The document describes the evolution of emergency medicine from idealized "good old days" to a modern system with triage, monitored care areas, and protocols to manage patient flow. Over time, challenges emerged like limited funding, increased patient volumes, and sometimes uncooperative patients. Innovations like monitored chairs, security involvement, and admission rules helped restore balance and efficiency to the system.

1. The Evolution of Utopian Medicine

2. The Good Old Days In the beginning….

3. The Good Old Days Patients received pre-hospital care..

4. The Good Old Days Ambulance … and were transported to hospital by ambulance

5. Ambulance Trolley The Good Old Days They were provided with a trolley to rest their weary bones

6. Ambulance Trolley Emergency Department The Good Old Days … and wait review

7. Ambulance Trolley Emergency Department The Good Old Days Emergency Medicine … in the Emergency Department

8. Ambulance Trolley Emergency Department The Good Old Days Emergency Medicine Admission to the healing wards was timely Hospital Bed Admission Whole Hospital

9. Ambulance Trolley Emergency Department Waiting Room The Good Old Days Emergency Medicine The Waiting Room was a place for relatives… Hospital Bed Admission Whole Hospital

10. Ambulance Trolley Emergency Department Waiting Room The Good Old Days Emergency Medicine … .to tarry awhile therein Hospital Bed Admission Whole Hospital

11. Ambulance Trolley Emergency Department Waiting Room The Good Old Days Emergency Medicine News travelled quickly throughout the lands… Hospital Bed Admission Whole Hospital

12. Ambulance Trolley Emergency Department Waiting Room The Good Old Days Emergency Medicine ‘ bout this place of healing… Hospital Bed Admission Whole Hospital

13. Ambulance Trolley Emergency Department Waiting Room The Good Old Days Emergency Medicine … and thus the sick did arrive in waves and droves Hospital Bed Admission Whole Hospital

14. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage The Good Old Days Emergency Medicine Whole Hospital Triage defined urgency for review and admission

15. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs The Good Old Days Emergency Medicine Whole Hospital

16. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable The Good Old Days Emergency Medicine Whole Hospital

17. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable The Good Old Days Emergency Medicine Whole Hospital Stable patients were able to wait

18. Ambulance Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital Trolley But those in greatest need…

19. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital ..entered the treatment zone

20. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital Then one day

21. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital Came a terrible funding drought

22. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital … the sage soothsayers were right…

23. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital And so it came upon the land

24. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine Whole Hospital An evil wind of change

25. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable The Good Old Days Emergency Medicine … lack of support…

26. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine The Good Old Days and a ramping plague…

27. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine The Good Old Days … and in a flash

28. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine … the ‘ Good Old Days’ were gone

29. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine There rose a need

30. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine For Peri-Departmental Medicine

31. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Emergency Medicine … and Utopian Medicine Was Born Utopian Medicine

32. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Utopian Medicine Capable of: Walking Sitting Talking Ramped patients were assessed

33. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Utopian Medicine Capable of: Walking Sitting Talking … and re-directed

34. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Utopian Medicine Unstable patients were assessed.. Capable of: Walking Sitting Talking

35. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Utopian Medicine … and treated in monitored chairs Capable of: Walking Sitting Talking

36. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Abusive Violent Uncooperative Utopian Medicine Virulence bred new contempt for the system

37. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Utopian Medicine Abusive Violent Uncooperative … and force was required to attain equilibrium

38. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Utopian Medicine Abusive Violent Uncooperative

39. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Utopian Medicine Abusive Violent Uncooperative

40. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Utopian Medicine Abusive Violent Uncooperative

41. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Utopian Medicine Abusive Violent Uncooperative … yet the infestation continued

42. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Utopian Medicine Abusive Violent Uncooperative

43. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Utopian Medicine Abusive Violent Uncooperative

44. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Utopian Medicine Sometimes the load became too great… Abusive Violent Uncooperative

45. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Utopian Medicine Abusive Violent Uncooperative

46. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Utopian Medicine Abusive Violent Uncooperative

47. Ambulance Trolley Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Utopian Medicine The Four Minute Rule was introduced Abusive Violent Uncooperative

48. Ambulance Emergency Department Waiting Room Hospital Bed Admission Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair Utopian Medicine … to coincide with the Four Hour Rule Abusive Violent Uncooperative

49. Ambulance Emergency Department Waiting Room Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair ED Review Utopian Medicine Emergency Medicine And Flow returned Abusive Violent Uncooperative

50. Ambulance Emergency Department Waiting Room Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair Utopian Medicine Emergency Medicine ED Review To the River of Decision Abusive Violent Uncooperative

51. Ambulance Emergency Department Waiting Room Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair ED Review Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

52. Ambulance Emergency Department Waiting Room Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair ED Review Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

53. Ambulance Emergency Department Waiting Room Triage Check Vital Signs Stable Unstable RAMP Capable of: Walking Sitting Talking Call Security Police Station Street Too Well Too Drunk Too Impatient Morgue Trolley Actually Sick: Too Sick for Monitored Chair ED Review Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

54. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

55. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

56. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

57. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Move to Resus Area Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

58. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

59. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Review by admitting team Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

60. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

61. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Utopian Medicine Emergency Medicine Discharge Abusive Violent Uncooperative

62. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Discharge Utopian Medicine Emergency Medicine Whole Hospital With the addition of AMAAMAUPDLIRAU Abusive Violent Uncooperative

63. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Hospital Bed Admission Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Discharge Utopian Medicine Emergency Medicine Whole Hospital … the hospital system was saved Abusive Violent Uncooperative

64. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Hospital Bed Admission Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Discharge Utopian Medicine Emergency Medicine Whole Hospital … and the ‘ Good Old Days’ returned once more The Good Old Days Abusive Violent Uncooperative

65. Ambulance RAMP Trolley Waiting Room Triage Check Vital Signs Street Police Station Admit Unstable Stable Morgue Too Well Too Drunk Too Impatient Capable of: Walking Sitting Talking Emergency Department Call Security ED Review Actually Sick: Too Sick for Monitored Chair Hospital Bed Admission Review by admitting team In-House Fighting Professional Tantrum Move to Resus Area Move to Corridor Stay in ED Discharge Utopian Medicine Emergency Medicine Whole Hospital The Good Old Days Abusive Violent Uncooperative