Volunteering

From Wikipedia, the free encyclopedia

Volunteers from around the world came to Ithaca, Queensland to address an influenza epidemic through the Women's Emergency Corps (later the Women's Volunteer Reserve) in July 1919.

 

Volunteers sweep the boardwalk in Brooklyn after the 2012 Hurricane Sandy.

 

Volunteering is generally considered an altruistic activity where an individual or group provides services for no financial or social gain "to benefit another person, group or organization". Volunteering is also renowned for skill development and is often intended to promote goodness or to improve human quality of life. Volunteering may have positive benefits for the volunteer as well as for the person or community served. It is also intended to make contacts for possible employment. Many volunteers are specifically trained in the areas they work, such as medicine, education, or emergency rescue. Others serve on an as-needed basis, such as in response to a natural disaster.

Etymology and history

The verb was first recorded in 1755. It was derived from the noun volunteer, in C.1600, "one who offers himself for military service," from the Middle French voluntaire. In the non-military sense, the word was first recorded during the 1630s. The word volunteering has more recent usage—still predominantly military—coinciding with the phrase community service. In a military context, a volunteer army is a military body whose soldiers chose to enter service, as opposed to having been conscripted. Such volunteers do not work "for free" and are given regular pay.

19th century

During this time, America experienced the Great Awakening. People became aware of the disadvantaged and realized the cause for movement against slavery. Younger people started helping the needy in their communities. In 1851, the first YMCA in the United States was started, followed seven years later by the first YWCA. During the American Civil War, women volunteered their time to sew supplies for the soldiers and the "Angel of the Battlefield" Clara Barton and a team of volunteers began providing aid to servicemen. Barton founded the American Red Cross in 1881 and began mobilizing volunteers for disaster relief operations, including relief for victims of the Johnstown Flood in 1889.

20th and 21st centuries

John F. Kennedy greets volunteers on 28 August 1961

 

The Salvation Army is one of the oldest and largest organizations working for disadvantaged people. Though it is a charity organization, it has organized a number of volunteering programs since its inception. Prior to the 19th century, few formal charitable organizations existed to assist people in need. 

In the first few decades of the 20th century, several volunteer organizations were founded, including the Rotary International, Kiwanis International, Association of Junior Leagues International, and Lions Clubs International. 

The Great Depression saw one of the first large-scale, nationwide efforts to coordinate volunteering for a specific need. During World War II, thousands of volunteer offices supervised the volunteers who helped with the many needs of the military and the home front, including collecting supplies, entertaining soldiers on leave, and caring for the injured.

After World War II, people shifted the focus of their altruistic passions to other areas, including helping the poor and volunteering overseas. A major development was the Peace Corps in the United States in 1960. When President Lyndon B. Johnson declared a War on Poverty in 1964, volunteer opportunities started to expand and continued into the next few decades. The process for finding volunteer work became more formalized, with more volunteer centers forming and new ways to find work appearing on the World Wide Web.

According to the Corporation for National and Community Service (in 2012), about 64.5 million Americans, or 26.5 percent of the adult population, gave 7.9 billion hours of volunteer service worth $175 billion. This calculates at about 125–150 hours per year or 3 hours per week at a rate of $22 per hour. Volunteer hours in the UK are similar; the data for other countries is unavailable.

In 1960, after the so called revolutionary war in Cuba ended, Ernesto Che Guevara created the concept of volunteering work. It was created with the intention that workers across the country volunteer a few hours of work on their work centers.

Types

Volunteering as utilized by service learning programs

Many schools on all education levels offer service-learning programs, which allow students to serve the community through volunteering while earning educational credit. According to Alexander Astin in the foreword to Where's the Learning in Service-Learning? by Janet Eyler and Dwight E. Giles, Jr.,"...we promote more wide-spread adoption of service-learning in higher education because we see it as a powerful means of preparing students to become more caring and responsible parents and citizens and of helping colleges and universities to make good on their pledge to 'serve society.'" When describing service learning, the Medical Education at Harvard says, "Service learning unites academic study and volunteer community service in mutually reinforcing ways. ...service learning is characterized by a relationship of partnership: the student learns from the service agency and from the community and, in return, gives energy, intelligence, commitment, time and skills to address human and community needs." Volunteering in service learning seems to have the result of engaging both mind and heart, thus providing a more powerful learning experience; according to Janet Eyler and Dwight E. Giles, it succeeds by the fact that it "...fosters student development by capturing student interest..." While not recognized by everyone as a legitimate approach, research on the efficacy of service learning has grown. Janet Eyler and Dwight E. Giles conducted a national study of American college students to ascertain the significance of service learning programs, According to Eyler and Giles,"These surveys, conducted before and after a semester of community service, examine the impact of service-learning on students." They describe their experience with students involved in service-learning in this way: "Students like service-learning. When we sit down with a group of students to discuss service-learning experiences, their enthusiasm is unmistakable. ...it is clear that [the students]believe that what they gain from service-learning differs qualitatively from what they often derive from more traditional instruction."

Skills-based volunteering

Skills-based volunteering is leveraging the specialized skills and the talents of individuals to strengthen the infrastructure of nonprofits, helping them build and sustain their capacity to successfully achieve their missions. This is in contrast to traditional volunteering, where specific training is not required. The average hour of traditional volunteering is valued by the Independent Sector at between $18–20 an hour. Skills-based volunteering is valued at $40–500 an hour, depending on the market value of the time.

