In the latest issue of the Medical Journal of Australia emergency medicine specialists share their insights and observations on the experience of working in a hospital emergency department.

For many doctors, a medical emergency is a rare event. However, for emergency department staff, witnessing trauma and death is commonplace. Dr Christopher J Ryan of the Department of Psychiatry, Sydney University, and Dr Robert P Dowsett of the Department of Emergency Medicine, Westmead Hospital, describe the feeling of putting their emotions on hold in order to cope with an emergency: "Any normal person would be anxious or afraid or despairing, but you can't afford to be . . . . You can't let your emotions get in the way, or you'll be less efficient and less likely to succeed."

Dr Keith Edwards of the Emergency Department, Liverpool Health Service, takes up the theme with a very personal viewpoint on the stark, shocking nature of death and the heartrending task of breaking the bad news to relatives and friends. His way of coping is to don his "Ned Kelly" suit of armour, "an outer hard shell that protects me from the bullets of misery, anguish and stress of people sick and dying". But he has a lingering concern that the frequent need to shut down emotionally may carry through to his relationships with family and friends.

Articles by Dr Gordian Fulde of the Department of Emergency Medicine, St Vincent's Hospital, Sydney, and Dr Gerald O'Reilly and colleagues of the Emergency and Trauma Centre, Alfred Hospital, Melbourne, examine the care of homeless people in the emergency department.

Hospital emergency departments are now one of the few agencies available 24 hours a day to assist people in crisis. For lonely, homeless people they can be a place of refuge where they can escape from the cold, obtain something to eat or drink, or find someone to talk to. Some of these people become quite well known to hospital staff. While the staff may find them a nuisance at times, they also may develop a certain affection and amused tolerance for their peculiar habits and colourful language. Staff may feel a sense of loss when such people eventually die.

These irregular visitors to the emergency department are a drain on already strained resources and time. In the current climate of economic rationalism, where the focus is on funding measurable outputs, the plight of these people is obscured. Providing basic human care for them is a service that is not recorded in the statistics. But O'Reilly and colleagues argue that some "outputs" — certain "human aspects" of medical care — are difficult to measure and, indeed, should not be measured.

As Dr Fulde concludes, "Whether the homeless to us, or we to them, become familiar or even "family", I think all emergency department staff, on the whole, feel privileged to be in a position to offer not only core healthcare but also comfort and help to our homeless. This is, I believe, why we are so sad and reflective when we lose one of them."

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACTS:    Dr Christopher Ryan 02 9845 6688 / 0419 751 655
                    Dr Keith Edwards 02 9828 3990 / 0412 292 918
                    Assoc Prof Gordian Fulde 02 8382 2040 / 0419 718 328
                    Judith Tokley, AMA 02 6270 5471 / 0408 824 306