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In residency, I had the habit of looking at the timestamps on critically ill patients who were transferred from outlying community hospital EDs. I was frequently in awe of the emergency physicians there and the two ED nurses they typically would have at night, who in an hour or so could...

diagnose, stabilize, call for helicopter transportion, send labs, intubate, and place a central line. We know that critical care saves the lives of critical patients, and we know that minutes matter.

I've therefore long been puzzled by the disconnect between the promise of freestanding EDs and what the literature shows is their current reality: expensive entities that tend to locate in the same sites as urgent cares and do fairly similar work.

Geography, in this case, is likely destiny: locating in well-served, affluent, dense suburbs leads to delivery of ED services to patients that have less need for them.

I'm therefore really excited about this new editorial, led by Drs. Cedric Dark and George Koshy, where we discuss the potential for FSEDs, when staffed and supplied sufficiently to delivery critical care, to be a critical lifeline in rural areas: www.sciencedirect.com/science/arti...