Dramatizations on television may have everyone in Kew Gardens believing that no matter what their ailment or injury may be, it can be treated successfully at any local emergency room. What is lost in this assumption is that there are several different types of hospitals that offer emergency services and trauma care, and that these facilities employ physicians of several different specialties. Surgeons, intensivists and cardiologists typically do not practice in emergency rooms. This gives rise to the question of what kinds of services should be performed in an ER.
The World Health Organizations lists the following factors as being determinants in what scope of trauma services a facility can offer:
- The type of facility.
- The priority a facility should place on arranging resources based on its type.
- The actual resources a facility has available.
For example, hospitals employing only general practitioners or that lack extensive surgical capabilities may not be equipped to attempt certain emergency surgeries and procedures. ER doctors are not typically considered to be general practitioners, yet their education and training focuses primarily on emergency response techniques rather than advanced surgery. If emergency surgery is required to save a patient’s life or preserve his or her quality of living, such care should be done by a trauma surgeon. If a facility lacks such a provider, it is expected that it will arrange to transport a patient to a hospital that has one.
Another major factor influencing a hospital’s ability to offer trauma care is its overall emergency environment. The America College of Emergency Physicians grades ER environments based on criteria such as access to emergency care, quality and patient safety, focus on health and injury prevention, and liability and disaster preparedness. Its latest report gave the overall emergency care system in America a grade of D+.