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Interrelationships between the Emergency Department and the intensive Care Unit In planning emergency facilities for the future and in redesigning current facilities, it would seem advantageous to transfer certain protracted functions of resuscitation out of the emergency rooms and integrate them closely into the operation of the intensive care unit. Recent developments have made the intensive care unit the focal point of nursing and medical care in many large hospitals. Concentrated in this area are resuscitation equipment, monitors, respirators, defibrillatory, pacemakers, suction devices, and, above all, the highly trained personnel needed for the care of the severely ill medical case or the injured patient. RECOMMENDATION Expansion of intensive care programs to ensure uninterrupted care beyond the immediate measures rendered in emergency departments. THE DEVELOPMENT OF TRAUMA REGISTRIES Emergency case records are often inadequate. Sufficient thought has not been given to extracting information concerning the nature of the accident, the clinical condition during transportation and at the time of entry to the emergency department, the resuscitative measures used, the response of the patient, the initial laboratory and X-ray records, and, finally, the ultimate outcome with or without temporary or permanent disability. This information is vital on several scores. It is essential in recreating the circumstances of the accident and in relating the mechanism of trauma to accident prevention. It is necessary for clinical analysis, for improvement of therapy, and for appraisal of emergency facilities. Finally, it could provide a basis for determining the duration, nature and degree of disability and the long-term, natural history of specific injuries. An example of the need for long-term records of this type is that of a patient in whom the ultimate manifestation of damage to the femoral artery accompanying a fracture of the femur was not apparent until 34 years later when generalized arteriosclerosis developed, and thrombosis of the involved femoral artery necessi- tated amputation. Information of this type on a broad scale could be obtained by the development of trauma registries within the 23
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