Emergency medicine is the only medical specialty defined by the area in which it is practiced i.e., the hospital emergency department (8:22). It is there that hospital personnel interact with police, firefighters, and paramedics to provide prehospital care (8:2). It is also where an increasing number of people with a broadening array of medical needs come for initial treatment. It involves a population of patients which like the sands of an hourglass converges on the hospital and then diverges with each patient eventually departing to his or her final functional destination (8:23). Emergency medicine is a highly technical and continuously evolving specialty. It can resemble a playing field where well trained personnel act as a coordinated team, their efforts directed towards a common goal. That goal is to prevent the deterioration of life and limb and to provide relief from suffering (8:2).
For the physician, the first priority in emergency medicine is to determine which patient is most ill (7:3). This initial assessment is known as triage (7:4). A concept which originated on the battlefields of France, triage involves sorting patients on the basis of need. It requires that the physician set priorities in a manner that ensures the best possible outcome of events (8:2). Furthermore, this responsibility must often be executed with a sense of urgency. Not only is the hourglass an appropriate metaphor for patient flow through the emergency department, but it also serves to emphasize the significance of time in emergency medicine (8:2).
Once a patient's initial assessment is complete, the physician must ensure that he or she is assigned a physical location within the department and without exception that vital signs are obtained (7:4). Having analyzed such data, the doctor should then be guided by the field's main principle: that regardless of its statistical improbability, the most potentially serious prob...