It’s a day like any other: Julie Blackburn visits Noble’s Hospital’s emergency department and finds it will be business as usual over Christmas.

There will be some peculiarly seasonal mishaps to deal with, most notably those involving the festive decorations.

’We see elderly people who have fallen out of lofts looking for them or off stepladders,’ says trauma coordinator, sister Kim Durbin said, adding: ’I’ve seen some horrendous breaks caused that way.’

But for the staff on duty in the emergency department (ED) over Christmas it will be a fairly normal day, if there is such a thing there.

Kim said: ’Every day is different: I think that’s one of the attractions for the nurses and doctors here.’

On the day I visited the department it was busy with a broad range of patients being treated for conditions varying from sports injuries, alcohol, an elderly patient with dementia who was giving concern, and three children, one with a nasty cut. They included ’some quite poorly people’ who were in the resuscitation rooms.

’They’re not critical but they do need timely treatment,’ said Kim.

Dr Tim Kerruish is clinical lead for the ED and the hospital’s interim medical director. Manx born, he has been working in hospitals in Australia before returning to the island last year.

His job is to ’keep the patients flowing through the ED’.

’That is how you measure the success of an ED,’ he said.

We have all heard stories of people turning up at emergency departments with the sort of minor ailments that could easily be treated at home - puting a plaster on someone’s finger is not unheard of - but Tim said that the idea that these people waste a lot of their time is a misconception: ’They have very little impact on this department because we deal with them so quickly.’

The ED has also introduced a new way of delivering care with nurses going out to treat patients in their own homes. This might be someone who required intravenous antibiotics which do not require a stay in hospital.

’It’s great for patients and really good for the hospital as you don’t have people blocking beds,’ Tim said.

He is hoping to get the ED extended to provide more observation beds. Patients often have to wait for the results of scans or blood tests and this can take up to 24 hours which would usually mean them being admitted to a ward, very often to be sent home as soon as the results arrive.

Instead they could wait in a bed on the observation ward, thus releasing beds on the main wards for more urgent cases.

There was a report published recently in the UK about the frequent incidence of violence that ED nurses and doctors, and paramedics are subjected to.

Whilst it might not be as bad in the island as it is in some of the larger NHS hospitals, staff here are not immune from it.

Tim said: ’Staff get sworn out, spat on and assaulted the same as in ED departments in the UK.’

It is not always, as you might think, caused by patients coming in having consumed too much alcohol. It might also be, for instance, an elderly dementia patient becoming confused and lashing out.

Kim said: ’We’ve had several assaults recently, and on paramedics as well. I’ve been bitten.’

Tim added: ’You need a thick skin to work in the ED and if someone who’s drunk and swearing at you upsets you then you’re not the right person to work here.

’You don’t take it personally and it requires a certain amount of resilience. What supports that is team resilience and we do have that here.’

Which is not to say that Tim and his staff don’t get upset over some cases, even moved to tears, especially the ones they aren’t able to save.

Tim said: ’We’ve seen some terrible things this year.’

When I asked him for his message to the public, to keep them out of the ED over the festive season, he said: ’Don’t drink too much, don’t drink and drive and be nice to each other.’

The ’be nice to each other’ he added was to do with the small things that mean a lot, like keeping an eye on an elderly neighbour who might be isolated by severe weather.

’We see a lot of loneliness in here,’ he said.

Kim also had a message for everyone: ’Use our services wisely: the chemists are very good and MEDS are on duty on Christmas Day.’

â?¢ You can find details of the duty chemists over the festive season at https://www.gov.im/categories/health-and-wellbeing/pharmacy/pharmacy-rota/

â?¢ The telephone number for the Manx Emergency Doctor Service (MEDS) is 650355. If you have chest pain or a life-threatening emergency you should always call 999.