Paul Atkinson

Thank you @DalEMCanada for the opportunity to share some thoughts on life and work at @EMSaintJohn @DalMedNB @DalMedSchool @HorizonHealthNB @CAEP_Docs @nb_docs youtu.be/wTk9uRpoEZs?si… via @YouTube

“A patient waits for hours in an emergency department… and dies before being assessed.” Not rare. Not random. ED crowding is the visible end of hidden system failure. New CJEM commentary: How health systems learn to fail. link.springer.com/article/10.100…

Do billing codes actually show how hard you’re working? 🩺🤔 A new @CJEMonline study suggests the answer is: Not really. Researchers found that while billing codes correlate with patient acuity (CTAS levels), they fail to reflect the discrete elements of physician work—like labs, meds, or teaching—independent of visit complexity. The Bottom Line: ❌ Billing codes are a limited surrogate for workload. ⚠️ Relying on them may hinder efforts to optimize staffing & prevent burnout. ✅ We need new, validated metrics that capture the true cognitive & physical intensity of the pediatric ED. 🔗 Read the research: link.springer.com/article/10.100… #PedsEM #MedTwitter #CJEM #PhysicianWellness #EmergencyMedicine

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A great read in the Canadian Journal of Emergency Medicine. @CJEMonline Health systems often fail to learn from evidence and warnings. That’s exactly what we’re seeing here: repeated alerts, repeated harm, and too little action. This is not only a major problem in Alberta, but also the country. linkedin.com/pulse/how-heal… #FixTheFoundation #ABHealth #ABleg #cdnpoli

🇨🇦 The U-POCUS protocol: urinalysis and POCUS to exclude symptomatic ureterolithiasis in ED patients The U-POCUS protocol has >99% sensitivity for excluding symptomatic ureterolithiasis and missed only one case in a multicenter retrospective cohort. This strategy could safely reduce reliance on non-contrast CT in the ED, minimizing radiation and cost without compromising diagnostic accuracy. Read the full open access study: link.springer.com/article/10.100…

CJEM Volume 28, Issue 1 (January 2026). Highlights include: new editorials on clinician wellbeing and equity in EM, original research on paramedic care and trauma outcomes, quality improvement work on hip fractures, and more. Explore the full issue with 18 articles spanning commentary, clinical research, and practice insights: 🔗 link.springer.com/journal/43678/…

Paper here via @CJEMonline : link.springer.com/article/10.100… If you work in healthcare, ask yourself: What labels do you reach for when the system fails someone?

Just the facts: calcium administration in trauma patients receiving massive blood transfusions by Theodore Muth Ever heard of the "Lethal Diamond" of trauma? Hypocalcemia is now recognized as a critical fourth factor alongside coagulopathy, hypothermia, and acidosis. It is an independent predictor of mortality and transfusion needs. Key Facts: • 55% of bleeding trauma patients are hypocalcemic upon arrival. • Citrate in blood products binds calcium, worsening the deficiency during massive transfusions. Management Tip: Guidelines suggest administering 1g of calcium chloride (or 3g calcium gluconate) with the first 4 units of red blood cells For more details read the full article: link.springer.com/article/10.100…

Do advanced care paramedics actually make a difference in cardiac arrest survival? Check out the PULSE study for more information... ➡️ rdcu.be/e0qQg @EMSaintJohn @DalhousieU @DalResearch

if you missed the #SavingEmergencyMedicine series curated by @PaulAtkinsonEM with leading voices from @CAEP_Docs addressing how to address the challenges we face, check out the free access links below... Part 1. Saving emergency medicine: is less more?rdcu.be/dWPaA Part 2. Saving emergency medicine part two: better together rdcu.be/dWPbI Part 3. Saving emergency medicine, part three: compassion rdcu.be/dWO8J Part 4. Can Emergency Medicine be Saved? rdcu.be/eVwJ5

Don't miss the excellent #WellnessWeek resources from @CAEP_Docs caep.ca/caep-emergency… and of course, don't forget to take a break... link.springer.com/article/10.100… @PaulAtkinsonEM @rodlim00

@CJEMonline @EMO_Daddy @EddyLang1 @CAEP_Docs @CAEPResidents @ClinMedJournals "Clarifying whether U-POCUS is primarily a screening pathway, a rule-out strategy or a diagnostic tool would help clinicians apply it more effectively..." @e_med_doc link.springer.com/article/10.100…

