The Evolution of Connecticut's Emergency Rooms
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Digital technology also is used to allow doctors to view electrocardiogram results of patients still en route to the hospital. “In the ambulance there are electronic EKG monitors that transmit the EKG to a cloud-based service through cellular transmissions, and then they come onto my iPhone or iPad as a PDF attachment,” he says. “We can diagnose patients before they even arrive.”
Modern emergency facilities often replace the white and beige institutional walls and tiles with warmer, more inviting colors. Yale-New Haven Hospital completed a major renovation of its emergency department in January, expanding from 30,000 to approximately 48,000 square feet. The size of the hospital’s trauma-care unit was tripled and state-of-the-art medical technology was installed. The expansion also was designed to take into consideration patient privacy and comfort.
“I think privacy is the most important thing after quality of care,” says D’Onofrio of Yale-New Haven. “When you pick out colors, you want it to have a calming effect both on the patient and the patient’s family. We are very attuned to the fact that we are responsible for life-and-death decisions and that families could easily have sent their loved ones to work or off to the store and then a crisis happened. We are often the people who have to tell their families this bad news and we really struggle to make sure we do the best that we can. Having a great environment to do that in is just one thing we can offer when things are not going well.”
An emergency department is a good indicator of what’s going on in the larger community says D’Onofrio.
“Whatever is happening in the community, we see it here,” she says. “If there’s flu out there we’re going to see it, with the economy down there’s more violence and we see it here, if people are using more prescription drugs and dying of more overdoses we see it here. We try to take an active part in surveillance and treatment and prevention. We constantly are working with the community because we are the community.”
In many ways emergency medicine is still in its infancy. It wasn’t until 1979 that the American Board of Medical Specialties began to recognize it as a separate discipline. Prior to that, physicians of various specialties would rotate duty at the emergency department. Patients might be seen by a cardiologist one night and a dermatologist the next.
Dominique Jean Larrey survived the French Revolution but was later captured by the Prussians in 1815 at the Battle of Waterloo. Sentenced to death, he was saved by a Prussian surgeon who recognized him and pleaded for his life to be spared. While the dangers faced by emergency medical staff today may not be quite as dramatic as those faced by Larrey, today’s ER personnel are still expected to do whatever it takes to make sure patients are helped.
“The emergency department is controlled chaos,” D’Onofrio says. “I cannot plan when something’s going to happen. I always have to have the resources for the worst-case scenarios. When Hurricane Sandy happened and everything else was closed, my doctors and nurses and techs and secretaries all braved the elements and left their families at home in the dark and came here to help the public. We will always do that. We never are not here. No matter what, the emergency department is open.”