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Healthy Talk
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Care in Critical Moments: A Look Inside the ER
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What really happens inside the Emergency Department—and how do ER teams prepare for life’s most critical moments?
In this episode of Healthy Talk, we sit down with Carla Chow to take a closer look inside emergency medicine and the care provided at Boone County Hospital.
From understanding when to seek emergency care to learning how ER staff respond to unpredictable and high-pressure situations, Carla shares insight into the teamwork, preparation, and compassion that drive the Emergency Department every day. We also discuss common misconceptions about the ER, emergency preparedness, and the important role community hospitals play in providing care close to home.
Whether you’ve visited the ER yourself or simply want a better understanding of the people and processes behind emergency care, this conversation offers an inside look at the dedicated team serving Boone County when patients need them most.
Stay informed, stay healthy, and keep the conversation going with Healthy Talk.
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Introduction
SPEAKER_00Hello everyone and welcome back to Healthy Talk, Empowering Your Wellness One Conversation at a Time. Most of us hope we never have to visit the emergency room. But when something scary or unexpected happens, we want to know experienced, compassionate people are ready to help. Today we're talking about emergency medicine, what really happens behind the scenes in the ER, and how the team at Boone County Hospital is prepared to care for our community when every second counts. Joining me today is Carla Chow, Director of the Emergency Department at Boone County Hospital. Carla, thanks so much for being here today. Well, thank you, Rachel. Happy to be here.
Getting to Know Carla
SPEAKER_00Before we jump into all things emergency, tell us a little bit about yourself and your role here at Boone County Hospital.
SPEAKER_02I've been the director of the ER here for about nine and a half years. And prior to that, I was a director of another ER. My nursing background, I am in the twilight of my nursing career now. For probably the first 20 years of my nursing career, I worked in cardiovascular ICU or open heart ICU. And then made the transition to emergency medicine after that and worked as an emergency room nurse in a variety of different level emergency rooms, level one to level four. And then once my husband and I moved back to Iowa, I worked at Mary Greeley and then at Paula and now here at Boone.
Understanding the Emergency Department
SPEAKER_00For listeners who may not realize everything the ER handles, what kind of situations does your team care for regularly?
SPEAKER_02It is a wide variety. First of all, the age can be anywhere from newborn to 100 or 104. I think we have had someone 104, and it encompasses everything that can happen to anybody. We take care of medical issues such as, you know, abdominal pains, appendicitis, chest pain, shortness of breath, strokes, kids that get hurt on the jungle gym, elderly people with falls, we see trauma, absolutely everything across the gamut you see in the emergency room, which I think is what keeps it interesting for the staff and for the physicians.
SPEAKER_00What would you say are some common misconceptions people have about the emergency department?
SPEAKER_02I think there's a couple of them. I think one that we see that across all ERs is an individual has an issue that's been ongoing for three or four months, like knee pain or shoulder pain, and you know, they've seen their doctor about it and they're trying to figure out what's going on. And they think, well, if I just go to the ER, they'll be able to figure out what's going on with me and take care of it. And that isn't usually the case when it's something of that nature. If your primary care physician is trying to figure it out, that's really who you need to stay with. However, if whatever that issue is is causing you pain, then certainly come to the ER and we can address the emergent issue of the pain that you're having with it. But I think that's one misconception. And I think another one is that when you arrive at the ER, if you came in before this guy behind you, that you should get to go back before them. And we use a triage system in the ER where depending on what the severity of your complaint is, depends on the order in which you're seen. Right. And that even happens once you're in the room. You know, if you're in the room and then an ambulance comes in that's a trauma, then we have to reprioritize. And so there's a constant shifting of who's the top priority that needs to be seen. So I don't want people to think that it's first come, first serve. Yeah, it's first come, first serve. Yeah.
SPEAKER_00What would you say makes a strong emergency department team?
SPEAKER_02I think respect for one another and for the patients. I think the camaraderie that we have amongst ourselves, we're really interdependent on one another. You know, the ER physician can't run the ER by himself. He needs the ER tech and he needs the ER nurse. And the nurses need the physician and the techs. We're all very interdependent on one another. And I think the respect that you show for each other, knowing the knowledge and the training that each one has, and maintaining a professional, respectful work environment with one another is important. And I think we do that very well.
When Should You Go to the ER?
SPEAKER_00One question I think a lot of people probably struggle with is deciding when they should actually go to the emergency room. I know I've had that as a parent, especially the first time something happens. You're like, I don't want to be that parent that's taking my kid in for a little thing, but then I don't want to be that parent that's being neglectful of something that needs to be. So what are some situations where someone absolutely should seek emergency care?
