OT & ED
A month ago I had my first emergency department (ED) experience after an attempted overdose. The whole experience, despite being terrifying, has made me so frustrated over – what is the role of ED? And what is the role of OT in ED?
🖼 Setting the scene:
It was a Monday morning, and I had just woken up from a nightmare. I said my goodbyes and multiple I love you’s to my husband as he left for work. That morning he sent me a text asking how my day was. I replied “good thanks, I have been really productive and I’m just about to have lunch”. But no one told me how savage the mood swings of BPD are. And as a small memory, a photo, trigged me, I opened my Pandora’s box of fire and fury, the place where I push away the traumatic events of my life. Next thing the paramedics were at my door…
🏡 At Home 🚨🚑🚞
I was extremely emotional as I lay on the floor crying. I was hoping that a sleep that I would never wake from would hurry up. As the paramedics stood and spoke over me I felt extremely vulnerable. I was told to stand up and get off the floor. As my mind was on a rampage, I couldn’t follow their instructions and I was physically picked up off the floor and pushed into the ambulance. As we were driving to hospital I could here the paramedics having a joking conversation. They were laughing about something that they had been talking about before coming to pick me up. I mentioned that I was going to faint and I was put on a bed, as I heard them laughing about how sick I looked. I felt like I was a crazy person, being wheeled off to a mental institution.
It got worse. The first thing about ED I noticed was the lights, sounds and the commotion of people coming and going. For someone with sensory processing issues and anxiety the pain was excruciating. Overwhelmed by the blood pressure machine squeezing my arm and the buzzing of machinery, I didn’t notice that someone had undressed me and put ECG plugs onto my breast.
I was placed in what seemed the busiest place of ED, with the curtains open. I felt like a guinea pig. I could hear all the patients’ conditions and how they had arrived to ED. I heard mine and was embarrassed – “what did they think of me?”.
After several hours of this nightmare, I was transferred to another bed near the nurses station. I could hear conversations about what people were doing on the weekend, people hysterically laughing was I becoming paranoid?- were they laughing at me?? And sure enough, as I was vomiting, I heard my nurse laugh to another nurse about me vomiting. I realised I wasn’t the only one who had overdosed as I heard more vomiting and more nurses laughing when they thought I couldn’t hear them. The thinking got worse, “am I just another girl with BPD creating a scene”.
After 12 hours had passed I wanted to go home. I begged the nurse to let me go home. However, as I hadn’t seen the psychiatric nurse I could not be discharged. I pleaded with her to please ask when the nurse would come, she said she would. However she never returned.
I lay there in agony, freezing in a bath of sweat as both my mind and body wanted to leave and never come back, it was then I cracked. I realised an OT was never going to come and I started screaming and swearing to go home and trying to restrain from punching the bed frames to cope.
Not all my admissions to ED have been met with this experience and I have met wonderful paramedics, police, nurses and doctors. However never an OT in this experience?
The ED environment is horrific for all people, especially those with mental health conditions. However this experience made me think does ED do harm to people ?
As OTs, we specialise in making the environment comfortable and safe for people. We understand how people, places and objects can cause distress and contribute to ill health. I know funding and role descriptions dictate where we are allocated to spend our time.
But shouldn’t an OT be essential in supporting people adjust to the ED environment so they can “get better” and leave safely. Possibly contributing to greater patient satisfaction.
As a result of this experience I am reluctant to call paramedics when I am in an emergency. I am reluctant to seek emergency psychiatric help from hospitals. And more persistent to by pass emergency support.
Its important that as OTs we start to think about the hospital as a contributing environment to someone accessing help.
What could we as OTs do?
* Check on comfort and distress tolerance– blankets, water, curtains pulled, noise levels, mints for people who are vomiting. 💦
* Sensory calming strategies- Are they any grounding strategies we can use with people once they have the okay from their doctor. Weighted blanket? Noise cancelling headphones, earplugs, and soothing music. 🎧
* Is there a quieter place for people with sensory issues? Are there beds located where there isn’t as much people traffic? 👩⚕️
* All these things would help people rest, access the mental health support they need, and be at ease. 🛏
*another option could be the Patient has an ED Bag with some of those things in it for their visits with an Instruction Sheet. (Awesome suggestion from a reader!)
* Research into this area is needed! ✍🏻 👨🔬
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