Volunteering in developing countries

Laura Bush poses with Peace Corps volunteers

 

An increasingly popular form of volunteering among young people, particularly gap year students and graduates, is to travel to communities in the developing world to work on projects with local organisations. Activities include teaching English, working in orphanages, conservation, assisting non-governmental organizations and medical work. International volunteering often aims to give participants valuable skills and knowledge in addition to benefits to the host community and organization.

Virtual volunteering

Also called e-volunteering or online volunteering, virtual volunteering is a volunteer who completes tasks, in whole or in part, offsite from the organization being assisted. They use the Internet and a home, school, telecenter or work computer, or other Internet-connected device, such as a PDA or smartphone. Virtual volunteering is also known as cyber service, telementoring, and teletutoring, as well as various other names. Virtual volunteering is similar to telecommuting, except that instead of online employees who are paid, these are online volunteers who are not paid.

Micro-volunteering

Micro-volunteering is a task performed via an internet-connected device. An individual typically does this task in small, un-paid increments of time. Micro-volunteering is distinct from "virtual volunteering" in that it typically does not require the individual volunteer to go through an application process, screening process, or training period.

Environmental volunteering

Environmental volunteering refers to the volunteers who contribute towards environmental management or conservation. Volunteers conduct a range of activities including environmental monitoring, ecological restoration such as re-vegetation and weed removal, protecting endangered animals, and educating others about the natural environment.

Volunteering in an emergency

Volunteers assist survivors at the Houston Astrodome following Hurricane Katrina in September 2005.

 

Volunteering often plays a pivotal role in the recovery effort following natural disasters, such as tsunamis, floods, droughts, hurricanes, and earthquakes. For example, the 1995 Great Hanshin-Awaji earthquake in Japan was a watershed moment, bringing in many first-time volunteers for earthquake response. The 2004 Indian Ocean earthquake and tsunami attracted a large number of volunteers worldwide, deployed by non-governmental organizations, government agencies, and the United Nations.

During the 2012 hurricane Sandy emergency, Occupy Sandy volunteers, formed a laterally organized rapid-response team that provided much needed help during and after the storm, from food to shelter to reconstruction. It is an example of mutualism at work, pooling resources and assistance and leveraging social media.

Volunteering in schools

Resource poor schools around the world rely on government support or on efforts from volunteers and private donations, in order to run effectively. In some countries, whenever the economy is down, the need for volunteers and resources increases greatly. There are many opportunities available in school systems for volunteers. Yet, there are not many requirements in order to volunteer in a school system. Whether one is a high school or TEFL (Teaching English as a Foreign Language) graduate or college student, most schools require just voluntary and selfless effort.

Much like the benefits of any type of volunteering there are great rewards for the volunteer, student, and school. In addition to intangible rewards, volunteers can add relevant experience to their resumes. Volunteers who travel to assist may learn foreign culture and language.

Volunteering in schools can be an additional teaching guide for the students and help to fill the gap of local teachers. Cultural and language exchange during teaching and other school activities can be the most essential learning experience for both students and volunteers.

Corporate volunteering

Benefacto, a volunteering brokerage, describe corporate volunteering as "Companies giving their employees an allowance of paid time off annually, which they use to volunteer at a charity of their choice."

A majority of the companies at the Fortune 500 allow their employees to volunteer during work hours. These formalized Employee Volunteering Programs (EVPs), also called Employer Supported Volunteering (ESV), are regarded as a part of the companies' sustainability efforts and their social responsibility activities. About 40% of Fortune 500 companies provide monetary donations, also known as volunteer grants, to nonprofits as a way to recognize employees who dedicate significant amounts of time to volunteering in the community.

According to the information from VolunteerMatch, a service that provides Employee Volunteering Program solutions, the key drivers for companies that produce and manage EVPs are building brand awareness and affinity, strengthening trust and loyalty among consumers, enhancing corporate image and reputation, improving employee retention, increasing employee productivity and loyalty, and providing an effective vehicle to reach strategic goals.

In April 2015, David Cameron pledged to give all UK workers employed by companies with more 250 staff mandatory three days’ paid volunteering leave, which if implemented will generate an extra 360 million volunteering hours a year.

Community volunteer work

Volunteers fit new windows at the Sumac Centre in Nottingham, England, UK.

 

Community volunteering, in the US called "community service", refers globally to those who work to improve their local community. This activity commonly occurs through not for profit organizations, local governments and churches; but also encompasses ad-hoc or informal groups such as recreational sports teams.

Benefits of community volunteer work

There are many proven personal benefits of community volunteerism. Working together with a group of people who have different ethnicity, backgrounds, and views reduces stereotypes. Community volunteerism has also been proven to improve student's academic success.

According to Where's the Learning in Service Learning? by Janet Eyler and Dwight E. Giles, immersing oneself into service learning and serving others has many positive effects both academic and personal. Not only does surrounding oneself with new people and learning how to work together as a group help one improve teamwork and relational skills, it reduces stereotypes, increases appreciation of other cultures, and works to allow young people to find others that they relate to.

Eyler and Giles noted that at the beginning and end of a college semester that included three hours of community service a week, students reported a much higher regard for cultural differences. At the end of the semester those who had participated in service-learning were noted as saying that the most important things that they had learned were not to judge others, and to appreciate every type of person because everyone shares some similar key characteristics.