SPEAKER_02Well, I think, you know, especially with parents, I always tell parents, go with your gut. Okay. You know, if you feel like you're uncomfortable with this, you're not sure about this, we absolutely want to see them. And if nothing else, just offer reassurance or maybe do some education on things that you need to look for that would be concerning. But things that you absolutely need to go to the ER for are if you're short of breath and you're having trouble breathing, if your lips are purple or blue or your nail beds, chest pain, stomach pain or pressure, seizures, an animal bite, snake bite, bat bites, human bites, those you need to be seen for. Any severe bleeding, any burns, especially what we call circumferential burns. Like you can burn the tip of your finger and you can probably take care of that at home. But if your whole finger all around it gets burnt, then you need to come in. That's a whole nother ballgame. Eye injuries, infants, if you have a baby that's under two months and has a fever, we always work up a baby that's less than two months old that has a fever, any kind of allergic reaction, because you never know if it's going to get better or if it's gonna get worse. So it's best just to come to the ER and we can at least monitor you. But there's medicines that we give. If you have uncontrolled pain, broken bones. Now the walk-in clinic can also take broken bones, but if you have a broken bone and you can see that it's deformed, just come to the ER. Uh suspected stroke, asthma, and of course mental health issues. If you're feeling like harming yourself or harming someone else, please come to the emergency room.
SPEAKER_00So when might urgent care or primary care clinics be a better option?
SPEAKER_02The walk-in clinic, if you're having like upper respiratory colds, flus, like an ear infection, sinus infection, urinary tract infection, something like that. And on our website, we have a good list of things that kind of say go to your primary doctor for this, go to the walk-in for that, and go to the ER for that. It it kind of lays it all out very nicely. So that's helpful.
SPEAKER_00Print it out and stick it on your fridge.
SPEAKER_02Yes, good idea.
SPEAKER_00Do you think people sometimes wait too long before coming in to the emergency room?
SPEAKER_02Yes, sometimes. You know, they don't want to be a bother, they're not real sure. But those big things like the chest pain, the shortness of breath, severe abdominal pain, it's best to come in right away. The most important thing is to rule out that there isn't something emergent or critical going on.
SPEAKER_00You'd rather go there and be like, you're actually okay, than not go and something horrible, horrible happens.
SPEAKER_02Yes, and now you've waited too long. And yeah, exactly.
Emergency Preparedness & Safety
SPEAKER_00Depending on the season, would you say there are certain emergencies or injuries you tend to see more often? Absolutely.
SPEAKER_02So we're coming up on the summer holidays, so we'll see firework injuries. It seems almost every year we have some related firework injuries. And I think of the winter and I think of skiing and snowboarding. Yeah. We often see things from there. The sporting season gets going. We see injuries related to that. So yeah, we absolutely do see right coming up this year through.
SPEAKER_00I'm sure the ER will be busy that week.
SPEAKER_02We are. We're planning with EMS and actually the whole hospital to, you know, a surge of patients coming in. So yeah, that'll be a big event for the town and for the hospital.
SPEAKER_00What are some simple ways that families can stay safer and hopefully avoid emergency room visit?
SPEAKER_02I think one of the biggest things now is helmets for kids using e-bikes, scooters. Yes. 100% of the time they need to have a helmet on and adults too. We've had adults that have and taken a tumble on those and they go a pretty good clip. Yeah. And we have seen significant injuries from that. And a helmet would make a huge difference. And it's an easy way to prevent a very serious.
SPEAKER_00When you see a head injury, do you go, this could have been so much better or not as bad if you were just wearing your helmet? Mm-hmm. Yes. That is a super easy thing to do. Just clip it on before you go. Are there things people can do ahead of time that help your ER staff provide quicker or more effective care during an emergency?
SPEAKER_02I think there's a couple. One of them, I think, and we all talk about this at your doctor's office, at the walk-in clinic, at the ER, bring a comprehensive med list. That's very important. It really helps us to see, you know, especially if you're in with a laceration and we can look at your med list and see you're on a blood thinner. So a comprehensive written-out med list is very helpful. And often we get parents that bring in their child with a fever and they say, Well, I didn't give them anything for the fever because I wanted you to see what their fever was here. And we 100% believe you if you say they have a fever. Right. If you checked it two hours ago and it was 103, we believe you. There's no doubt if you come in with a child with a fever, so please treat the fever at home and you can bring them in after you've given them Tylenol too.
Behind the Scenes in the ER
SPEAKER_00The emergency department can be a very emotional place for patients and families. How does your team support people during difficult moments?
SPEAKER_02I think for our team, compassion is a huge part of emergency care. You know, patients come in and they're scared or they're overwhelmed. So our staff works hard to explain what's happening, answer questions that they may have, and help people feel supported during these stressful situations.
SPEAKER_00Emergency medicine can obviously be stressful. You just said how it's stressful for people, but it can be stressful for staff too. So how does your team manage high pressure situations?
SPEAKER_02One thing that people may not understand is there's a lot of training that goes on behind the scenes. And there's a lot of certifications that both the physicians and the nursing staff have to have. Of course, basic BLS is one of them, but the nursing staff has to have advanced cardiac life support, pediatric life support, a two-day trauma nurse course, and these have to be recertified, some are every two years and some are every four years. And then we also take an emergency nurse pediatric course as well on how to care for sick children. So there's constant recertification in these classes to keep us current on the latest trends and to keep it fresh in our mind. And then we also do drills. We practice CPR drills or code drills, trauma drills. So there's a lot of behind the scenes that we're doing. And then the physicians also have to have advanced life support, pediatric life support, and they have to take an advanced trauma life support class as well. So there's lots of training behind the scenes.
