CALGARY - A decade ago, emergency room doctor Grant Innes stopped and looked at the chaos that surrounded him.
More than a dozen stretchers filled the emergency waiting room. People were throwing up into garbage cans. And there was nowhere for them to go.
"I had the closest thing I've ever had to a panic attack, and I thought, `I can't do this, I can't work like this, this is ridiculous,"' he said Monday.
That was the moment the Calgary doctor decided he needed to do something to help change the way emergency departments are run.
Innes now works as the head of the city's three emergency departments. He's one of more than 700 doctors who are meeting in Calgary this week, in part to discuss ways to cut down the number of hours patients wait in crowded emergency rooms to see a doctor.
The situation is still dire.
"We have huge numbers of very sick patients essentially left behind in hallways and on ambulance stretchers for long periods of time," said Innes.
"And across the country, in every major Canadian city, in every large urban emergency room, you have patients who are deteriorating or having adverse events as a result of these delays to care."
How many hours patients lie on ambulance stretchers or curled up on waiting room chairs before being seen by a doctor is slowly becoming a political issue across the country.
In February, Ontario's health minister unveiled a plan to cap waiting times at eight hours for patients with complex problems and four hours for patients with minor issues.
Shortly after, Alberta Premier Ed Stelmach asked his government to look into the issue after almost 200 health care professionals gathered in Edmonton to say wait times had soared.
"There's no question patients are dying because of the wait times. We just don't really know how many," said Innes, pointing to research from Australia that showed mortality rates rose when emergency department wait times increased.
The issue was thrust into the spotlight last year when Brian Sinclair, a 45-year-old double-amputee, died in a Winnipeg emergency department after waiting for about 34 hours without being examined.
It's hard to read about such cases, but it's harder for overworked doctors to live with the conditions that make it possible, said Innes.
"That's what is so demoralizing about this whole problem, is to see sick people and to deal with sick people who are not receiving the care they should be receiving."
Michael Howlett, a doctor from Truro, N.S., said staff in his hospital suffer from a high level of burnout, which could lead to an inability to identify with the sick people in their care.
"When people are emotionally exhausted, their ability to put the same amount of effort into the work that they bring each day is more limited. And when they have a greater sense of de-personalization, their ability to connect with their patients and to empathize and to advocate for them, starts to decline."
It's impossible to talk about fixing emergency room wait times without addressing serious flaws in the health-care system as a whole, said several doctors attending the conference.
"It's definitely the canary in the coal mine, so lots of problems elsewhere in the health system are reflected in the ER," said Michael Schull, an emergency physician who works at Toronto's Sunnybrook Health Sciences Centre.
About 15 to 20 per cent of patients in Ontario acute care beds could be moved to nursing homes or long-term care homes if there was room for them, or back into the community with the right supports, he said.
People also come to the emergency room when they can't find a family doctor.
Solutions are also complex, said Schull, who worked on a study to be presented at the conference that looked at a pilot project aimed at improving the way patients move through an Ontario hospital, thereby freeing up ER space.
The project showed no change in wait times, but showed an improvement in how doctors and nurses perceived their work environment and ability to do their job, he said.
Innes said even if more funding for beds and staff isn't provided, doctors and nurses need to be creative in finding solutions.
For example, a doctor could work in the waiting room, looking at patients before space is actually found to bring them into the emergency department.
He points to an emergency room in Toronto where no patients are left in a waiting room, but everyone is immediately brought into the department. Sometimes, if there's no space, they'll be left in chairs, but at least they're being seen by medical staff.
"Some people think that's not adequate care, it's not ideal care," said Innes. "But, nevertheless, sitting in a chair inside an emergency department where you have access to doctors and nurses is much better than sitting in a waiting room where you have access to nothing."
