Dr Jeff Peimer: ER physician providing care for troubled kids in Williams Lake

As a physician in South Africa, Dr Jeff Peimer blended his time between two passions - psychiatry and emergency medicine. He loved the ER for its fast-pace and medical diversity. He loved psychiatry for its careful, respectful listening, its need to ask the right questions to get to the right diagnosis as patients told their deepest thoughts and fears.

When he moved with his family to Williams Lake in 2011 to work in the local ER, the father of two children saw a need to provide more compassionate and co-ordinated care for youth who turned up in ER departments with mental health concerns.   

"The ER is not a great place for kids with mental health issues — it is traumatic and chaotic, but sometimes it is the only place they can go. If children and youth have to come to the ER, we need to teach ER doctors how to look after their needs in a way that is consistent, and clinically appropriate, time after time."

The stakes can be high for youth who are turned away or don't get linked to the care they need. Not only can the youth fall through the cracks, their mental health issues worsening, they are even at risk of self harm or suicide.

Dr Peimer envisioned a solution: a clearly defined protocol that enables doctors to treat youth in distress and effectively connect them back to community resources. He was inspired to action, taking a key lead on an ER protocol development after attending the first learning session in Kelowna for the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative.

Dr Peimer and the members of a working group got down to it, researching the medical literature, drafting algorithms, collaborating with physicians and mental health experts around the province. Dr Peimer personally devoted hundreds of hours of his time to the project.

The result is a new made-in-BC approach that starts from the moment a child or youth presents to the ER triage desk, with a "what to expect" pamphlet for youth and family, an algorithm to guide physicians and nurse from triage to discharge, the HEARTSMAP assessment tool, a communication plan, and a safety plan at discharge.

"It helps the ER staff connect with a young person who may be sitting in the ER with purple hair, piercings, staring at the floor saying nothing. It helps assess for safety, urgency, and disposition, and closes the loop of referral so that everyone knows that young person is going to be followed up after the ER with appropriate, good care."

For Dr Peimer, his intense involvement in the ER protocol these past four years has been a passion and a privilege. "It has been extremely rewarding. Emergency Room doctors work at the coalface. We can see the issues and we can help fix them."

Doctors of BC is interested in profiling physicians you know who are making a positive difference for their patients and in their communities.  Drop us a line at communications@doctorsofbc.ca with your suggestions.

The CYMHSU Collaborative received support and funding from Doctors of BC and the BC government through the Shared Care Committee. A short ER protocol training video and accompanying fact sheet can be found on the Collaborative's toolbox here.

HEARTSMAP initiative is funded by the Specialist Services Committee (SSC), a joint collaborative committee of Doctors of BC and the BC Ministry of Health.