Nurse, who should see the doctor first? Emergency departments are chronically overcrowded, according to a report (PDF) released last week by the Canadian Association of Emergency Physicians. Most Canadians don't need a research study to tell them something they already know about wait times and a system that doesn't seem to be based on a first-come, first-served service. In fact, many people amuse themselves, while waiting to be seen by a doctor, by diagnosing the severity of the illnesses and injuries affecting their fellow patients. Here is a chance for you to play triage nurse (the person who decides who jumps the queue) at Sunnybrook Health Sciences Centre in Toronto. Read the four patient scenarios below and use the Comments section to tell us which patient should be seen first by a doctor and why. Rank the patients in the order you believe they should be seen. On Thursday, we'll publish an update with an interview with a clinical educator who trains nurses, who'll explain how and why a real ED would handle these cases. The Patients A 30-year-old male complains of chest pain and shortness of breath, when he moves around and even when he is lying flat in bed. He recently returned from a long flight from Australia and the symptoms seem to have started after he arrived home. He has no medical problems and takes no medications other than multi-vitamins. A 25-year-old female was walking down the street and slipped on some ice, twisting her left ankle. She is accompanied by her boyfriend who helps her limp into the Emergency Department. Her ankle is slightly swollen and she is able to put some weight on the foot when walking. The nurse examines her foot, but sees no obvious signs of a broken bone. Nevertheless, the patient says her pain level is 8/10. A 50-year-old male, sitting in a wheel chair, is pushed into the Emergency Department by his wife. They had been eating breakfast half an hour earlier when he suddenly complained of a headache and blurred vision. His wife noticed he was having difficulty speaking and "his right arm was not working." She helped him get into the car and drove him directly to the Emergency Department. A 65-year-old male was working in his garage when he accidently shot himself in the hand with a nail gun. He immediately pulled the nail out and applied a bandage which seems to have stopped the bleeding. He produces the nail and says his wife made him come to the Emergency Department for a tetanus shot.