There has been a lot of focus on emergency departments of late – complaints about long waiting times and not being seen immediately. I think a lot comes from the lack of understanding about the role of emergency departments. This is written to further the understanding of how our emergency departments in Malaysia work (for Malay link, please click here).

Most emergencies are divided into three major areas: 
1. Red Zone (critical zones – patients just died/about to die and requiring urgent resuscitation). These patients are seen immediately. 
2. Yellow Zone (semi-critical cases – patients who may potentially worsen or are unstable in terms of their vital signs or certain ‘red flag’ diagnosis. These patients are seen within 15-30 minutes of presentation. 
3. Green Zone (non-critical cases – cough and cold, minor scrapes and lacerations. There are further subdivisions in the green zone based on age and critical cases). Waiting time depends on staff, number of people and can go up to 4-5 hours. 


When first attending the emergency department, patients are seen at the triage desk – which then will send the patients to the appropriate zones. Triage desks are basically manned by medical assistants (M.As) who will make this decision based on the complaint, the presentation of the patient, and if needed, the secondary triage will further re-classify the case based on the vital signs and/or relevant investigations.

Staffing and Working Hours 

The emergency department is staffed by doctors, medical assistants, staff nurses, community nurses (J.Ms) and health attendants. They all have their own responsibilities, but in the emergency department, only doctors are allowed to see patients (in some district clinics, medical assistants also see patients), and medical assistants and staff nurses help with the monitoring, procedures and other administrative duties. They work on a three shift system which is 8 hours long per shift, which is often a gruelling situation, and staff may have to work two shifts per day at times. 

On a night shift, depending on the staff available, there may only be 1-2 doctors per zone and when there are too many patients in the red or yellow zone, the doctors from green zone will assist the other zones. During these shifts, it is common to try and sneak a bite to eat or a prayer break when possible – because often you have no idea when patients are going to start pouring in! 

What Is An Emergency? 

An emergency includes problems like heart attacks, seizure, severe asthma or respiratory diseases, severe motorvehicle accidents, patients going into shock (among others) – cases that need to be seen urgently and treated as quickly as possible. 

As a general rule, if you can walk, talk and breathe, you may not be considered an emergency. Please understand that as health professionals, we will try our best into see you – patients are not turned away from emergency departments, but please understand, that just because you only pay a paltry RM1, it does not mean you should be flooding the emergency departments. 

If your child has a cough and cold – do not come to emergency immediately. Try giving some Paracetamol first and sponging to bring down the temperature. Most pharmacies sell over the counter medications, as does Seven Eleven. There are private GPs or government clinics that will be open. If you have pain somewhere, please understand that we will not triage you to yellow zone if the pain does not seem to be severe. 

Working in emergency is challenging – sometimes more than often you are tired, overworked and often faced with patients banging on your door demanding to be seen when they have been waiting for three hours, only for a cough and cold, or a mild pain. It is high volume, relentless work and a lot of this comes from people who do not understand the role of emergency. 

At the end of the day, Malaysians also have the understand the system is such to serve critical cases – please do your part as responsible consumers before making those complaints.
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