Member Spotlight: Sarah Arulchelvam – A New Graduate Physiotherapist in the Emergency Department

Sarah Arulchelvam is a new to practice physiotherapist making impactful strides in a unique and evolving role in an Emergency Department (ED). With a passion for acute care and a flexible, team-based approach, she is helping to push the boundaries of physiotherapy practice in Ontario. 

“I graduated from McMaster University’s physiotherapy program in August 2024, so I still consider myself a relatively new graduate,” Sarah explains. “After completing the program, I was drawn to the acute care setting because of the fast-paced, collaborative nature of the hospital environment.” 

Sarah began her career at Michael Garron Hospital, a community hospital in Toronto, where she primarily worked in oncology and geriatrics. Her interest, however, in exploring different practice areas and settings developed early on. 

“During school, I became aware of physiotherapy in the Emergency Department as an emerging role, though full-time opportunities were quite limited at the time,” she says. “So, when a position opened in the ED at Markham Stouffville Hospital, I was excited to take the opportunity and make that transition. I’m still new in this position and continue to learn and grow within the role, but it’s been a rewarding experience so far.” 

Pushing Scope and Supporting Flow

Working in the Emergency Department requires adaptability and interdisciplinary collaboration. “In the ED, the dynamic and resource-limited environment often calls for physiotherapists to extend their role beyond traditional boundaries, always within safe, ethical, and team-based frameworks,” says Sarah. 

“As the consistent allied health provider on the floor, I frequently take on tasks that support patient care and flow.” 

Sarah often assists with occupational therapy responsibilities, such as equipment recommendations, activities of daily living (ADL) assessments, and basic cognitive screenings. She also initiates referrals to community services and contributes to discharge planning, all of which are roles that are not traditionally part of physiotherapy but are essential in this setting.

“I believe this kind of interdisciplinary flexibility is necessary in today’s emergency care settings and reflects how the physiotherapy role is evolving in acute environments like the ED.” 

A Generalist Approach for Complex Care 

Rather than narrowing her focus early, Sarah chose a broad clinical approach to meet the unpredictable needs of the ED. “As a new graduate, I bring current, evidence-based knowledge across all major areas of physiotherapy, including musculoskeletal (MSK), neurological, and cardiorespiratory,” she says. “I’ve embraced a generalist approach, which has been a real strength in the ED.” 

This approach allows her to perform MSK special tests, vertigo assessments like the Dix-Hallpike, and assist in patient flow coordination. While some of these assessments are atypical for a hospital setting, they are critical for providing thorough assessments and optimal care. 

Sarah also works closely with geriatric nurse practitioners to create discharge plans for non-admit older adults. She balances short-term supports with long-term planning, such as initiating long-term care applications or retirement home referrals. 

Impact on Patient Outcomes and System Goals

The physiotherapy role in the ED is particularly impactful for non-admit patients such as those who receive care without being formally admitted. “A significant portion of these individuals are older adults who present with issues such as falls, pain, or difficulty coping at home,” Sarah explains.

“While they may not require hospital admission, their needs still warrant timely assessment and intervention.” 

By optimizing mobility, supporting pain management, and contributing to discharge planning, Sarah helps prevent unnecessary admissions and ensures safe transitions back to the community.

“Although still early in my time in this role, I’ve seen firsthand how early physiotherapy involvement can support better patient flow and lead to more appropriate, timely discharges.” 

She also emphasizes the importance of early mobilization in reducing deconditioning and contributing to shorter ED stays, especially for high-risk or geriatric patients.

Policy, Advocacy, and Education

Sarah believes that for system-level goals like reducing hallway medicine and readmissions, physiotherapists must be engaged from the outset. “Many government-funded clinical pathways are designed with the expectation of short hospital stays,” she explains. “To meet these timelines, system-level decision-makers must recognize that discharge planning begins the moment a patient is admitted.” 

She urges policymakers to appreciate how early physiotherapy assessment can coordinate care and prevent complications.

“Early mobilization not only prevents deconditioning and reduces complications but also serves as a cost-saving strategy.” 

More research is needed, particularly in Canada, to highlight the value of physiotherapy and early mobilization in EDs, she adds. 

Sarah also wants fellow physiotherapists and health professionals to understand the unique demands of ED practice. “The ED is a dynamic and unpredictable environment. ED physiotherapists must be highly flexible. In addition to managing patients in the ED, we often function as float physiotherapists, assisting colleagues on inpatient units when needed.”

A Day in the Life

“A typical day for me as an emergency department (ED) physiotherapist runs from 9 am to 7 pm, and no two days are ever quite the same,” says Sarah. “The work is dynamic and often unpredictable. It requires flexibility, communication, and frequent coordination with various members of the healthcare team.”

Sarah begins by reviewing the ED patient count, focusing on non-admitted patients. She often collaborates with the geriatric emergency management (GEM) nurse practitioner and works with the Access and Flow team to identify patients who may benefit from physiotherapy. 

After chart reviews, she typically sees patients in blocks of two or three, checking with bedside nurses first and often hunting down essential equipment. “ED mobility aids like two-wheeled walkers and canes tend to go missing due to fast patient turnover, so I frequently search the department or even other units,” she explains. 

Assessments may require creativity and often involve adapting to the available physical environment and maintaining ongoing communication with physicians, occupational therapists, and flow coordinators to ensure a safe discharge.

“Since the ED is constantly evolving, I regularly check for PT referrals throughout the day. New patients are always arriving or being flagged for discharge, so it’s important to stay on top of the caseload daily.” 

She also supports other departments when the ED is quieter. “Ultimately, working in the ED requires not only clinical expertise but also strong collaboration, creativity, and a proactive mindset to support patient flow, safety, and quality care under high-pressure conditions.” 

Sarah’s experience highlights not only the evolving scope of physiotherapy but also the profession’s vital contribution to system-wide healthcare goals. Her story offers inspiration and insight for other physiotherapists, whether they are new graduates or seasoned clinicians. It’s a compelling case for why more ED-based physiotherapy roles are deserving of increased funding and support. 

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