Provision of Care in the Emergency Department

A key question that emerges from the description of delays in the availability of day-today emergency care in South Central Los Angeles is: Why weren't the emergency departments overrun with casualties? Were there long waits for care? Available evidence from LAEMSA, fire service, and hospital interviews shows that emergency departments, while in some cases receiving large numbers of patients, were not overrun. Two factors may account for this: a drop in patient load, and creation of suturing and ambulatory care clinics. Hospital administrators estimate that the daily ER load dropped by as much as 50% (this would be consistent with the Martin Luther King/Drew Medical Center data). Generally a significant number o people who typically come to emergency departments for primary care didn't come during the riots (also see Hospitals, 1968a; and Kentucky, 1968). It was impossible during the course of this study to identify reasons for this. The majority of people who did come had injuries related to the civil disturbance that had to be dealt with. Apparently people had to compare the severity of their illness with how dangerous it would be to go immediately for care Wednesday, Thursday and Friday versus waiting for the disturbance to end. ER staff interviews indicated that uninjured older people and mothers with children needing primary care did not come in during the civil disturbance. Both of these populations are the least able to protect themselves. All the interviewed hospital staff reported that special care teams, and clinics were established to deal with the injuries (see: Walt, 1967). Triage solved the daily problem because patients were distributed differently, thus preserving the ER for seriously injured patients. For example, at Martin Luther King/Drew Medical Center, the availability of two volunteer General Surgery Physicians allowed three operating rooms to be used Wednesday evening. A circulating nurse moved between each operating room allowing three teams to be formed. A specially created clinic cared for all minor injuries received in the emergency department. Three Physician Assistants set up a unit to suture and care for injuries to the arms, hands, legs, and other parts of the body. These clinics allowed the emergency department to concentrate on the more seriously injured. Daniel Freeman Medical Center and Saint Francis Medical Center also established suturing clinics. None of the hospitals experienced problems with finding a bed for a critically injured patient. For example, Martin Luther King Hospital used post anesthesia beds, which have monitors and are appropriately staffed, for additional patients. They also treated and discharge about 60% of patients with gunshot wounds. These actions, and those discussed above, are typically part of a hospitals disaster plan's standard operating procedures.

Medical Care for the Injured

Continue to Patience Discharge from the Emergency Department

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