This House of Noble Deeds: The Mount Sinai Hospital, 1852-2002

18 Department of Emergency Medicine

18 Department of Emergency Medicine ON JUNE 3,1855, two days before the opening of the doors of the Jews’ Hospital on West 28th Street, the Board of Directors (today’s Trustees) decreed that “the Visiting Committee be instructed not to receive any patients other than Jews except in cases of accident, until further notice.”1 At the outbreak of the Civil War, the federal government asked for help, and the Hospital set up extra cots as beds to accommodate wounded Union Army soldiers. In 1862, when the Hospital was still located on 28th Street, Civil War draft riots erupted immediately outside the Hospital’s doors, and Hospital personnel administered aid to victims of the riots. These two events were important factors in convincing the Directors that the Hospital was nonsectarian in nature and that the name should be changed to The Mount Sinai Hospital, an event that took place in 1866. Five years later, the Orangemen riots also broke out near the Hospital, and a number of casualties were treated at Mount Sinai. In 1872, the Hospital moved to Lexington Avenue and 67th Street, and over the years there was a small but steady increase in the number of emergencies and accident cases, the latter caused mainly by traffic and machinery. In 1889, a fire broke out at the Presbyterian Hospital, then located at 70th Street and Park Avenue, and Mount Sinai immediately accepted forty of their patients. The first reference to an actual emergency room (ER) appears in the Annual Report for 1888, when the House Staff treated 301 emergency cases. This tiny ER was often referred to as “the accident closet” and was located in the entrance hall of the main Lexington Avenue building. When the Hospital moved uptown to its current location, in 1904, the ER was given larger quarters on the lower level of the medical ward building. An ambulance entrance on 100th Street near Madison Avenue provided an entryway separate from the main Hospital entrance. Mount Sinai began its own ambulance service in 1902. The service picked up patients, transported them to different hospitals, and 200 brought them home. Initially, a member of the House Staff rode along in the ambulance. As the use of private ambulance services expanded, Mount Sinai’s own ambulance service was slowly phased out and was terminated by the end of World War II. What came to be known as Emergency Services continued to develop and expand throughout the years. An admitting physician was assigned to cover the reception area. On weekdays and weekend mornings , any patient could present himself or herself for admission to the hospital, regardless of the nature of the illness. Urgent and emergent cases were seen in the ER at all hours and either admitted or treated and released, usually with a return visit scheduled for one of the clinics or a referral to their private physician. Residents in the various specialties were called to the ER to treat patients as needed. In 1947, 33,192 emergency cases were treated. In 1967, a separate pediatric emergency area was created and staffed by the Department of Pediatrics. In 1985, with the ER now under the direction of Barbara Richardson of the DEPARTMENT OF EMERGENCY MEDICINE 201 One of Mount Sinai’s early electric ambulances, c. 1910. Department of Medicine, the Hospital was designated as an Emergency Medical Services (EMS) ambulance destination site and a level II trauma center. That same year, a separate walk-in referral area was created for the more efficient treatment of patients with minor ailments. In 1989, Emergency Services moved into the new Guggenheim building, essentially doubling its space. However, by the time the building opened, the number of visits had almost doubled from the number recorded when the facility was planned; the space was inadequate from the outset, and Richardson had major problems with physician coverage . A similar situation existed at Mount Sinai’s principal academic af- filiate, the City Hospital Center at Elmhurst. At this point, some knowledge of the development of the specialty of emergency medicine (EM) is necessary to understand the evolution of the EM program at Mount Sinai. Between 1955 and 1970, visits to emergency departments quadrupled throughout the United States, and the public began to recognize that, for the most part, these facilities were understaffed. During the 1960s, a few physicians in disparate locations began to give up their office practices...