Community volunteer work has proven to be a powerful predictor in students' academic lives and college experience as a whole. Studies have shown that students who participate in community service as a part of their college course of study have a much higher correlation of completing their degree (Astin, 1992; Pascarella and Terenzini, 1991). In addition, college students who participate in community volunteer projects as a part of their college experience report finding a much greater relevance in their academic studies after completing community volunteer projects. According to University Health Services, studies have found that volunteering can positively impact a student’s overall mental and emotional health.

Social volunteering or welfare volunteering

In some European countries government organisations and non-government organisations provide auxiliary positions for a certain period in institutions like hospitals, schools, memorial sites and welfare institutions. The difference to other types of volunteering is that there are strict legal regulations, what organisation is allowed to engage volunteers and about the period a volunteer is allowed to work in a voluntary position. Due to that fact, the volunteer is getting a limited amount as a pocket money from the government. An organization having one of the biggest manpower in Europe is the German Federal volunteers service (Bundesfreiwilligendienst), that was founded in 2011, by having more than 35.000 federal volunteers in 2012. A much older institution is the Voluntary social year (Freiwilliges Soziales Jahr) in Austria and Germany.

Volunteering at Major Sporting Events

Sochi Olympics 25,000 volunteers worked at the 2014 Sochi Winter Olympics. They supported the organisers in more than 20 functional areas: meeting guests, assisting navigation, organising the opening and closing ceremonies, organising food outlets, etc. Volunteer applications were open to any nationals of Russia and other countries. The Sochi 2014 Organising Committee received about 200,000 applications, 8 applicants per place. Volunteers received training over the course of more than a year at 26 volunteer centres in 17 cities across Russia. The majority of participants were between 17 and 22 years old. At the same time, 3000 applications were submitted from people over 55 years old. Some of them worked as volunteers during the 1980 Olympics in Moscow. It was the first experience with such a large-scale volunteer program in the contemporary Russia.

2017 FIFA Confederations Cup and 2018 FIFA World Cup in Russia

For the first time in its history, Russia will host the FIFA World Cup from 14 June till 15 July 2018. Moreover, it will be the first time the World Cup games will be played both in Europe and Asia. The games will be hosted by 12 stadiums in 11 Russian cities.

The volunteer program of the 2018 FIFA World Cup has engaged thousands of people from Russia and other countries around the world. 

The program included several stages: recruitment, selection and training of volunteers, organisation of their work during the championship. The recruitment of volunteers for the FIFA Confederations Cup and the FIFA World Cup via FIFA.com started on 1 June 2016 and closed on 30 December 2016. Some of the volunteers worked at the 2017 FIFA Confederations Cup: 1733 people assisted the organisers in Saint Petersburg, 1590 worked in Moscow, 1261 in Sochi, 1260 in Kazan, a total of 5844 participants. 

The FIFA World Cup will be supported by 17,040 volunteers of the Russia 2018 Local Organising Committee.

Candidates living in Russia were selected by 15 volunteer centres in the host cities based in some of Russia's leading higher educational institutions: Synergy University, Moscow State Institute of International Relations, Plekhanov Russian University of Economics, Russian State Social University, Moscow Automobile and Road Construction University, Saint Petersburg State University of Economics, Samara State University, Volga Region State Academy of Physical Culture, Sport and Tourism, Don State Technical University, Ogarev Mordovia State University, Volgograd State University, State University of Nizhny Novgorod, Samara State Aerospace University, Immanuel Kant Baltic Federal University, and Ural Federal University. 

Candidates from other countries were selected remotely. 

Candidates had to be at least 18 years old, have a good knowledge of English, have a higher or vocational secondary education, and possess teamwork skills. 

Volunteers were trained remotely, in volunteer centres and at World Cup venues. 

Volunteers will be providing assistance in a variety of areas:

1. Distributing accreditations;
2. Selling and checking tickets;
3. Assisting radio communications professionals;
4. Organising leisure and entertainment activities for guests of the event;
5. Organising food outlets;
6. Providing interpretation services;
7. Working with sponsors;
8. Providing medical services and organising doping control procedures;
9. Supporting mass media operations;
10. Organising arrivals and departures of players and guests;
11. Working with VIP guests;
12. Assisting players and referees;
13. Assisting players and guests with accommodation;
14. Providing navigation assistance to guests;
15. Assisting TV and radio broadcasting;
16. Organising transportation;
17. Managing volunteers;
18. Organising operations of the stadium;
19. Monitoring compliance with FIFA social and environmental requirements;
20. Organising the opening and closing ceremonies of the championship.

Their work started ahead of the events: on 10 May 2017 for the 2017 FIFA Confederations Cup, and on 10 May 2018 for the 2018 FIFA World Cup.

Legacy of 2018 FIFA World Cup Volunteer Program: Russian National Competition of Important Social Projects

On 20 October 2017, the Russian National Competition of Important Social Projects "Legacy of 2018 FIFA World Cup Volunteer Program" was launched. The competition has engaged about 1500 people: applicants to the 2018 FIFA World Cup volunteer program and future city volunteers.

The idea of the competition was that anyone could submit a project that would draw the attention of Russian cities residents to the FIFA World Cup in Russia and leave a legacy after the championship was over. 