🚑 We have recently launched the: CJEM Equity Collection! We are seeking submissions that use an equity lens to improve the quality and impact of emergency medicine care globally. Join our expert editors Jaspreet Khangura, Kathryn Dong, and Patrick McLane in advancing EDI in EM. ✅ Median 4 days to first decision! ✅ Ongoing submissions ✅ Expert support for authors 🔗Submit your manuscript today: link.springer.com/collections/eh… #EmergencyMedicine #HealthEquity #FOAMed #MedTwitter #CJEM

Recent headlines about patients dying while waiting in Canadian emergency department waiting rooms are heartbreaking and all too familiar. But these events are not isolated tragedies—they are predictable outcomes of a system that hasn’t learned to adapt. @CJEMonline @CAEP_Docs

@raghu_venugopal @KirkLubimov Very well framed @raghu_venugopal. Sincere sympathy for the family and the staff, yet important lessons for everyone in health to learn. I hope that this can be a #WakeUpCall about #StolenBeds that will be acted upon across Canada. #SavingEmergencyMedicine #SavingLives

ER doc here. This is a tragic case and I don't justify the wait - at all. However, the spit-balling by Kirk below is so wrong on so many levels it's difficult to track. But let's try. 👇👇👇 @KirkLubimov First - when any death - predicted or unpredicted occurs it's important to let the family grieve in whatever way they need to. These are extraordinarily difficult even for experienced physicians. Like the healthcare worker in the video - the role is to quietly listen, to answer questions honestly and to explain the series of events clearly and in plain language. In this video, the healthcare worker appears present and listening. We don't know what happened before or after. An allegation of "negligence" takes into account Kirk knows zero about the (likely inadequate) staffing of the ER that day (which is out of the hands of those on duty) or what ER providers were doing. They may have been providing CPR or placing on artificial ventilators several other patients, but that is "negligence" enough for Kirk. Kirk mistakes the heartbeat and blood pressure as well. Those are vital signs, they are vital, but when you're a bad-faith commentator - who cares, right? Kirk - the blood pressure was 210 - not the "heart beat". This is not a small detail. Many ER patients have a BP of 210 and are fine, but only a tiny percent have a heart rate of 210 - and that is never fine. It's important to know what you're talking about. Kirk then goes on to say just "fire them all". Imagine if we sent firefighters with a garden hose to a forest fire or police to a call with squirt guns. Under Kirk's logic - because they wear badges - they're on the hook no matter how badly they're supported. He'd just fire them all. Under this logic - there would be no one left in healthcare. Even further - Kirk goes on absurdly to want to "jail them". This is unhinged. I know Kirk doesn't know this but there are bad outcomes in healthcare that happen which undergo a serious review and even remediation - but I want to inform him we don't jail healthcare workers in Canada who in a good-faith manner go to work to help people but because of UCP system design and under-support cannot do their duty. Lastly, this is not about "free" healthcare. I'm not sure what planet Kirk is on but healthcare in Canada is not free. We all contribute to it from our taxes. If you look in a "not free" healthcare system like in the US there are bad outcomes even in for-profit equity-driven systems when they are under-supported. It's not about free or not free - it's about supported vs under-supported. That's a big difference. In a tragic scenario like this we need serious commentators and people focused on helping average Canadians. Kirk, I'm sorry, you don't offer that here.

Wishing all in Emergency Medicine peace at this special time of year @CAEP_Docs @EMO_Daddy @PaulAtkinsonEM @EddyLang1 @hrosenberg33 @JenniferThullFreedman

emsj.ca/savingem/ Check out the updated #SavingEmergencyMedicine resources from @EMSaintJohn @CJEMonline @DalEMCanada

CJEM invites comment and papers on #StolenBeds: emergency department beds occupied by admitted patients awaiting inpatient care. A core driver of crowding, access block, and delay. Part of the CJEM #crowding collection. @EddyLang1 @PaulAtkinsonEM @EMO_Daddy

I had a chance to sit down and discuss #SavingEM #compassion and TPI awareness this week on the excellent @NSTrauma & @TheResusCourse #Trauma_ing podcast. Thanks guys! trauma-ing.com/podcast/compas… @CJEMonline @DalMedSchool @WoundWarriorCA @WorkSafeNB