Emergency Rooms

The Evolution of Emergency Medical Care

Medical care delivery for life-threatening problems has evolved together with advances in knowledge, technology, and increasing urbanization. Much of the modern delivery of emergency care has its roots in military history, where prompt attention to trauma continues to be of paramount importance. As emergency medical care necessarily ties into first aid and pre-hospital care, increasing knowledge and services in those areas also influenced ED development. Pioneering efforts in emergency treatment date back to Julius Caesar's military campaigns more than 2,000 years ago: doctors treated the wounded on the field of battle and sent survivors to hospital-like facilities. Napoleon's army employed ambulances (horse-drawn wagons) to transport the wounded to medical facilities at the end of the 18th century.

Two models of emergency care delivery evolved, termed Anglo-American and Franco-German. The latter emphasizes treatment at the scene of acute illness or injury, with subsequent transport to a specialty medical or surgical service when the patient requires further intervention for the problem diagnosed in the field. The Franco-German model often bypasses the ED; physicians participate in pre-hospital emergency medical services (EMS). The Anglo-American model produced the ED as it is known in North America, which relies primarily on hospital-situated facilities to care for the acutely ill and injured. Patients are transported to the ED treatment site by EMS personnel with varying levels of medical knowledge after a limited amount of first aid given in the field. The evolution of the ED in the Anglo-American model has produced the modern version of the ER or casualty ward.

Hospital workers take a blood sample from an emergency room patient at a Los Alamos, New Mexico, public hospital

Casualty wards have been mentioned by Shakespeare and Dickens. Nineteenth-century London's St. Bartholomew's Hospital had a casualty room that could seat as many as 600 patients, who were treated by surgeons and apothecaries for injuries and relatively simple illnesses. Early 20th-century Manchester had a set of multiple first aid stations to treat injured port workers, who were transported to a designated hospital when further care was necessary. Multiple 20th-century military conflicts produced significant advances in emergency trauma care that gradually filtered into civilian EDs and more specialized trauma centers in many nations.

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