A short history of Emergency Departments: How Opto Health are looking into the past to illuminate the path forwards

At Opto Health, we’re committed to revolutionising Emergency Departments (EDs) across the country with our innovative digital triage solution. When our technology arrives in hospitals, we’ll help to eradicate long waits by reliably and efficiently triaging those who present at EDs using our simple clinical priority scoring system. The story of technological innovation in healthcare is rich and varied, and as Opto leads the latest wave of pioneering solutions, we took a moment to dive into the past and have a look at what came before.?

The concept of urgent care has been around as long as there have been humans to require it, with sources dating as far back as 10th Century England indicating that primitive ambulances were in operation from around this time. Patients in need of medical care might be transported to a more appropriate care setting using a hammock slung between two horses. Medieval society, however, was a place of intense and rigid social stratification and as with the rest of Europe, medical attention was reserved for those with the wealth and means to seek it.?

The modern concept of a more egalitarian process of emergency care was born in the 18th Century, emerging out of two key historical developments: the industrial revolutions that took Europe by storm, and the advent of armed? conflict on a scale hitherto unwitnessed. Napoleon’s Surgeon in Chief - Baron Dominique Jean Larrey - is often credited as an early pioneer of emergency care. During the French Revolution in 1793, he took charge of flying artillery units and transformed them into ‘ambulance volantes’ - flying ambulances. These units were tasked with transporting men from the battlefield into hospitals as quickly as possible. Indeed, Larrey is often credited with coining the modern concept of triage, which comes from the French verb ‘trier’, meaning to sort. Larrey developed the concept of treating the wounded in accordance with the gravity of their injuries and the urgency of their need for care, as opposed to their military rank, class, or nationality.?

The dawn of the industrial revolution over the 18th and 19th Centuries further illuminated the need for a system to deal with emergency care that worked across society, and not just for a select few. The rapid construction of factories across Europe meant that large numbers of working class people were now spending their days in dangerous conditions where accidents were inevitable. An article in the medical journal The Lancet in 1905 highlighted how residents in Berlin had developed and evolved a system for emergency care. Early attempts included a subscription-based system called a ‘Sanit?tswache’, or first-aid system, where a building was rented and surgeons were hired to attend to patients. A later development? was the introduction of accident stations, or ‘Unfallstationen’, where workers could insure against workplace accidents by joining a cooperative that funded medical centres. These two approaches were united at the dawn of the 20th Century, with a centralised office that communicated via telephone with ambulance services.?

In the UK, a national ambulance service was only introduced in 1948. Prior to this, police and firefighters were expected to transport patients to hospitals. To compound the problem, first aid training was only made mandatory for these other emergency services in 1925. A joined-up emergency service slowly came together, with the 999 emergency number introduced in 1937 after 5 women died in a house fire. The telephone service was automated in 1976 which allowed it to be extended nationwide, and by 1986 the service could be accessed through mobile phones.?

Incredibly, emergency medicine was only recognised as a distinct discipline in the UK in 2005, with the formation of the College of Emergency Medicine. While technological innovation has been rife across the healthcare sector, it is notable that specifically in the area of emergency care, technological solutions have been slower to materialise. This is perhaps understandable: in EDs more than any other department, the decisions that are made can often be described as life and death. The situation is further complicated by the presence in EDs of children and those living with mental health conditions, which require sensitive and safe handling. Allowing technology to influence such important decisions therefore brings with it a certain degree of stakes that clinicians might not always feel comfortable dealing with.?

However, the regulatory frameworks in place to implement new technologies in the NHS are extremely rigorous and robust, and clinicians’ concerns can be somewhat alleviated by the lengthy processes any new solution must undergo before being approved for use in a medical context. Furthermore, with the NHS under unprecedented strain this winter due to seasonal pressures and a summer of industrial action, the need to support the sterling work done by staff in EDs all over the country has never been more apparent. With the advent of a raft of new technologies on the horizon, the history of EDs would suggest that now is the time to welcome pioneering new solutions into emergency rooms across the NHS.?

To learn more about Opto Health and the work that we do to support the NHS, visit our website: https://optohealth.co.uk/