The project was expected to produce tangible (work of art, place of attraction for guests and residents in the city, open playground, graffiti, developed areas in city parks, films, etc.) or intangible (events, conferences, festivals, exhibitions) legacy.

26 projects qualified to the final and were supported by the Russia 2018 Local Organising Committee and the host cities of the 2018 FIFA World Cup. The jury included the General Director of the Russia 2018 Local Organising Committee Alexey Sorokin, Ambassador of the 2018 FIFA World Cup in Russia Alexey Smertin and Advisor to the Head of the Federal Tourism Agency Svetlana Sergeeva.

Some of the projects were combined or further developed by the Local Organising Committee. 

Among the projects were: Football Championship for Moms, Ramp Production out of Recycled Plastic, Your Championship Sticker Packs, etc.

Volunteer days, weeks and years

Designated days, weeks and years observed by a country or as designated by the United Nations to encourage volunteering / community service

• Global Youth Service Day
• International Volunteer Day
• International Year of Volunteers
• Join Hands Day
• Mandela Day
• MLK Day of service
• Mitzvah Day
• Random Acts of Kindness Day
• Sewa Day
• Make A Difference Day
• World Kindness Day

Political view

Modern societies share a common value of people helping each other; not only do volunteer acts assist others, but they also benefit the volunteering individual on a personal level. Despite having similar objectives, tension can arise between volunteers and state-provided services. In order to curtail this tension, most countries develop policies and enact legislation to clarify the roles and relationships among governmental stakeholders and their voluntary counterparts; this regulation identifies and allocates the necessary legal, social, administrative, and financial support of each party. This is particularly necessary when some voluntary activities are seen as a challenge to the authority of the state(e.g., on 29 January 2001, President Bush cautioned that volunteer groups should supplement—not replace—government agencies’ work).

Volunteering that benefits the state but challenges paid counterparts angers labor unions that represent those who are paid for their volunteer work; this is particularly seen in combination departments, such as volunteer fire departments.

Difficulties in cross-national aid

Difficulties in the cross-national aid model of volunteering can arise when it is applied across national borders. The presence of volunteers who are sent from one state to another can be viewed as a breach of sovereignty and showing a lack of respect towards the national government of the proposed recipients. Thus, motivations are important when states negotiate offers to send aid and when these proposals are accepted, particularly if donors may postpone assistance or stop it altogether. Three types of conditionality have evolved:

1. Financial accountability: Transparency in funding management to ensure that what is done by the volunteers is properly targeted
2. Policy reform: Governmental request that developing countries adopt certain social, economic, or environmental policies; often, the most controversial relate to the privatization of services traditionally offered by the state
3. Development objectives: Asking developing countries to adjust specific time-bound economic objectives

Some international volunteer organizations define their primary mission as being altruistic: to fight poverty and improve the living standards of people in the developing world, (e.g. Voluntary Services Overseas has almost 2,000 skilled professionals working as volunteers to pass on their expertise to local people so that the volunteers' skills remain long after they return home). When these organizations work in partnership with governments, the results can be impressive. However, when other organizations or individual First World governments support the work of volunteer groups, there can be questions as to whether the organizations' or governments' real motives are poverty alleviation. Instead, a focus on creating wealth for some of the poor or developing policies intended to benefit the donor states is sometimes reported. Many low-income countries’ economies suffer from industrialization without prosperity and investment without growth. One reason for this is that development assistance guides many Third World governments to pursue development policies that have been wasteful, ill-conceived, or unproductive; some of these policies have been so destructive that the economies could not have been sustained without outside support.

Indeed, some offers of aid have distorted the general spirit of volunteering, treating local voluntary action as contributions in kind, i.e., existing conditions requiring the modification of local people’s behavior in order for them to earn the right to donors’ charity. This can be seen as patronizing and offensive to the recipients because the aid expressly serves the policy aims of the donors rather than the needs of the recipients.

Moral resources, political capital and civil society

Some files for helping people in a volunteers station in Shenzhen, People's Republic of China

 

Based on a case study in China, Xu and Ngai (2011) revealed that the developing grassroots volunteerism can be an enclave among various organizations and may be able to work toward the development of civil society in the developing countries. The researchers developed a "Moral Resources and Political Capital" approach to examine the contributions of volunteerism in promoting the civil society. Moral resource means the available morals could be chosen by NGOs. Political capital means the capital that will improve or enhance the NGOs’ status, possession or access in the existing political system.

Moreover, Xu and Ngai (2011) distinguished two types of Moral Resources: Moral Resource-I and Moral Resource-II (ibid).

1. Moral Resource I: Inspired by Immanuel Kant’s (1998 [1787]) argument of "What ought I to do," Moral Resource-I will encourage the NGOs’ confidence and then have the courage to act and conquer difficulties by way of answering and confirming the question of "What ought I to do."
2. Moral Resource II: given that Adorno (2000) recognizes that moral or immoral tropes are socially determined, Moral Resource-II refers to the morals that are well accepted by the given society.

Thanks to the intellectual heritage of Blau and Duncan (1967), two types of political capital were identified:

1. Political Capital-I refers to the political capital mainly ascribed to the status that the NGO inherited throughout history (e.g., the CYL).
2. Political Capital-II refers to the Political Capital that the NGOs earned through their hard efforts.

