The Evolution of Connecticut's Emergency Rooms
Dr. John Sottile and nurses evaluate an EKG transmitted remotely from EMTs in the field at the Hospital of Central Connecticut.
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Back in the 1790s, during the French Revolution, military surgeon Dominique Jean Larrey had an epiphany. He noticed how rapidly the flying artillery (horse-drawn cannons) of the French army transported weapons across the battlefield and realized they could be used to save lives instead of destroy them. He created flying ambulances, horse-drawn stretchers that quickly transported wounded soldiers away from the front lines to places where they could be treated more effectively.
It was a giant leap in medical history and saved thousands of lives. As a result, Larrey often is acknowledged as the father of emergency medicine. More than 200 years later, emergency medicine continues to use cutting-edge technology to save lives. Some Connecticut hospitals are making emergency department wait times available on their websites, others regularly use video conferencing to have patients examined by experts from other parts of the globe, and emergency departments routinely employ new treatments to save the lives of patients in ways that would not have been possible in the past. Even the name has changed.
“I know the TV show was called ‘ER,’ but in the hospital setting you’ll always hear the ‘emergency department.’ We’re no longer a big room where everyone goes,” says Dr. Peter Jacoby, chairman of emergency services at Saint Mary’s Hospital in Waterbury.
The way emergency departments are being used by the general public also has changed. A report released in October by the Association of American Medical Colleges estimates the nation is short approximately 9,000 primary-care doctors. As the availability of general practitioners declines, emergency departments often have filled the health care void out of necessity.
“We’ve become the answers to everyone’s problems,” Jacoby says. “We are expected to do much more besides the very acute emergencies.”
Dr. Gail D’Onofrio, chief of the emergency department at Yale-New Haven Hospital, agrees that “emergency” visits will be increasing. “I think with the Affordable Care Act we may see even more people because more will be covered by some type of insurance,” she says. “What we’re hoping for down the road is that we have more primary-care doctors to keep the population healthy and to work on prevention.”
Though emergency departments may be busy, both Jacoby and D’Onofrio say the vast majority of patients who come in do need treatment and the services provide a level of convenience for them.
“You can say, well, is an injured ankle an emergency?” Jacoby explains. “If you decide to wait and call your primary-care doctor, and then go get an X-ray, and then you have to go find crutches and figure out how to get off that ankle, and then get an appointment with an orthopedic physician, that might take you a week. If you come to the emergency department you may wait a little while, but we’re going to X-ray you, we’re going to set you up with your crutches, we’re going to fix your leg and we’re going to get you a referral to an orthopedic physician.” He adds, “In the United States we are used to one-stop shopping. We don’t like to go to 50 stores anymore; we go to malls to shop. We go to emergency departments because we know we can get seen, get diagnosed and get treatment 24/7.”
However, frequent use of emergency departments can lead to overcrowding, especially when there’s an outbreak of an illness, as was the case in late December and early January when the state saw a spike in influenza cases.
“Emergency departments everywhere were flooded,” Jacoby says. “We saw a lot of flu cases and there was a very virulent respiratory viral disease, and a GI viral disease going around as well. It’s like the perfect storm—you have all that coming in and you have all the car accidents, strokes and heart attacks that you get all the time as well.”
Although things may have gotten hectic at Saint Mary’s, Jacoby says that doesn’t mean the emergency department was strained to a breaking point or that patients shouldn’t be encouraged to come in for treatment. “You still manage to see them all and you just have to examine those who you think are the sickest first,” he says.