Editing Emergency department (section)

==History==
Accident services were provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the world's first specialized trauma care center was opened in 1911 in the United States at the University of Louisville Hospital in [[Louisville, Kentucky]].  It was further developed in the 1930s by surgeon Arnold Griswold, who also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital.<ref>{{cite book |url=https://archive.org/details/areferencehandb02buckgoog |page=[https://archive.org/details/areferencehandb02buckgoog/page/n245 212] |title=A Reference Handbook of the Medical Sciences Embracing the Entire Range of Scientific and Practical Medicine and Allied Science |date=1908 |publisher=W. Wood |via=Internet Archive }}</ref><ref>{{cite journal |url=http://www.louisville.edu/ur/ucomm/mags/summer2000/cover_story.html |journal=UofL Magazine |issue=Summer 2000 |title=30 Ways We've Changed the World |first=Russ |last=Brown |archive-url=https://web.archive.org/web/20160303211305/http://louisville.edu/ur/ucomm/mags/summer2000/cover_story.html |archive-date=3 March 2016|url-status=dead}}</ref>

Today, a typical hospital has its emergency department in its own section of the ground floor of the grounds, with its own dedicated entrance. As patients can arrive at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need.<ref>{{cite journal | vauthors = Oredsson S, Jonsson H, Rognes J, Lind L, Göransson KE, Ehrenberg A, Asplund K, Castrén M, Farrohknia N | display-authors = 6 | title = A systematic review of triage-related interventions to improve patient flow in emergency departments | journal = Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | volume = 19 | issue = 1 | pages = 43 | date = July 2011 | pmid = 21771339 | pmc = 3152510 | doi = 10.1186/1757-7241-19-43 | doi-access = free }}</ref>  This process is called [[triage]].

Triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of [[vital signs]], and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have a dedicated area for this process to take place and may have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a triage [[nurse]], although dependent on training levels in the country and area, other health care professionals may perform the triage sorting, including [[paramedic]]s and [[physician]]s. Triage is typically conducted face-to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance crew; in this method, the paramedics will call the hospital's triage center with a short update about an incoming patient, who will then be triaged to the appropriate level of care.

Most patients will be initially assessed at triage and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need.  However, some patients may complete their treatment at the triage stage, for instance, if the condition is very minor and can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department.

The [[Cardiopulmonary resuscitation|resuscitation]] area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. In such situations, the time in which the patient is treated is crucial. Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and [[Advanced Cardiac Life Support]] training. These personnel may be assigned to the resuscitation area for the entirety of the shift or may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance, the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases may also be attended by [[resident physician|residents]], [[radiographer]]s, [[Emergency medical services|ambulance personnel]], [[respiratory therapists]], hospital [[pharmacists]] and students of any of these professions depending upon the skill mix needed for any given case and whether or not the hospital provides teaching services.

Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, [[ultrasonography]], [[Computed tomography|CT]] or [[Magnetic resonance imaging|MRI]] scanning. Medications appropriate to manage the patient's condition will also be given. Depending on underlying causes of the patient's chief complaint, he or she may be discharged home from this area or admitted to the hospital for further treatment.

Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, and these areas might typically be termed as a ''prompt care'' or ''minors'' area. Such patients may still have been found to have significant problems, including [[Fracture (bone)|fractures]], [[Dislocation (medicine)|dislocations]], and [[Wound|lacerations]] requiring [[Surgical suture|suturing]].

Children can present particular challenges in treatment. Some departments have dedicated [[pediatrics]] areas, and some departments employ a [[Play therapy|play therapist]] whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.

Many hospitals have a separate area for evaluation of [[Mental illness|psychiatric problems]]. These are often staffed by [[psychiatrist]]s and mental health nurses and [[social worker]]s. There is typically at least one room for people who are actively a risk to themselves or others (e.g. [[Suicide|suicidal]]).

Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors face great pressures to overtest and overtreat. The fear of missing something often leads to extra blood tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomach aches, with a high cost on the health care system.<ref>{{Cite web |url=https://news.yahoo.com/s/ap/20100621/ap_on_bi_ge/us_med_overtreated_er |title=ER doctors: Lawsuit fears lead to overtesting - Yahoo! News |access-date=14 January 2017 |archive-url=https://web.archive.org/web/20100625125300/http://news.yahoo.com/s/ap/20100621/ap_on_bi_ge/us_med_overtreated_er |archive-date=25 June 2010 |url-status=dead  }}</ref>