Fail, fail, fail, fail, succeed

ESI Level L

The triage system used by most North American emergency departments is the ESI (Emergency Severity Index). Incoming patients are assigned to one of five levels by the triage nurse based on acuity and anticipated needed resources. Not surprisingly, the levels are numbered one through five, with level one being assigned to patients who are actively dying, and level five to wound checks or medication refills.

When you are a triage nurse, it isn’t uncommon to come across patients whose needs don’t fall into any of the available categories. EMTALA (Emergency Medical Treatment and Labor Act) mandates that anyone who presents to an ER in the U.S. must be medically evaluated, which can create a bit of a conundrum. That means that no one is ever turned away, whether their complaint makes any sense or not. I’ve often thought that perhaps there should be a level L, denoting the true nature of some patients need: loneliness.

After all, loneliness, if not a disease state itself, will certainly lead to ill health. And the antidote is about as simple as it gets – someone just needs to listen, to be present for and acknowledge this afflicted individual. The dosage of attention doesn’t even have to be that big, and you don’t need a doctors order or a pharmacy to fill it. It doesn’t even cost anything…

Just a little compassion, a little focused listening, and the acute phase of the illness can be controlled (at least in the short term) quite easily.

Facilitating the rich tapestry of human existence – just another moment in the day of an ER nurse…