Obviously, "Moral resource-I itself contains the self-determination that gives participants confidence in the ethical beliefs they have chosen", almost any organizations may have Moral Resource-I, while not all of them have the societal recognized Moral Resource-II. However, the voluntary service organizations predominantly occupy Moral Resource-II because a sense of moral superiority makes it possible that for parties with different values, goals and cultures to work together in promoting the promotion of volunteering. Thus the voluntary service organizations are likely to win the trust and support of the masses as well as the government more easily than will the organizations whose morals are not accepted by mainstream society. In other words, Moral Resource II helps the grassroots organizations with little Political Capital I to win Political Capital-II, which is a crucial factor for their survival and growth in developing countries such as China. Therefore, the voluntary service realm could be an enclave of the development of civil society in the developing nations.

Health benefits

Volunteering has the ability to improve the quality of life and health including longevity of those who donate their time and research has found that older adults will benefit the most from volunteering. Physical and mental ailments plaguing older adults can be healed through the simple act of helping others; however, one must be performing the good deed from a selfless nature. There are barriers that can prevent older adults from participating in volunteer work, such as socio-economic status, opinions held by others, and even current health issues. However, these barriers can be overcome so that if one would like to be involved in volunteer work they can do so. Volunteering improves not only the communities in which one serves, but also the life of the individual who is providing help to the community.

Mental health benefits

Volunteering is known not only to be related to happiness  but also to increase happiness. Also, giving help was a more important benefit of better reported mental health than receiving help. Studies have also shown that volunteering can cause a decrease in loneliness for those volunteering as well as those for whom people volunteer.

Statistics

In the United States, statistics on volunteering have historically been limited, according to volunteerism expert Susan J. Ellis. In 2013, the U.S. Current Population Survey (US) included a volunteering supplement which produced statistics on volunteering.

Criticisms

In the 1960s, Ivan Illich offered an analysis of the role of American volunteers in Mexico in his speech entitled "To Hell With Good Intentions". His concerns, along with those of critics such as Paulo Freire and Edward Said, revolve around the notion of altruism as an extension of Christian missionary ideology. In addition, he mentions the sense of responsibility/obligation as a factor, which drives the concept of noblesse oblige—first developed by the French aristocracy as a moral duty derived from their wealth. Simply stated, these apprehensions propose the extension of power and authority over indigenous cultures around the world. Recent critiques of volunteering come from Westmier and Kahn (1996) and bell hooks (née Gloria Watkins) (2004). Also, Georgeou (2012) has critiqued the impact of neoliberalism on international aid volunteering. 

The field of the medical tourism (referring to volunteers who travel overseas to deliver medical care) has recently attracted negative criticism when compared to the alternative notion of sustainable capacities, i.e., work done in the context of long-term, locally-run, and foreign-supported infrastructures. A preponderance of this criticism appears largely in scientific and peer-reviewed literature. Recently, media outlets with more general readerships have published such criticisms as well.

Another problems noted with volunteering is that it can be used to replace low paid entry positions. This can act to decrease social mobility, with only those capable of affording to work without payment able to gain the experience. Trade unions in the United Kingdom have warned that long term volunteering is a form of expoitation, used by charities to avoid minimum wage legislation. Some sectors now expect candidates for paid roles to have undergone significant periods of volunteer experience whether relevant to the role or not, setting up 'Volunteer Credentialism'.

Emergency department

From Wikipedia, the free encyclopedia

The main patient area inside the Mobile Medical Unit operated in Belle Chasse, Louisiana

 

An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center. 

Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. 

The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume.

History

Accident services were already provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the first specialized trauma care center in the world was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky, and was developed by surgeon Arnold Griswold during the 1930s. Griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital.

Today, a typical hospital has its emergency department in its own section of the ground floor of the grounds, with its own dedicated entrance. As patients can present at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need. This process is called triage. 

Triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have a dedicated area for this process to take place, and may have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a triage nurse, although dependent on training levels in the country and area, other health care professionals may perform the triage sorting, including paramedics or physicians. Triage is typically conducted face-to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance crew; in this method, the paramedics will call the hospital's triage center with a short update about an incoming patient, who will then be triaged to the appropriate level of care.

Most patients will be initially assessed at triage and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need. However, some patients may complete their treatment at the triage stage, for instance if the condition is very minor and can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department. 

The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training. These personnel may be assigned to the resuscitation area for the entirety of the shift, or may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance, the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases may also be attended by residents, radiographers, ambulance personnel, respiratory therapists, hospital pharmacists and/or students of any of these professions depending upon the skill mix needed for any given case and whether or not the hospital provides teaching services.

Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the patient's condition will also be given. Depending on underlying causes of the patient's chief complaint, he or she may be discharged home from this area or admitted to the hospital for further treatment.

Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, and these areas might typically be termed as a prompt care or minors area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing. 

Children can present particular challenges in treatment. Some departments have dedicated pediatrics areas, and some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.

Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal).

Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors face great pressures to overtest and overtreat. The fear of missing something often leads to extra blood tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomach aches, with a high cost on the health care system.

Nomenclature in English

Emergency department became commonly used when emergency medicine was recognised as a medical specialty, and hospitals and medical centres developed departments of emergency medicine to provide services. Other common variations include 'emergency ward,' 'emergency centre' or 'emergency unit'. 

