From Crisis to Compassion: Rethinking How We Save Emergency Medicine

The Crisis We See Every Day

Stretchers in hallways. Ambulance offload delays. Overworked staff. Escalating moral distress.

Emergency medicine is in crisis - not just operationally, but philosophically. And solving it will take more than better workflows or bed counts.

We need to return to something more fundamental: compassion.

• Emergency medicine is not failing because we stopped caring - it’s failing because we’re working in broken systems.

• Compassion is not a luxury - it’s a clinical skill that improves outcomes and prevents burnout.

• Sustainable emergency care requires three pillars: resources, training, and compassion.

• We must shift from surviving chaos to building systems - and cultures - that care for everyone, including clinicians.

A Story from the Sea

The 1912 sinking of the Titanic offers a powerful metaphor:

• Sidney Goodwin, the “Unknown Child” buried in Nova Scotia, represents those we lose - not due to individual failures, but systemic ones.

• Thomas Andrews, the ship’s designer, who stayed onboard helping others until the end, reflects frontline clinicians who keep showing up - drained but committed.

• J. Bruce Ismay, the White Star Line chairman who escaped the sinking ship, stands in for leadership that minimizes risk, ignores warning signs, and self-preserves.

Emergency departments weren’t designed to absorb all unmet needs. Yet that’s what they’ve become - by default, not by design.

A Line That Stays With Me

“Every patient who presents to an emergency department is a failure of the public health system, not a success.”

— William Haddon

This isn’t a statement of blame - it’s a statement of reality.

Patients arrive in our EDs after already being failed:

• By a lack of primary care access

• By delays in mental health services

• By systems that offload complexity downstream

In 2021, our team wrote Saving Emergency Medicine – Is Less More? The opening lines struck a chord:

“Emergency departments are failing. Triage lineups, packed waiting rooms, ambulance offload delays…

Nurses hitting the wall, leaving for more sustainable lives… A vicious cycle of demand, dysfunction and distress.”

And perhaps most crucially:

“The ED is the wrong place for most patients… So why is it acceptable to keep frail, acutely ill patients in noisy, overcrowded rooms for hours or days?”

A Framework for Change

While no single solution exists, we can start with a simple framework:

1. Resources

Give emergency teams the space and tools to do their work safely.

2. Training

Invest in programs that prepare, sustain, and grow resilient teams.

3. Compassion

Not a soft skill - a core clinical competency.

Compassion isn’t about sentiment. It’s about action. The willingness to engage suffering and do something about it. It’s the only reason many of us still show up.

What the Science Says: Compassionomics

The emerging science of Compassionomics shows us that compassion is not just humane - it’s effective:

• Reduces cortisol

• Improves immunity

• Decreases pain

• Speeds up recovery

Patients who feel cared for use fewer resources - and get better faster.

For clinicians, compassion protects against burnout and fosters better team culture. It doesn’t take much: 40 seconds of genuine connection can have a measurable impact.

Beyond Empathy: The Neuroscience of Caring

Compassion (emotion + action) lights up more positive neural circuits than empathy alone.

Even Charles Darwin noted this in his writings on survival: communities built on what he called “sympathetic kindness” tend to thrive.

Sometimes, empathy is hard (read more).

Sustainable Compassion = Caring for Others and Ourselves

There’s a myth in medicine: that to care for others, we must sacrifice ourselves.

Not true.

Imagine a graph with two axes: self-interest and concern for others.

• One corner = apathy

• Another = selfishness

• Another = burnout from selfless overgiving

• The ideal? Otherish givers — those who care deeply, while still protecting their own well-being

This is where compassion becomes sustainable.

Why Emergency Medicine Is Struggling

It’s not because we don’t care.

It’s because we’re being asked to care without support, structure, or sanity.

But we can still change how we show up:

• Resources to do the job

• Training to do it well

• Compassion to make it meaningful

Final Words

Saving emergency medicine isn’t just about fixing systems - it’s about restoring why we do this work.

When we build with compassion - for our patients and for each other - we make emergency care not just survivable, but sustainable.

Dr. Paul Atkinson is an emergency physician based in Saint John, NB. He is co-author of the Saving Emergency Medicine series and a contributor to national and international discussions on the future of emergency care.

Follow him on Twitter: @PaulAtkinsonEM