When you arrive at the Emergency Room, your first stop is triage. This is the place where each patient's condition is prioritized, typically by a nurse, into three general categories.

The categories are:

• Immediately life threatening
• Urgent, but not immediately life threatening
• Less urgent

This categorization is necessary so that someone with a life-threatening condition is not kept waiting because they arrive a few minutes later than someone with a more routine problem. The triage nurse records your vital signs (temperature, pulse, respiratory rate and blood pressure). She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category.

The next stop is registration -- not very exciting and rarely seen on TV. Here they get your vital statistics. You may also provide them with your insurance information, Medicare, or Medicaid card. This step is necessary to develop a medical record so that your medical history, lab tests, X-rays, etc., will all be located on one chart that can be referenced at any time. If the patient's condition is life-threatening, if the patient arrives by ambulance or beds are immediately available this step may be completed at the bedside.

Now you are brought to the exam room. You will be seen by an emergency room nurse who gets more detailed information about you. Some emergency departments have been subdivided into separate areas to better serve their patients. At Grandview, a fast track area for minor injuries and illnesses has been established to allow quick treatment for those with urgent medical care needs.

Once the nurse has finished her tasks, the next visitor is an emergency-medicine physician. He gets a more detailed medical history about your present illness, past medical problems, family history, social history, and a complete review of all your body systems. He then creates a list of possible causes of your symptoms.

When the emergency physician has all the information he can get, he makes a determination of the most likely diagnosis. Or, he may decide that he does not have enough information to make a decision and may require more tests.

Once your care is completed, if you require admission to the hospital, our ER staff and the nurses within the hospital work together to place you in the most appropriate room as quickly as possible.

If you are not admitted to the hospital, the Emergency Department team will provide you discharge instructions for follow up care with your family physicians or appropriate care centers. If your condition every changes, please feel free to return to the Emergency Room.

Having a lot of people caring for patients in an emergency department can be quite confusing to the person coming in the door.

The emergency physician comes to the team after spending four years in college studying hard in order to get accepted into medical school. Medical school is four more years of study covering all the essentials of becoming a physician. It generally includes two years of classroom time, followed by two years rotating through all the different specialties of medicine. Toward the end of medical school, each medical student must select a particular specialty (emergency medicine, family practice, pediatrics, etc.). The medical student then completes an internship (one year) and residency (two to three additional years) in order to be a specialist in emergency medicine.

The emergency nurse comes to the team in a number of ways. One way is completing a four-year degree in college to obtain a BSN. (Bachelor of Science in nursing). Or, a nurse may complete a three-year diploma program (usually at a hospital) or a two-year degree program (usually at a community college). After completing any of these academic endeavors, the nursing graduate is eligible to take a licensing exam. After passing an exam, the nursing graduate becomes an RN (registered nurse) and can practice nursing.

Grandview's emergency departments utilize nurse practitioners (NP). They can examine, diagnose and treat patients (usually the less complicated ones) and review their findings with the physician. In most states, they can prescribe medications.

Our emergency department has emergency technicians who do a variety of tasks depending on the institution and state laws. Some of these tasks may include taking your vital signs, drawing your blood, starting your IV, performing EKGs, transporting you to and from various tests, and providing aid and comfort to family and friends. Training varies widely, but these technicians are often ambulance personnel or are trained through the hospital.

This essential member of the team is one you don't hear about very often. He/she often handles the communication needs of the ER. A few important examples of important communication needs include the emergency physician needing to speak to the patient's family physician, families calling about their loved ones, family physicians needing to inform the emergency department about patients being sent in, or patients calling in needing medical advice. Also, he/she coordinates the ordering of diagnostic tests.

As a teaching hospital, you may be examined by an intern or resident. Teaching hospitals are those that have training programs for physicians and are usually affiliated with a medical school. Interns are in their first year of training after graduating medical school. After the first year, the physician in training is called a resident. These physicians are supervised by an attending physician who usually has extensive experience in emergency medicine.