““Winter is coming.””

— Motto for House Stark (A Song of Ice and Fire)

For the Readers and Watchers of the Game of Thrones series these ominous words are familiar, but they are also familiar to those working in the ED. The clocks have gone back, the weather is getting colder and the nights longer. We are expecting increased crowding in our departments, lots of bronchi babies and infants with croup. As well as slips/ trips/ falls, and an increasing number of presentations with difficulty in breathing on the adult side.

All of this is expected, and every year at trust level Hospitals will have a winter plan, but how can staff on the ground prepare themselves?

Here are five tips:

Be nice to each other - everyone will be under pressure and is likely to be stressed, this applies to staff in the ED and out of it as well. We all need to be civil with each other and try to be helpful.
Look after yourself - this means taking breaks, and eating and drinking, also relaxing and sleeping when at home. If you are not on top form surviving work will be harder.
Look after your colleagues - because we will all fail at point two at some point. I would officially like to endorse a policy of buying your reg coffee when you have one! All joking aside if your colleagues are skipping breaks or drinks offer them one, it is harder to refuse.
Don't rush - when we are overloaded it is easy to try and work faster, but this can lead to mistakes. It is most important to work effectively and safely, and to acknowledge when you need help rather than taking on more work.
Handover properly - unfortunately a number of patients will be staying in the department when you are leaving - ensure you have handed over fully to minimise the risk of things being missed. We use the RSVP tool, but your trust may use something different.

For those of you who want some further reading on some specific winter challenges the following might be useful:

We have our Paediatric Emergency Medicine module on Resp/ ENT problems
Feedback from our Simulation of a Newborn with Resp Distress
Life in the Fast Lane on Hypothermia
The RCEM guideline on Crowding in the ED
St Emlyns Entry on Crowding (A.K.A the Fellowship of Corridor Medicine)
BMJ Careers article on Resilience - this is a term that has crept in over the last few years and some disagree over its use, however the reality is we all need to learn to survive under pressure.

Finally a few more words from George R.R. Martin and why working together as a team we will get through winter...