My professional role is that of a Paramedic for twenty nine years: all with much pride and satisfaction.

I often find myself having to advocate for “our mutual patients” in dehumanizing severe pain, who are afforded much delayed access to the emergency doctor and care towards a definitive intervention. My peers at my and with the other Ambulance Services that we regularly meet in our emergencies have observed and witnessed the same needless suffering by their patients as well.

I have for long observed that there is a very real lack of compassion in our hospitals’ emergency departments towards a select group of our patient population that presents in severe pain: and this I call COMPASSIONISM! I used one Ambulance Service and one specific hospital (I must not name them) as proxies for all other hospitals and ambulance services for obvious practical reasons.

I lobbied their respective varied levels of management and executive to work for changes to the current applications of THE CANADIAN TRIAGE ACUITY SCALE in our Emergency Departments (“CTAS Guidelines”; most of the USA, Europe and Austalia have the near exact equivalent): they would have me and you believe that the “CTAS” APPLICATION is unshakeable. In fact THE CANADIAN TRIAGE ACUITY SCALE Guideline is applied as branded ideology in all our Emergency Departments. What else would trump "above all else you must do no harm" if not collective ideology?

I argued that there ARE humane, moral and ethical and compassionate changes that can easily be put into more or less immediate effect with the hospitals’ issuance of Policy Directives of New Professional Standard Minimums of Practice for doctors and triage nurses that will give the patient in severe pain a HIGHER PRIORITY ACCESS TO THE ERMERGENCY DOCTOR AND HIS TREATMENT. I have not been successful.

I have been at this since November, 2006.

There is at the very least, a need for a modified Mission Statement at our Emergency Departments, in the interest of public service, to correct the DUTY OF CARE that remains unfulfilled.

“Pain never killed anyone”: from a doctor, triage nurses (not same hospitals), from two ambulace service supervisors (from different services), a few paramedics (not only in my service): odd what persistence with the truth does to some people; and mostly delivered with no hint of irony or satire in their inflexion or body language!

The lack of compassion in our emergencies is not caused by our respective governments' cut backs and policies and the consequent offload delay/wait times mess; rather offload delay is the revelation, the shining light on the COMPASSIONISTS casting their long shadows =the doctors, the designated authorities overseeing the COMPASSIONISM in our emergencies who refuse to issue the required Policy Directives!

There is much wilful ignorance in the health care continuum. In Canada (and almost certainly, this is also true in the USA, Britain and Australia) the Ambulance Services are in my measured view, by their collective deliberate inaction, not much less guilty as all the Hospitals that refuse to effect changes to the CTAS GUIDELINES as currently applied to mitigate the- not- as- yet- criminal Compassionism. I do not accept their excuse that it is not within their sphere of influence to compel the Chiefs of Emergency and their Hospital CEO’s! THEY CAN CERTAINLY ADVOCATE: SIMPLE COMPASSION! And why not publicly?

We who provide Emergency Care as Professionals, all know what severe pain is. And of the factual daily reality in our emergencies that NON-PAIN-PATIENTS who are routinely prioritized at a HIGHER CTAS LEVEL have frequently waited 5/6 hours with no increase to their medical acuity and with no deleterious effects: in the name of the GOD we believe in, why do our emergency departments condemn and dehumanize the patient in severe pain to suffer the same 5/6 hours, and often plus an other hour or more, for the next bed, before the victimized patient gets access to the Emergency Doctor and definitive intervention! THESE PATIENTS PRESENTING IN SEVERE PAIN REMAIN IN SEVERE PAIN FOR ALL THESE HOURS!! The juxtaposition incites in me much disgust and contempt: civility and respect are indeed a very thin veneer.

Do they not know what needs to be done exactly? How confronting are they of one an other?

With what level of emotional comfort do these doctors supress their lack of morals and ethics and galling hypocracy, when they finally reach the bedside of their patients -who under their watch- were condemned and dehumanized to suffer needlessly in severe pain, TO FEEL OBLIGED TO APOLOGIZE TO THESE PATIENTS, before finally offering something for the pain and initiating care towards definitive treatment!!!!

It is fair to say that we all, as victimized patients that suffered needlessly and their families, as emergency doctors, as nurses and paramedics, as managers, chiefs and executives, in the emergency health continuum, and as those who cared and do care, as those who were wilfully ignorant and wilfully ignorant will be, as those who did not care and will not care, as those who were surprized, dismayed and overwhelmed and unsure, whatever the measure of our morals and ethics were and will be, WILL recognize ourselves I am certain in these pages.
PHILIP MICALLEF