SPEAKER_00Are a lot of those different than if you were going to be a nurse on med surge?
SPEAKER_02Yes. Some of them are the same, but the trauma nurse course and the emergency nursing course, which are both two-day courses, and they're intense courses. And part of that coursework is then you have to run a trauma. You're the lead on the trauma and you have to work through the scenario in front of an instructor and what you would do. So they're very intense training, but very thorough and good training. So yeah.
SPEAKER_00Without sharing anything confidential, do you have a patient moment or experience that has stayed with you throughout your career?
SPEAKER_02I think there's many. There's those where the outcome was good, the outcome was positive. And then the others that stick with you are the ones where the outcome wasn't good, where it wasn't what you what
Community & Boone County Hospital
SPEAKER_02you wanted.
SPEAKER_00What are you most proud of when it comes to our emergency department at Boone County Hospital?
SPEAKER_02I would say without a doubt, it's the people, the staff, and the physicians that work there. I get kind of emotional talking about them, but I think we just have a wonderful team here at Boone County Hospital. For a smaller town and a small hospital, I think we have excellent nurses, physicians, and techs that really put 100% effort into their day here and how they care for patients.
SPEAKER_00How would you say that care in a rural community hospital differs from what people would expect at a larger hospital?
SPEAKER_02I think sometimes it's like the resources. Like we don't have ultrasound or MRI available after four o'clock. Okay. So those things can only be scheduled eight to four Monday through Friday. So we don't have those resources where they would at a larger hospital. That's some of it. Another thing on the positive is I think, you know, your wait times at a larger urban hospital are going to be a lot longer. I think we get people in pretty quickly. I think if you're on the waiting end of it, it seems forever to get tests back or whatnot. But I think, you know, the turnaround is pretty average for what it would be at any hospital, maybe a little bit quicker here. But I think it's the personalized care too. You know, a lot of our staff know people in the community and they live here.
SPEAKER_00They're part of it. It's their community too. They want to help and take care of their family, friends, neighbors.
SPEAKER_02Yes, yes, absolutely.
SPEAKER_00What would you say that serving this community means to you personally?
SPEAKER_02I think for me personally, and and I think I can speak for our team as well, that serving our community means, you know, we come to work every day with a commitment to compassion, to excellence, quality care, readiness, especially when people out there most vulnerable. For our team, it's more than just delivering medical care. It's about being a trusted safety net, whether it's a life-threatening emergency, a mental health crisis, or someone who just simply doesn't know where else to go. But we're here 24-7 and we're here to provide not only clinical expertise, but also, you know, reassurance, dignity, and respect. It also means, I think, being prepared for anything. It requires constant teamwork, adaptability. We're constantly reprioritizing what we need to be taking care of immediately. We have to have some resilience. We train, we support one another, and we hold ourselves accountable. Our community depends on us to be ready in moments that really truly matter. And I think on a deeper level, serving our community means building trust. Every interaction is an opportunity to make someone feel seen, heard, and cared for. And that really is something we take very seriously. I'm incredibly, incredibly proud of our team here because they just don't do their jobs. They genuinely care about the people behind every patient's story. And I think it's that commitment is what defines us on how we search. Absolutely.
Closing Thoughts
SPEAKER_00What advice would you give to someone interested in a career in healthcare or emergency medicine?
SPEAKER_02I would say first shadow somebody. Okay. Come in and shadow, you know, and maybe not just the ER, but you know, maybe on the med surge unit, you know, in OB, shadow for a few hours to kind of get a feel for it. But I will tell you, it's a very rewarding career. I think it's something that once you become involved in it, and it's a very rewarding career. And it's something that I have found to be for my life, it was absolutely what I was called to do.
SPEAKER_00Finally, if listeners remember one thing from today's conversation, what would you want it to be?
SPEAKER_02That RER is here to care for our community and we take pride in taking good care of our community.
SPEAKER_00Carla, thank you so much for joining us today and giving us a behind-the-scenes look at emergency medicine and the incredible work happening here at Boone County Hospital.
SPEAKER_01Well, thank you, Rachel. It was really nice visiting with you.
SPEAKER_00And thank you to all our listeners listening to Healthy Talk. We hope today's conversation not only answered questions about when to seek emergency care, but also reminded that there's a compassionate, highly trained team here at Boone County Hospital, ready to care for our community when it matters most. If you enjoyed today's episode, be sure to subscribe and share it with a friend or a family member. Stay connected with Boone County Hospital for more conversations focused on health, wellness, and the people caring for our community every day. Until next time, stay informed, stay healthy, and keep the conversation going with Healthy Talk.