To the Editor: In physiology, the Frank–Starling curve demonstrates that cardiac muscle initially responds to an increased workload with an increased force of contraction.1 However, after the point of maximum efficiency is reached, further workload produces a decrease in both the force of contraction and the ejection fraction, leading to cardiac failure.

It now appears that the same curve could describe the current situation in many Australian emergency departments.

We used to operate at point A on the curve (Box). If there was a mini-disaster or a moderately large number of victims of a road accident, the department was able to increase output to cope with the situation. The “adrenalin stimulation” experienced by all members of the team meant that the department coped, and that staff were left with a sense of satisfaction.

Now our department finds itself at point B on the curve. Extra workload can result in a decrease in performance and output. The patients obviously suffer, but so do the staff. The once-challenging and enjoyable parts of the job now generate frustration and exacerbate the background dysfunction.

On a recent weekend, the emergency department experienced an influx of sick elderly patients as a result of a local heatwave, with temperatures reaching 42°C. The problem was identified as a mini-disaster only in retrospect. At the time it was thought to only exemplify another bad day. This is an example of the syndrome of “learned helplessness”2 that staff are experiencing.

Politicians and health administrators need to understand that our public hospital emergency departments are struggling with their daily workloads and are no longer equipped to deal with medium- to large-scale emergencies.

Access block as a medical model

At point A, an increase in workload leads to increased performance to cope (moving to point A1). At point B, an increase in workload leads to a decrease in performance (to point B1).