'Accident and Emergency' or 'A&E' is still the accepted term in the United Kingdom, some Commonwealth countries, and the Republic of Ireland, as are earlier terms such as 'Casualty' or 'casualty ward', which continue to be used informally. The same applies to 'emergency room' or 'ER' in North America, originating when emergency facilities were provided in a single room of the hospital by the department of surgery.

Signage

Regardless of naming convention, there is a widespread usage of directional signage in white text on a red background across the world, which indicates the location of the emergency department, or a hospital with such facilities.

Signs on emergency departments may contain additional information. In some American states there is close regulation of the design and content of such signs. For example, California requires wording such as "Comprehensive Emergency Medical Service" and "Physician On Duty", to prevent persons in need of critical care from presenting to facilities that are not fully equipped and staffed.

In some countries, including the United States and Canada, a smaller facility that may provide assistance in medical emergencies is known as a clinic. Larger communities often have walk-in clinics where people with medical problems that would not be considered serious enough to warrant an emergency department visit can be seen. These clinics often do not operate on a 24-hour basis. Very large clinics may operate as "free-standing emergency centres", which are open 24 hours and can manage a very large number of conditions. However, if a patient presents to a free-standing clinic with a condition requiring hospital admission, he or she must be transferred to an actual hospital, as these facilities do not have the capability to provide inpatient care.

• Examples of emergency department signage
• 

  Santa Clara Valley Medical Center.
  
• 

  Mayo Clinic Hospital in Rochester.
  
• 

  Trilingual signage in French, Dutch and English at an emergency department in Brussels, Belgium.
  

United States

The Centers for Medicare and Medicaid Services (CMS) classified emergency departments into two types: Type A, the majority, which are open 24 hours a day, 7 days a week, 365 days a year; and those who are not, Type B. Many US emergency departments are exceedingly busy. A study found that in 2009, there were an estimated 128,885,040 ED encounters in US hospitals. Approximately one-fifth of ED visits in 2010 were for patients under the age of 18 years. In 2009–2010, a total of 19.6 million emergency department visits in the United States were made by persons aged 65 and over. Most encounters (82.8 percent) resulted in treatment and release; 17.2 percent were admitted to inpatient care.

The 1986 Emergency Medical Treatment and Active Labor Act is an act of the United States Congress, that requires emergency departments, if the associated hospital receives payments from Medicare, to provide appropriate medical examination and emergency treatment to all individuals seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Like an unfunded mandate, there are no reimbursement provisions.

Rates of ED visits rose between 2006 and 2011 for almost every patient characteristic and location. The total rate of ED visits increased 4.5% in that time. However, the rate of visits for patients under one year of age declined 8.3%.

A survey of New York area doctors in February 2007 found that injuries and even deaths have been caused by excessive waits for hospital beds by ED patients. A 2005 patient survey found an average ED wait time from 2.3 hours in Iowa to 5.0 hours in Arizona.

One inspection of Los Angeles area hospitals by Congressional staff found the EDs operating at an average of 116% of capacity (meaning there were more patients than available treatment spaces) with insufficient beds to accommodate victims of a terrorist attack the size of the 2004 Madrid train bombings. Three of the five Level I trauma centres were on "diversion", meaning ambulances with all but the most severely injured patients were being directed elsewhere because the ED could not safely accommodate any more patients. This controversial practice was banned in Massachusetts (except for major incidents, such as a fire in the ED), effective 1 January 2009; in response, hospitals have devoted more staff to the ED at peak times and moved some elective procedures to non-peak times.there were 1,800 EDs in the country. In 2011, about 421 out of every 1,000 people in the United States visited the emergency department; five times as many were discharged as were admitted. Rural areas are the highest rate of ED visits (502 per 1,000 population) and large metro counties had the lowest (319 visits per 1,000 population). By region, the Midwest had the highest rate of ED visits (460 per 1,000 population) and Western States had the lowest (321 visits per 1,000 population).

Most Common Reasons for Discharged Emergency Department Visits in the United States, 2011

Age (in years)	Reason for Visit	Visits
less than 1	Fever of unknown origin	270,000
1–17	Superficial injury, contusion	1.6 million
18–44	Sprains and Strains	3.2 million
45–64	Nonspecific chest pain	1.5 million
65–84	Nonspecific chest pain	643,000
85+	Superficial injury, contusion	213,000

Freestanding

In addition to the normal hospital based emergency departments a trend has developed in some states (including Texas and Colorado) of emergency departments not attached to hospitals. These new emergency departments are referred to as free standing emergency departments. The rationale for these operations is the ability to operate outside of hospital policies that may lead to increased wait times and reduced patient satisfaction.

These departments have attracted controversy due to consumer confusion around their prices and insurance coverage. In 2017, the largest operator, Adeptus Health, declared bankruptcy.

United Kingdom

The emergency department at The Royal Infirmary of Edinburgh

 

A&E sign common in the UK.

 

UK road sign to a hospital with A&E

 

All A&E departments throughout the United Kingdom are financed and managed publicly by the NHS of each constituent country (England, Scotland, Wales and Northern Ireland). As with most other NHS services, emergency care is provided to all, both resident citizens and those not ordinarily resident in the UK, free at the point of need and regardless of any ability to pay. 

