspective on COVID and how it’s impacted emergency care. The emergency department volumes across the country have obviously declined, up to 40 to 50% decline during the months of COVID. Some of that’s understandable. I think some of that’s to the credit of the public who has recognized how important our healthcare focus is on coronavirus and how important the preservation of our resources and PPE has been. I think we've seen a little bit of recovery in that. Obviously, we want patients with those time sensitive conditions to continue to seek our care, to continue to feel comfortable coming to the hospital. I think there still is a little bit of fear, but I will tell you we’ve gone to extensive effort to make sure that the patients that do come in are isolated, kept safe. They're not being exposed unnecessarily to coronavirus. We still need to care for emergency conditions. We’ve got a little bit of recovery on that, but it’s going to take a little longer.

Host:   So tell me about some of the procedures and the protocols you’ve put in place to keep people safe in the ER.

Dr. Tout:   I think extensive time’s been spent developing better intake processes, better screening processes. At almost all healthcare facilities, you're screened at the door now. Questions are asked, temperatures are taken to determine, again, are you coming in with something that’s potentially COVID or are you coming in with something that’s unrelated? In our particular emergency department, we split the population. Those coming in with infectious or respiratory go one direction, patients coming in without those symptoms go another direction. All of our staff is masked. There's extensive cleaning and sanitizing protocols. All patients coming in are masked because, as you know, the symptoms aren’t often clear cut for coronavirus, but we’ve split our population. We’ve spent a lot more time focusing on, again, isolation, sanitizing process, containment, and just educating the staff on how important again not translating coronavirus to someone who isn’t coming in with it is. It’s been a very split flow of patients in our department necessarily.

Host:   Does that include many of the pieces of equipment that might be used like x-rays or anything else like that?

Dr. Tout: Oh absolutely. Again, our radiology department can speak to that more specifically, but more cleaning is involved, more downtime between patients if we do have someone who’s suspect. Using only areas of the hospital for COVID type patients versus everyone. Again, each department is responsible for their own set of different measures. That involves our environmental health people too. The way they clean a room, how much downtime there is in the room after cleaning it. It’s been a lot of effort involved in trying to stay ahead of the virus.   

Host:   So what about calling 911? I always have this image of all the ambulances picking up anybody who calls, and it could be a COVID patient or it could be a heart attack patient.

Dr. Tout:   Yes, you're absolutely right. Interestingly we have a very collaborative effort here in northeast Ohio. All of our systems are involved in the development of our EMS protocols. So no matter where you call from northeast Ohio, it’s the same approach to a patient. We spent the first probably four months of this year actually developing COVID specific EMS protocols where in the early stages patients with minor non-emergent things were actually signed off. Patients who didn’t have coronavirus symptoms were often given options if they were stable enough. Those that did have coronavirus potential, lots of personal protective equipment by our paramedics, a lot of training and helping them to recognize signs, symptoms, and management of those patients, a lot of sterilization of the ambulances in between transports. Our hospital actually purchased a very specific device which is an ultraviolet light sterilization instrument. So after every ambulance run with a patient delivered here, they utilize that device to sterilize the interior of the ambulance before they go out on the next run. They have, again, very specific processes again to avoid cross contamination of patients.

Host:   So given all that information, when should I call 911?

Dr. Tout:   If it’s a time sensitive condition, absolutely call 911. We’re blessed in this area with highly trained paramedics. They know how to intervene on strokes, on chest pains, on anybody with a neurologic change, on severe infections with blood pressure or cardiovascular instabilities. Again, if there's any potential for decline in a status quickly of a time sensitive condition, 911 should absolutely be utilized.  

Host:   Finally when I think through this process, I know when you really need it maybe you don’t think this far, but I'm sure my relatives would. Say I'm having a heart attack and I really know I've got to go to the hospital, once I leave the emergency room how do you protect me in the rest of the hospital?

Dr. Tout:   There's just as extensive process on the rest of the hospital. There are cath lab procedures. There are bed procedures on all of the floors. Our medical attending staff has been very extensively trained on how to maintain personal protective equipment. Lots of training on the in-house side once the ER’s departed has been as elaborate if not more so than what we do in the emergency department.

Host:   Do you do COVID testing on that section as well as the rest of the hospital?

Dr. Tout:   Yes. The COVID testing remains a challenge, I think, across the country, but we test in the emergency department. We have a rapid test that can be utilized for anybody that’s needing immediate placement or immediate procedure where we want to know, again, to what extent do we need safety precautions. We have send out tests that are back within 12 to 24 hours on the additional population. There are multiple algorithms on how you test, who you test, when you test, but yes. We can do testing anywhere in the whole hospital as well as through our office practices now.

Host:   Is there anything else you’d like to add?

Dr. Tout:   I guess I would like to add that one of our biggest challenges in keeping the public safe and keeping our patient’s safe is our limited visitor policy. That’s, again, a very difficult thing for us as providers, especially with limited time in the emergency department and sometimes with families having the wealth of information that you need to work somebody up. We’ve been very limited in allowing visitors into rooms. Again, I hope that’s recognized as a safety precaution for the visitor, for the patients, for our staff as we work through this really challenging and puzzling time. Just to be aware, it’s not meant to limit anybody. It’s meant to keep people safe.

Host:   I'm sure you can have the person check in either with the nursing staff or something in the emergency room to find out how things are going.

Dr. Tout:   Yes. We do our best as far as our care providers and our assistant physicians alike trying to make trips to the waiting room, trying to collect cell phones, trying to circle back with family members, but we also do recognize that sometimes it’s hard for those folks not to be at the bedside with their family member who I'm sure is anxious or stressed just by the fact that they're here. Yeah, we do our best to communicate.

Host:   Dr. Tout, thank you so much for sharing this today.

Dr. Tout:   You're very welcome. I appreciate the opportunity.

Host:   I really appreciate what you guys are doing and I'm sure all of us do on the dedication because I'm sure it’s incredible stressful. So thank you so much.

Dr. Tout:   Thank you. It’s definitely been a different time and different challenges than we’ve ever had to deal with before, but I think together we’ll get through it.

Host:   To learn more about what Southwest General is doing to keep you safe, visit If you found this podcast helpful, please share it on your social channels and please check out the full podcast library for additional topics that may be of interest to you. This is Southwest General Healthtalk. I'm Alyne Ellis. Thanks for listening.