The emergency department is and has become even more so, an extremely stressful environment. I've spent my time in emergency departments not only as somebody who works there but with family members.
The number one issue for emergency personnel, emergency physicians in this country and probably emergency nurses, as well, and to a certain extent paramedics, is crowding. Every hospital in this country is crowded which means that every emergency department has people lying on stretchers for eight, 12, 16, 28 hours waiting for a bed to become available for their loved one to be properly treated. That leads to inadequate care in the emergency department itself because our emergency nurses are trained to deal with emergency situations. It's not really their job to provide toileting care to an 85-year-old lying on a stretcher in a hallway.
The elderly get poor care, not by malfeasance, just because of the nature of the beast. Patients are always coming and always have to be assessed. If I was sitting with my elderly father in an emergency department in Montreal and I was watching him for 24 hours in a brightly lit hallway with no privacy whatsoever, his toileting and basic human needs not being met, I think I would be angry. I think if I was bringing a child with a facial laceration from a dog bite and was forced to sit in the Children's Hospital of Eastern Ontario for 12 hours waiting for somebody to assess my child's laceration, I think I would be angry.
That impact is felt every day. The basic problem is hospital crowding leading to emergency department congestion leading to ridiculous lengths of care which are totally unacceptable in our health care system, coupled with the fact that we have inadequate nursing staff and we have paramedics unable to offload their patients, who then have to sort of sit in hallways waiting for a stretcher in emerg.
If there was one institutional issue that is at the core of all of this, I believe that it's crowding.