Emergency medicine trains clinicians to recognize patterns early, anticipate deterioration, and intervene before outcomes become irreversible. We pride ourselves on seeing what others miss. Yet we are repeatedly instructed, explicitly or implicitly, to ignore the largest pattern of all. Political decisions consistently and predictably shape who arrives in our emergency departments, how sick they are, and how unsafe the environment becomes for the people expected to care for them.

If political decisions can make emergency departments more dangerous places to work, then insisting that politics does not belong in health care is not neutrality. It is denial.

Emergency physicians, nurses, paramedics, technicians, and support staff do not practice in a vacuum. We practice at the point where public policy meets human physiology. Immigration enforcement strategies, policing tactics, gun legislation, housing instability, mental health access, and public health funding do not influence emergency care in theory. They do, however, determine volume, acuity, volatility, and risk. They decide whether an ED shift is strained or combustible.

The death of Alex Pretti

The death of Alex Pretti, an ICU nurse killed during a law enforcement operation, makes this reality impossible to ignore. When a health care worker is injured or killed in the context of political or enforcement activity, that is not a political distraction from medicine. It is medicine. It is occupational exposure shaped upstream by political choices. Discomfort with naming that reality does not make it less real. It only leaves clinicians unprotected.

Emergency departments already function as society’s catch basin. When primary care is inaccessible, chronic illness arrives in crisis. When mental health systems are underfunded, the ED becomes the default containment space. When housing collapses, discharge planning becomes an ethical fiction. When enforcement escalates, fear and force enter clinical space through triage, EMS handoffs, and waiting rooms.

This is not ideology. It is operations.

Resilience as a liability

Emergency medicine is often described as resilient. That framing is meant as praise, but it deserves scrutiny. Resilience, in practice, has become the justification for exposing health care workers to risks that would be unacceptable in any other profession. When a system relies on clinicians to adapt endlessly to unsafe conditions without addressing their source, resilience stops being a virtue and becomes a liability.

The insistence that politics does not belong in health care reinforces this dynamic. It shifts responsibility away from decision makers and onto the clinicians expected to absorb the consequences. The more adaptable we are, the less urgency there is to change the conditions requiring adaptation in the first place.

Calls to keep politics out of health care are often framed as professionalism. In reality, they function as a demand for silence. They ask clinicians to absorb escalating risk without analysis, to experience violence without context, and to continue stabilizing the downstream effects of decisions we are discouraged from naming. That expectation is not neutrality. It is containment.

Politics does not stop at the hospital doors. It shapes staffing ratios, boarding times, security posture, and whether clinicians feel safe walking to their cars after a shift. Physicians and nurses experience these realities together, regardless of role or training path. The emergency department does not distinguish between political and clinical harm. It treats what arrives.

Emergency medicine exposes an uncomfortable truth. Silence does not protect clinicians. Denial does not improve safety. Refusing to acknowledge the forces shaping our work does not preserve objectivity. It preserves vulnerability.

The most consequential pattern in emergency medicine is not what we fail to recognize, but what we are repeatedly told not to name.

Marilyn McCullum is an emergency nurse.