How Emergency Rooms Work

Who's On First

The vast array of people caring for patients in an emergency department can be quite confusing to the average health care consumer -- as confusing as if you were watching your first baseball game ever and no one was around to explain all those players.

Additionally, most people are uncertain of the training and background necessary to become a member of the emergency-department team. Well, here's the scorecard.


Emergency Physician

The emergency physician comes to the team after spending four years in college studying hard to get as high a GPA (grade point average) as possible in order to get accepted into medical school.

Medical school is a four-year course 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, internal medicine, surgery, 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.

Physicians must pass an all-day written exam and an all-day oral exam to become board certified in emergency medicine. As of 2001, there were approximately 32,000 emergency physicians practicing in the United States, of which 17,000 were certified by the American Board of Emergency Medicine.

Emergency Nurse

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). Alternately, a nurse may complete a three-year diploma program (usually at a hospital) or a two-year associates 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 this exam, the nursing graduate becomes an RN (registered nurse) and can practice nursing. Many emergency nurses take an additional exam to become a CEN (Certified Emergency Nurse).

Physician Assistant

Many emergency departments utilize physician assistants (PA). PAs work under the supervision of an emergency physician. 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. Typically, a PA has at least two years of college (most have a four-year degree) and some health-care experience before completing a two-year program to become a physician assistant. An exam is required to become licensed.

Emergency Department Technician

Many emergency departments have emergency technicians who perform 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 else are trained through the hospital.

Unit Secretary

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.

Physicians in Training

At teaching hospitals, you may be examined by an intern or resident. Teaching hospitals are hospitals 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.