Tuesday, 26 June 2018

There's good emergency service triage. And then there's the other kind

It came as a bit of a surprise when the French Emergency Department doctor (‘urgentiste’) I was talking to asked if we could postpone for a week the webinar we were planning.

‘You may have picked up that there’s a bit of a controversy in France around emergency services right now, and we’re even more crazily busy than usual.’

Well, I hadn’t picked that up. But two friends were with us from the glorious Eastern French city of Strasbourg where we used to live. One of them was a nurse, so I reckoned she’d know. Though actually both of them were fully up to date, and for a good reason.

‘Yes, a terrible scandal,’ they told me. 'In Strasbourg.’

The problem had arisen on a call to the emergency services. Rather than describe what happened, I’ll just translate the transcription of the call, between a frightened caller and a triage clerk:

‘Miss, I’m in pain…’

‘OK, so you phone a doctor, OK, got it? You understand, phone SOS Médecins [the primary doctor emergency service].'

‘I can’t.’

‘You can’t? Oh, really, you can phone the ambulance service but you can’t…’

‘I’m going to die.’

‘Yes, you’re going to die, without a doubt, some day, like everyone else… Ring SOS Médecins, OK?’

‘Please, help me, Miss.’

‘I can’t help you. I don’t know what’s wrong with you.’

‘It hurts, it hurts…’

It’s hard to disagree with the Enquiry finding that the clerk’s tone was harsh.

That was at 11:30. At 12:32, a relative rang again and, by sheer bad luck, was dealt with by the same clerk. Again, the call wasn’t put through to a physician, although two were available.

At 13:47, SOS Médecins itself called the emergency service. This time a different clerk answered. She put the call through to a physician who immediately sent an ambulance. It arrived at 13:58. Some two hours twenty minutes had been wasted by then, and that proved critical: although the patient was immediately hospitalised, she died at 17:30.

She was 22.

This tragic litany proved career-limiting for the first triage clerk, who has been suspended pending dismissal. It did no good to the emergency service director either, with the report of the Enquiry recommending that his resignation, already offered, be accepted.

It’s a classic case of rare – or hopefully rare – ineptitude. A fine object lesson in how not to run triage. Triage is the process by which healthcare staff decide what level of care a patient might need. Clearly, it failed in this case.

However, that there’s one other aspect of these events which casts a still deeper shadow over them. The woman who died was called Naomi Musenga. As my French friends point out, even on the telephone, her accent would have revealed her sub-Saharan African roots.
Naomi Musenga, in a photo from franceouest.fr
Would she have been treated differently if she’d been white?
Would the clerk have reacted differently had the caller’s voice identified her as white? Who can say? But the way things are in the world today, how can we immediately rule it out?

At any rate, it’s no wonder my French ED physician was too busy for a webinar this week.

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