New clinical technologies can be expected to alter the way care is delivered in the ED, but in ways that are difficult to predict. In general, however, a wide range of technologies that provide faster and more mobile diagnostic capabilities can be anticipated. Such technologies can be expected to diffuse gradually from the hospital to the prehospital environment. For example, strategically locating advanced imaging equipment in the ED would shorten patient wait times and improve throughput by accelerating diagnosis. Among the technologies positioned to do just that are 16-slice or higher CT scanners and high-field magnetic resonance (MR) systems, cardiac CT angiography (CTA), portable ultrasound systems, rapid diagnostics, and laboratory automation. As with all medical technologies, well-designed, controlled studies should be used to assess their efficacy and cost-effectiveness in general and for ED applications in particular.

The improved temporal resolution and ever-increasing thin-slice imaging ability of these systems will have a significant impact on ED imaging. The performance of 16-slice CT is the proven standard for general whole-body clinical utility in the ED. However, 64-slice scanners offer a full complement of applications for both radiology and cardiology. In between, there are 32- and 40-slice systems that are less costly than 64-slice systems and are upgradable.

Manufacturers are redefining “open” MR by improving the performance of these systems with stronger magnets or redefining the term to include wider-bore, short-cylinder systems with traditional high-field image quality. With some of these systems, such as the Siemens Magnetom Espree, the patient’s head frequently remains outside the gantry. The combination of a patient table with lateral movements and wide offset capability makes these systems well suited to orthopedic studies.

Although 1.5-tesla MR imaging systems continue to offer the broadest range of applications and clinical utility, the newer very-high-field (3.0-tesla) MR systems offer improved performance, particularly for neurologic, orthopedic, and spinal studies. Body imaging techniques continue to improve with new surface coils and software designed to reduce motion artifacts. The 3.0-tesla MR imaging systems show promise for cardiac imaging with cardiac sequences that are near-real-time and do not require patients to hold their breath. Adoption of very-high-field MR is currently limited but will expand as more sequence development work using these systems is done.

A promising new imaging system developed in South Africa is currently

Front Matter (R1-R26)

Summary (1-16)

1 Introduction (17-36)

2 The Evolving Role of Hospital-Based Emergency Care (37-80)

3 Building a 21st-Century Emergency Care System (81-128)

4 Improving the Efficiency of Hospital-Based Emergency Care (129-164)

5 Technology and Communications (165-208)

6 The Emergency Care Workforce (209-258)

7 Disaster Preparedness (259-290)

8 Enhancing the Emergency Care Research Base (291-320)

Appendix A Committee and Subcommittee Membership (321-322)

Appendix B Biographical Information for Main Committee and Hospital- Based Emergency Care Subcommittee (323-336)

Appendix C List of Presentations to the Committee (337-342)

Appendix D List of Commissioned Papers (343-344)

Appendix E Statistics on Emergency and Trauma Care Utilization (345-352)

Appendix F Historical Development of Hospital-Based Emergency and Trauma Care (353-364)

Appendix G Recommendations and Responsible Entities from the Future of Emergency Care Series (365-382)

Index (383-398)