In England departments are divided into three categories:

• Type 1 A&E department – major A&E, providing a consultant-led 24 hour service with full resuscitation facilities
• Type 2 A&E department – single specialty A&E service (e.g. ophthalmology, dentistry)
• Type 3 A&E department – other A&E/ minor injury unit/ walk-in centre, treating minor injuries and illnesses 

Historically, waits for assessment in A&E were very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in emergency departments that required departments in England to assess and treat patients within four hours of arrival, with referral and assessment by other departments if deemed necessary. It was expected that the patients would have physically left the department within the four hours. Present policy is that 95% of all patient cases do not "breach" this four-hour wait. The busiest departments in the UK outside London include University Hospital of Wales in Cardiff, The North Wales Regional Hospital in Wrexham, the Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth.

In July 2014, the QualityWatch research programme published in-depth analysis which tracked 41 million A&E attendances from 2010 to 2013. This showed that the number of patients in a department at any one time was closely linked to waiting times, and that crowding in A&E had increased as a result of a growing and ageing population, compounded by the freezing or reduction of A&E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, despite a rise of just 3% in A&E visits, and this trend looks set to continue. Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers. 

A&E services in the UK are often the focus of a great deal of media and political interest, and data on A&E performance is published weekly. However, this is only one part of a complex urgent and emergency care system. Reducing A&E waiting times therefore requires a comprehensive, coordinated strategy across a range of related services.

Many A&E departments are crowded and confusing. Many of those attending are understandably anxious, and some are mentally ill, and especially at night are under the influence of alcohol or other substances. Pearson Lloyd's redesign – 'A Better A&E' – is claimed to have reduced aggression against hospital staff in the departments by 50 per cent. A system of environmental signage provides location-specific information for patients. Screens provide live information about how many cases are being handled and the current status of the A&E department. Waiting times for patients to be seen at A&E have been rising.

Critical conditions handled

Cardiac arrest

Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced life support as taught in advanced life support and advanced cardiac life support courses.

Heart attack

Patients arriving to the emergency department with a myocardial infarction (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG; aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sub lingual (under the tongue) or buccal (between cheek and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs. 

An ECG that reveals ST segment elevation suggests complete blockage of one of the main coronary arteries. These patients require immediate reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolysis (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction. Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolysis if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty.

Trauma

Major trauma, the term for patients with multiple injuries, often from a motor vehicle crash or a major fall, is initially handled in the Emergency Department. However, trauma is a separate (surgical) specialty from emergency medicine (which is itself a medical specialty, and has certifications in the United States from the American Board of Emergency Medicine).

Trauma is treated by a trauma team who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. Some other international training bodies have started to run similar courses based on the same principles.

The services that are provided in an emergency department can range from x-rays and the setting of broken bones to those of a full-scale trauma centre. A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour". 

Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma centre. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport.

Mental illness

Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many US states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. The emergency department conducts medical clearance rather than treats acute behavioral disorders. From the emergency department, patients with significant mental illness may be transferred to a psychiatric unit (in many cases involuntarily).

Asthma and COPD

Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have an urgent chest X-ray and arterial blood gases and are referred for intensive care if necessary. Noninvasive ventilation in the ED has reduced the requirement for tracheal intubation in many cases of severe exacerbations of COPD.

Special facilities, training, and equipment

An ED requires different equipment and different approaches than most other hospital divisions. Patients frequently arrive with unstable conditions, and so must be treated quickly. They may be unconscious, and information such as their medical history, allergies, and blood type may be unavailable. ED staff are trained to work quickly and effectively even with minimal information.

ED staff must also interact efficiently with pre-hospital care providers such as EMTs, paramedics, and others who are occasionally based in an ED. The pre-hospital providers may use equipment unfamiliar to the average physician, but ED physicians must be expert in using (and safely removing) specialized equipment, since devices such as military anti-shock trousers ("MAST") and traction splints require special procedures. Among other reasons, given that they must be able to handle specialized equipment, physicians can now specialize in emergency medicine, and EDs employ many such specialists. 

ED staff have much in common with ambulance and fire crews, combat medics, search and rescue teams, and disaster response teams. Often, joint training and practice drills are organized to improve the coordination of this complex response system. Busy EDs exchange a great deal of equipment with ambulance crews, and both must provide for replacing, returning, or reimbursing for costly items. 

Cardiac arrest and major trauma are relatively common in EDs, so defibrillators, automatic ventilation and CPR machines, and bleeding control dressings are used heavily. Survival in such cases is greatly enhanced by shortening the wait for key interventions, and in recent years some of this specialized equipment has spread to pre-hospital settings. The best-known example is defibrillators, which spread first to ambulances, then in an automatic version to police cars and fire apparatus, and most recently to public spaces such as airports, office buildings, hotels, and even shopping malls. 

Because time is such an essential factor in emergency treatment, EDs typically have their own diagnostic equipment to avoid waiting for equipment installed elsewhere in the hospital. Nearly all have radiographic examination rooms staffed by dedicated Radiographer, and many now have full radiology facilities including CT scanners and ultrasonography equipment. Laboratory services may be handled on a priority basis by the hospital lab, or the ED may have its own "STAT Lab" for basic labs (blood counts, blood typing, toxicology screens, etc.) that must be returned very rapidly.

