Emergency Room Health Care: Commodity, Right, Privilege, First Line of Defense
Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist who is currently retired ,, He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board certified by the American Board of Psychiatry... more
While the political battles rage around health care amid easy assurances that hospital emergency rooms are always available, we need to recognize that there are ideological enemies of American Democracy utilizing cyber warfare, terrorist attacks, etc. to bring us down. To contaminate reservoirs, dams, and water supplies with poisonous agents (viral, bacterial, radiologic, etc.) is not difficult.
Those emergency services that are being counted on for routine, but very expensive, care need to be organized in just the way you've seen on popular TV medical shows on a triage basis. Yes it is a military model, but we will be at war.
The effectiveness of triage was impressed on me by my experience as part of the 6022 USAF Hospital in Japan a long time ago.The infectious problem was epidemic meningitis. We only had sulfonamides to combat it. It was brought in by a traveling non military family and everyone near the ER or in contact with someone who had been had to be treated. We only lost an 11-year-old boy. The rest of the family was saved. I took the subsequent exercises much more seriously. It was also noticed that the sick call contained between 40% and 70% were primarily psychiatric depending on the day of the week. Cases were substantially psychiatric, so each of the mandated drills contained a psychiatric component which were all taken care of by assigning a corpsman to bring me the cases and together we could isolate them from the ordinary drill. In one actual case, the isolation of an individual who was on the "hot line" transferring bombs and ammunition required such action. Most of the psych cases could be handled in the general hospital with special monitoring but some required transfer to a hospital with specialized services (Tachikawa). About half of those transferred were sent back to the continental U.S. The individual from the bomb hot line had to be sent back and eventually discharged.
This experience allowed me to construct a successful emergency treatment unit of Yale Psychiatry and Yale New Haven Hospital later on. Wherever you are, Col. Smith: Thanks!
One last item from those days was my participation in an enterprise of the Caribbean Federation for Mental Health headed by the late Bert Schaffner, a N.Y. psychiatrist who was an early advocate of both mental health and gay rights. The object of the endeavor was to provide initial mental health services for the Caribbean Islands by going to a country where ancestors came from or which held some special meaning. I was an instructor in Psychiatry, Public Health, and Sociology, and introduced psychotropics to the island of St. Kitts. With the support of Arthur Lake M.D., later knighted, and the use of seven detention cells, we were able to treat the severely mentally ill on the Island of St. Kitts and a ~10,000 dollar annual payment from st. Kitts to Anguilla for hospitalization was brought to an end. I was able to send a medical student to follow up on occurrences one year later to find that largactil (thorazine) was still in use locally. The St. Kitts Mental Health Association had disbanded. The administrator who had discussed with me the problems of primogeniture and his resulting migratory life was now denying the efficacy of psychiatric intervention. And the persistent homophobic attitude of the Islands had returned and led to the repudiation of the Caribbean federation and the loss of the association. The masters-level thesis on the part of Yale medical students is no more, but were the residual memory of St. Kitts better, they might acknowledge a debt of at least a set of evening cocktails on the beach to Yale, Psychiatry, Yale Public Health and to the late Bert Schaffner. I am quite satisied with the learning experience!
Most important of all was the opportunity to learn from my patients and students through the years!
What can we do as individuals? We can unlearn routine dependence on ERs and use patient care services instead. Like most behaviors, this is more complex than meets the eye. It means being cognizant of early signs and symptoms of disease. Yes, unease usually comes before disease. Moving even further up the logic tree we need to be more adept at preserving health through diet, avoidance of excess use of alcohol, salt, sugar, tobacco, etc. We need to be sensitive to shifts in mood, attention span, and irritability. Behavior with personal power-enhancing tools may subtly change toward aggression. Cars, motorcycles, power mowers, archery sets, guns, social media responses, etc. all are subject to be influenced by altered internal states.
By now, you've noted that self awareness on many levels can be your contribution to national defense.
