Established by Dr. Gail V. Anderson, one of the original founders of emergency medicine and past president of the American Board of Emergency Medicine (ABEM), the Department of Emergency Medicine (DEM) is an autonomous clinical and academic department within the Medical Center and Medical School. It has responsibility for initial triage, evaluation, management, and disposition of approximately 400-500 patients daily with the complete spectrum of adult medical and surgical problems as well as pediatric trauma.

Non-emergent OB/GYN patients, pediatric non-trauma patients, and medically uncomplicated psychiatric patients are seen respectively in the Emergency Areas of the Women’s and Children’s Hospital and the Psychiatric Evaluation Area located in Unit I. Emergency Medicine residents rotate in the Pediatric and GYN Emergency Areas at Women’s and Children’s Hospital and may electively rotate in the Psychiatric Evaluation Area as part of their training. The Department of Emergency Medicine is also responsible for an active Paramedic Base Station, the Hyperbaric Treatment Chamber on Catalina Island, the Center for Life Support Training and Research, and the Emergency Evaluation Area of the Los Angeles County Jail Service.

A dedicated x-ray facility is located in the Emergency Department and portable x-ray is also available at the bedside. Also, the department has its own bedside ultrasound and fluoroscopy units and the residents receive instruction on their use. Upon leaving the residency, our graduates are quite competent in the use of these diagnostic modalities as they apply to Emergency Medicine. Ancillary imaging such as CT scanning, nuclear imaging, and MRI are also available 24 hours a day.

Primary laboratory support is provided by the main hospital laboratory on a prioritized STAT basis. Mini-labs are also located in each of the clinical areas where urine is tested, hematocits are spun, and slides can be stained. These areas also have the materials to quickly check serum glucose (dextrostix), hemoglobin and pregnancy tests.

The patient population is quite mixed but includes a significant Hispanic population, a substantial working class population and a large number of indigent patients. Since the County Hospital is tasked with providing care for all those who cannot afford it elsewhere, the mean socioeconomic level tends to be low with the attendant problems of chronic poor health maintenance, variable compliance, and lack of support systems. Superimposed on this demography is a high incidence of gang and drug related violence and vehicular injury leading to a large volume of both penetrating and blunt major and minor trauma.

Although the volume and acuity of the patient load is not unique to such large urban centers, the autonomy of the DEM is. All patients are evaluated and stabilized by Emergency Medicine residents and staff and are either discharged or admitted as deemed appropriate. Admissions are not subject to acceptance by the receiving service, although courtesy consultations are routine. The environment of the Emergency Department is therefore one in which the EM resident, under staff supervision, has complete responsibility for acute patient care and is not in competition with residents from other specialties.