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‘Organized chaos’: Life in the ER

By Staff Sgt. Aubrey White 633rd Air Base Wing Public Affairs

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"I can help who's next," a deep voice announced from behind a large desk and computer that hide all but his short-cut black hair. A hand reaches out from behind the counter gesturing for the next person in line to approach.

A masked woman inches forward, sniffling with each step she takes. Before she could utter one word, a man pushing a shrieking woman in a wheelchair comes bolting toward the desk, a trail of blood following.

The deep voice, who is actually a startled young man dressed in military fatigues, jumps up out of his seat at the commotion that ripped through his otherwise peaceful Sunday morning.

"Your heart rate goes up, you get tunnel vision, your hands might shake a little bit and you have to say to yourself, 'calm down, you've got this,' and you focus on what the patient needs," said U.S. Air Force Maj. Karen Lugg, the emergency room flight commander at the 633rd Medical Operations Squadron, of an emergency situation.

"Emergency nursing is just figuring out what it is that could kill you and making sure that does not happen," she continued. "We've got to keep your blood in you, we've got to keep you breathing and we've got to make sure your heart is beating; after that we can take a deep breath and fix the rest."

Every day the USAF Hospital Langley emergency department staff treats upwards of 100 patients who suffer from a wide variety of ailments ranging from common colds to broken bones; they see it all. What separates this ER from civilian facilities is its dedication to providing care specifically for U.S. Service members and their families.

"Lately we've been seeing an uptick in our tempo in terms of up to 130 [people]; it's pretty high daily," Lugg explained. "We also are the emergency service for a lot of folks from the Navy as well as Army personnel and their dependents."

Because it isn't up to the staff to determine whether or not a person feels they are having an emergency, Lugg encouraged individuals to go to the ER if they are concerned for their health and cannot see their primary care manager in a timely manner. For this reason, the ER features two sections called the Fast Track and the Main ER.

"Fast Track would be for patients that are here for like colds, something that doesn't need a lot of intervention," Maj. Johnny Guerra, ER element leader at the 633rd MDOS, explained. "Most of the volumes of the patients that we see are Fast Track and so there might be a little delay in getting to them quickly, but we try and do what we can to make sure they're seen in a timely manner.

"Then we have the main ER for individuals who are coming in with chest pain, abdominal pain, things that are going to require a little bit more invasive stuff like putting in an IV, taking X-rays, ultrasounds, CAT scans," he continued. "The main ER has approximately 17 beds."

In addition to being mindful of the department's foundation, Guerra asked that patients refrain from calling them directly to seek treatment over the phone because it is illegal to do so; however, the TRICARE Nurse Advice Line can legally triage over the phone and direct patients to the best treatment route.

Lugg and Guerra asserted their doctors, nurses, technicians and administrative staff are highly-skilled professionals prepared to take on the volume of Department of Defense beneficiaries who live in close proximity to Langley.

"We meet the standards just like a community hospital or ambulance service would provide," Guerra explained. "Our folks are at the highest level that is recognized throughout the United States; our docs are board certified; the people that we have in here are the cream of the crop, they're experts in what they do."

Included in the ER staff are in-house paramedics who respond to all 911 emergencies on base as well as inflight emergencies after 4:30 p.m.

"The ER accepts [patients], all day, every day, 365 [days a year]; we're never closed, there's no downtime," Lugg said. "Our motto for the squadron is 'Med-Ops Never Stops' and that's us. We never stop. Our staffing provides the best team care to our patients and it's constant."

Guerra admitted sometimes the ER staff gets to a point where the work feels repetitive, so building a family-like atmosphere at work and allowing for leave, when possible, helps break up the routine.

"Sometimes it's a juggle and sometimes we might have to tweak things here or there, but that's important because that's time to spend with their family and decompress," Lugg agreed. "You can accomplish mission and try to have some time off as well to replenish your soul."
Despite working through the "organized chaos" that is the ER; both nurses agreed remembering to have empathy for patients goes a long way in their care.

"There was a case one time that had me reflect on why I was doing what I was doing," Guerra recalled of a patient he treated. "She was a very young lady, she was very angry with everyone, and after getting to why she was angry, she basically said she's got something terminal and she'll never have a family. She pointed to me saying, 'You have kids, you have a family, you're married,' Her telling me that there are people out there who are hurting, sometimes we don't know why until they're able to open up. That made me choke up a lot and that's the kind of stuff we come across on a daily basis. We need to be a little bit more compassionate regardless of how tough it is.

"To do what nobody else will do, a way that nobody else can do, in spite of all we go through; that is to be a nurse," Guerra continued, reciting a quote by Rawsi Williams, BSN, RN. "We love what we do; we love it. I wouldn't change it for the world."

For information about Joint Base Langley-Eustis, Virginia, medical care, visit www.jble.af.mil/medicalinformation.asp.