12:00a.m. 7th September 2008

Nursing director and district senior emergency nurse David Johnson in the emergency reception area at Nambour Hospital. David, in foreground, and Registered Nurse Darryl Low, at rear. Photo: Nicholas Falconer/178119

It's another world in many ways.

No one wants to be there – but if you have to, it’s because you need quality care and attention.

And if you’re a potential patient – be patient, because the staff at the emergency department of Nambour General Hospital are very professional and careful how they go about their jobs.

Your first port of call after the emergency waiting room will be at triage – a milder version of what you see in TV series like MASH or ER – but just as critical.

“Triage is a process of assessing a patient, finding out whether what the patient tells us needs urgent treatment – or not,” national award-winning nursing director district senior emergency nurse David Johnson says.

Johnson said working out what the patient is not telling you is as important as what they have said.

For the most important function of triage is to determine a priority patient system, to ensure those with life-threatening conditions are placed above others.

There are five levels of priority ranging from the life-threatening to those who can wait up to two hours after being given pain reducing treatment, should it be necessary.

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“There is a lot of pressure – you have to get it right,” Johnson says.

To get to work triage, he said, “you have to undergo a rigorous national training program”.

“You have to get 100% competency – if you don’t, you don’t progress.”

He said even though some complaints may seem trivial, the triage team has to be certain.

“You don’t bet with peoples’ lives; you err on the side of safety.”

Johnson gives an example of a recent Daily report about a child suffering meningitis, which has symptoms similar to common colds.

“Lots of children present with colds and flu-like symptoms,” he says.

“You have to be able to pick out that one, the one with the symptoms you can’t quite put your finger on.”

On the other hand, there were the regulars, those with chronic mental illnesses which need fairly constant medical attention.

“You get to know them.

“Every psychiatric patient is ‘going to die’ by some organic cause – but you have to take it on its merits.

“And somewhere along the line they’re going to come unstuck – you don’t want it to be on your watch.”

Then there are the domestic violence cases, the drunks, the drug-afflicted, even those with quick-fix remedies they pulled off the internet before arriving at emergency.

But it’s the drugs presenting the main problem.

“We are now seeing a different level of impulse and control problems; different substances are being taken.

“Things are a bit more risky now.

“If someone is drunk, they can be clumsy, but if they’re on speed or amphetamines they can feel like superhumans.

“Queensland Health have been good in supporting zero tolerance to abuse and violence in the workplace.

“We have good access to security – it’s a constant.”

Yet despite all the new arrivals and all the hype about coping with ever-increasing numbers, Johnson says the caseload is highly predictable.

“We know down to a couple of cases how busy we will be any time of the day, even what likely symptoms there are.

“On the Sunshine Coast there are more kids, more ageing people – we know we’ll see people with chest pains and respiratory disorders.

“We also know almost every day we will have a road accident or trauma patient.”

But a lot has no prior warning and the stress placed on families and health care workers can put a lot of extra pressure on everyone.

And Johnson says the idea winter is busier than summer is fanciful.

“In summer, tourists and travellers swell the Coast population by 100,000.”

He is aware many people who come into the waiting room of the hospital get upset by seemingly feeling they have been “dumped” there, or their case forgotten.

“Not everyone understands the system put in place,” he says.

“They think about what’s happening to themselves, not the department.”

But it’s precisely because the hospital has sought to separate some of the trauma from the waiting room patients this sentiment sometimes exists.

“We put some safeguards in place at Nambour, screening off traumatic situations.

“The downside is quite often someone thinks there’s not much happening.

“But behind the doors there could be absolute scenes of carnage.

“People don’t understand the machinery behind the doors.”

Johnson has nursed for 23 years now, nearly nine of them at Nambour.

And he says the rewards are great, if unspoken.

“We have a lot of really tired staff, but they stay in the profession, they get satisfaction," he said.

“People don’t like to say thank you, but every emergency nurse has high-level problem solving abilities, and thrives on preparing for the unusual presentation with complex issues and a lot of complications.”

As for the age-old “hospital crisis” stories, Johnson says he leaves that to the politicians.

But he had one message.

“The Minister said we don’t have a crisis – so we don’t.

“But at the end of the day we are hearing from patients and staff we are under enormous pressure.

“And they say it’s only increasing.”