Hospitals and injury are always such a staple of angst fics, but 9 times out of 10 the author has clearly never been in an emergency situation and the scenes always come off as over-dramatized and completely unbelievable. So here’s a crash course on hospital life and emergencies for people who want authenticity. By someone who spends 85% of her time in a hospital. 

Emergency Departments/Ambulances.

• Lights and sirens are usually reserved for the actively dying. Unless the person is receiving CPR, having a prolonged seizure or has an obstructed airway, the ambulance is not going to have lights and sirens blaring. I have, however, seen an ambulance throw their lights on just so they can get back to the station faster once. ers made me late for work.
• Defibrillators don’t do that. You know, that. People don’t go flying off the bed when they get shocked. But we do scream “CLEAR!!” before we shock the patient. Makes it fun.
• A broken limb, surprisingly, is not a high priority for emergency personnel. Not unless said break is open and displaced enough that blood isn’t reaching a limb. And usually when it’s that bad, the person will have other injuries to go with it.
• Visitors are not generally allowed to visit a patient who is unstable. Not even family. It’s far more likely that the family will be stuck outside settling in for a good long wait until they get the bad news or the marginally better news. Unless it’s a child. But if you’re writing dying children in your fics for the angst factor, I question you sir. 
• Unstable means ‘not quite actively dying, but getting there’. A broken limb, again, is not unstable. Someone who came off their motorbike at 40mph and threw themselves across the bitumen is. 
• CPR is rarely successful if someone needs it outside of hospital. And it is hard ing work. Unless someone nearby is certified in advanced life support, someone who needs CPR is probably halfway down the golden tunnel moving towards the light. 
• Emergency personnel ask questions. A lot of questions. So many ing questions. They don’t just take their next victim and rush off behind the big white doors into the unknown with just a vague ‘WHAT HAPPENED? SHE HIT HER HEAD?? DON’T WORRY SIR!!!’ They’re going to get the sir and ask him so many questions about what happened that he’s going to go cross eyed. And then he’s going to have to repeat it to the doctor. And then the ICU consultant. And the police probably. 
• In a trauma situation (aka multiple injuries (aka car accident, motorbike accident, falling off a cliff, falling off a horse, having a piano land on their head idfk you get the idea)) there are a lot of people involved. A lot. I can’t be ed to go through them all, but there’s at least four doctors, the paramedics, five or six nurses, radiographers, surgeons, ICU consultants, students, and any other specialities that might be needed (midwives, neonatal transport, critical retrieval teams etc etc etc). There ain’t gonna be room to breathe almost when it comes to keeping someone alive.
• Emergency departments are a life of their own so you should probably do a bit of research into what might happen to your character if they present there with some kind of illness or injury before you go ahead and scribble it down.
• We never shock a flatline. That’s Hollywood CPR, it’s not actually how it works. So solid line? Nope. We shock what’s called V-Fib, and (pulseless) V-Tach. So squiggles and big, fast, ugly waves, basically.
• There’s no running in emergency medicine. Unless our lives are in imminent danger, which they shouldn’t be because scene safety is first and foremost, we walk and calmly direct. It’s the patient’s emergency, not the provider’s. Rushing lends to a more frantic mindset, and frantic mindsets lead to bad decisions.
• And finally to not make this too long, paramedics will stay and play a lot of the time. We don’t rush on scene, grab a patient, and go. Sometimes we’ll grab them just to put them in the back of the ambulance, and then we’ll sit there for another ten minutes doing whatever we need to do. Broken limbs seems to be a theme, sometimes depending on the injury, we’ll start an IV and give pain medications before ever even attempting to move or splint the limb. We’re not just a fancy taxi, we’re actually medical providers that can do a lot of things, and we like to do them.

Wards

• Nurses run them. No seriously. The patient will see the doctor for five minutes in their day. The nurse will do the rest. Unless the patient codes.
• There is never a defibrillator just sitting nearby if a patient codes. 
• And we don’t defibrillate every single code. 
• If the code does need a defibrillator, they need CPR.
• And ICU. 
• They shouldn’t be on a ward. 
• There are other people who work there too. Physiotherapists will always see patients who need rehab after breaking a limb. Usually legs, because they need to be shown how to use crutches properly.
• Wards are separated depending on what the patient’s needs are. Hospitals aren’t separated into ICU, ER and Ward. It’s usually orthopaedic, cardiac, neuro, paediatric, maternity, neonatal ICU, gen surg, short stay surg, geriatric, palliative…figure out where your patient is gonna be. The care they get is different depending on where they are.

ICU.

• A patient is only in ICU if they’re at risk of active dying. I swear to god if I see one more broken limb going into ICU in a fic to rank up the angst factor I’m gonna . It doesn’t happen. Stop being lazy. 
• Tubed patients can be awake. True story. They can communicate too. Usually by writing, since having a dirty great tube down the windpipe tends to impede ones ability to talk. 
• The nursing care is 1:1 on an intubated patient. Awake or not, the nurse is not gonna leave that room. No, not even to give your stricken lover a chance to say goodbye in private. There is no privacy. Honestly, that nurse has probably seen it all before anyway. 
• ICU isn’t just reserved for intubated patients either. Major surgeries sometimes go here post-op to get intensive care before they’re stepped down. And by major I mean like, grandpa joe is getting his bladder removed because it’s full of cancer. 
• Palliative patients and patients who are terminal will not go to ICU. Not unless they became terminally ill after hitting ICU. Usually those ones are unexpected deaths. Someone suffering from a long, slow, gradually life draining illness will probably go to a general ward for end of life care. They don’t need the kind of intensive care an ICU provides because…well..they’re not going to get it??

Operations.

• No one gets rushed to theatre for a broken limb. Please stop. They can wait for several days before they get surgery on it. 
• Honestly? No one gets ‘rushed’ to theatre at all. Not unless they are, again, actively dying, and surgery is needed to stop them from actively dying. 
• Except emergency caesarians. Them babies will always get priority over old mate with the broken hip. A kid stuck in a birth canal and at risk of death by pelvis is a tad more urgent than a gall stone. And the midwives will run. I’ve never seen anyone run as fast as a midwife with a labouring woman on the bed heading to theatres for an emergency caesar.
• Surgery doesn’t take as long as you think it does. Repairing a broken limb? Two hours, maybe three tops. Including time spent in recovery. Burst appendix? Half an hour on the table max, maybe an hour in recovery. Caesarian? Forty minutes or so. Major surgeries (organs like kidneys, liver and heart transplants, and major bowel surgeries) take longer. 
• You’re never going to see the theatre nurses. Ever. They’re like their own little community of fabled myth who get to come to work in their sweatpants and only deal with unconscious people. It’s the ward nurse who does the pick up and drop offs.