Non-emergency use

Metrics applicable to the ED can be grouped into three main categories, volume, cycle time, and patient satisfaction. Volume metrics including arrivals per hour, percentage of ED beds occupied and age of patients are understood at a basic level at all hospitals as an indication for staffing requirements. Cycle time metrics are the mainstays of the evaluation and tracking of process efficiency and are less widespread since an active effort is needed to collect and analyze this data. Patient satisfaction metrics, already commonly collected by nursing groups, physician groups and hospitals, are useful in demonstrating the impact of changes in patient perception of care over time. Since patient satisfaction metrics are derivative and subjective, they are less useful in primary process improvement. Health information exchanges can reduce nonurgent ED visits by supplying current data about admissions, discharges, and transfers to health plans and accountable care organizations, allowing them to shift ED use to primary care settings.

In all Primary Care Trusts there are out of hours medical consultations provided by general practitioners or nurse practitioners. 

In the United States, high costs are incurred by non-emergency use of the emergency room. The National Hospital Ambulatory Medical Care Survey looked ath the ten most common symptoms for which giving rise to emergency room visits (cough, sore throat, back pain, fever, headache, abdominal pain, chest pain, other pain, shortness of breath, vomiting) and made suggestions as to which would be the most cost-effective choice among virtual care, retail clinic, urgent care or emergency room. Notably, certain complaints may also be addressed by a telephone call to a person's primary care provider.

In the United States, and many other countries, hospitals are beginning to create areas in their emergency rooms for people with minor injuries. These are commonly referred as Fast Track or Minor Care units. These units are for people with non-life-threatening injuries. The use of these units within a department have been shown to significantly improve the flow of patients through a department and to reduce waiting times. Urgent care clinics are another alternative, where patients can go to receive immediate care for non-life-threatening conditions. To reduce the strain on limited ED resources, American Medical Response created a checklist that allows EMTs to identify intoxicated individuals who can be safely sent to detoxification facilities instead.

Overcrowding

Emergency department overcrowding is when function of a department is hindered by an inability to treat all patients in an adequate manner. This is a common occurrence in emergency departments worldwide. Overcrowding causes inadequate patient care which leads to poorer patient outcomes. To address this problem, escalation policies are used by emergency departments when responding to an increase in demand (e.g., a sudden inflow of patients) or a reduction in capacity (e.g., a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying ‘normal’ processes.

Emergency department waiting times

Emergency department (ED) waiting times have a serious impact on patient mortality, morbidity with readmission in less than 30 days, length of stay, and patient satisfaction. A review of the literature bears out the logical premise that since the outcome of treatment for all diseases and injuries is time-sensitive, the sooner treatment is rendered, the better the outcome. Various studies reported significant associations between waiting times and higher mortality and morbidity among those who survived. It is clear from the literature that untimely hospital deaths and morbidity can be reduced by reductions in ED waiting times.

Exit block

While a significant proportion of people attending emergency departments are discharged home after treatment, many require admission for ongoing observation or treatment, or to ensure adequate social care before discharge is possible. If people requiring admission are not able to be moved to inpatient beds swiftly, "exit block" or "access block" occurs. This often leads to crowding and impairs flow to the point that it can lead to delays in appropriate treatment for newly presenting cases ("arrival access block"). This phenomenon is more common in densely populated areas, and affects pediatric departments less than adults ones.

Exit block can lead to delays in care both in the people awaiting inpatient beds ("boarding") and those who newly present to an exit blocked department. Various solutions have been proposed, such as changes in staffing or increasing inpatient capacity.

Frequent presenters

Frequent presenters are persons who will present themselves at a hospital multiple times, usually those with complex medical requirements or with psychological issues complicating medical management. These persons contribute to overcrowding and typically require more hospital resources although they do not account for a significant number of visits. To help prevent inappropriate emergency department use and return visits, some hospitals offer care coordination and support services such as at-home and in-shelter transitional primary care for frequent presenters and short-term housing for homeless patients recovering after discharge.

In the military

Emergency departments in the military benefit from the added support of enlisted personnel who are capable of performing a wide variety of tasks they have been trained for through specialized military schooling. For example, in United States Military Hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more. Often, some civilian education and/or certification will be required such as an EMT certification, in case of the need to provide care outside the base where the member is stationed. The presence of highly trained enlisted personnel in an Emergency Departments drastically reduces the workload on nurses and doctors.

Violence against health care workers

According to a survey at an urban inner-city tertiary care centre in Vancouver, 57% of health care workers were physically assaulted in 1996. 73% were afraid of patients as a result of violence, almost half, 49%, hid their identities from patients, 74% had reduced job satisfaction. Over one-quarter of the respondents took days off because of violence. Of respondents no longer working in the emergency department, 67% reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies cited by those surveyed.

Medication errors

Emergency Department of Dartmouth General Hospital

 

Medication errors are issues that lead to incorrect medication distribution or potential for patient harm. As of 2014, around 3% of all hospital-related adverse effects were due to medication errors in the emergency department (ED); between 4% and 14% of medications given to patients in the ED were incorrect and children were particularly at risk.

Errors can arise if the doctor prescribes the wrong medication, if the prescription intended by the doctor is not the one actually communicated to the pharmacy due to an illegibly-written prescription or misheard verbal order, if the pharmacy dispenses the wrong medication, or if the medication is then given to the wrong person.

The ED is a riskier environment than other areas of the hospital due to medical practitioners not knowing the patient as well as they know longer term hospital patients, due to time pressure caused by overcrowding, and due to the emergency-driven nature of the medicine that is practiced there.