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ER (TV series)

ER is an American medical drama television series created by Michael Crichton that aired on NBC from September 19, 1994, to April 2, 2009, with a total of 331 episodes spanning 15 seasons. It was produced by Constant c Productions and Amblin Television, in association with Warner Bros. Television. ER follows the inner life of the emergency room (ER) of Cook County General Hospital (a fictionalized version of the real Cook County Hospital) in Chicago, and various critical issues faced by the department's physicians and staff.

The show is the second longest-running primetime medical drama in American television history behind Grey's Anatomy. The highest awarded medical drama, ER won 126 industry awards from 433 nominations, including the George Foster Peabody Award in 1995, TCA Award for Program of the Year in 1995, and Primetime Emmy Award for Outstanding Drama Series in 1996. As of 2014, ER had grossed over US$3 billion in television revenue. It is considered one of the best medical dramas of all time, pioneering the field of medical fiction and setting a model for other contemporary medical dramas to follow.

Development
In 1974, author Michael Crichton wrote a screenplay then entitled "ED" (for emergency department) based on his own experiences as a medical student in a busy hospital emergency room. Producers were not interested in the screenplay, and Crichton turned to other topics. In 1990, he published the novel Jurassic Park, and in 1993 began a collaboration with director Steven Spielberg on the film adaptation of the book.

After its release, Crichton and Spielberg then turned to what was now known as ER, but Spielberg decided to film the story as a two-hour pilot for a television series rather than as a feature film after considering the potential for various stories to be told in the setting. He passed the script on to a team at his production company, Amblin Entertainment. Anthony Thomopoulos, then head of Amblin's television division, got in touch with then CEO of Warner Bros. Television, Les Moonves, about the idea for the series and to send the script. Spielberg's Amblin Television provided John Wells as the show's executive producer.

Warner Bros. pitched ER to NBC, alongside Crichton, Spielberg and Wells. Warren Littlefield, head of NBC Entertainment at the time, liked the project, but there was much debate and controversy among other executives at the network, who were dubious about the nature of the series. NBC offered a chance to make a two-hour made-for-TV movie from the script, which was rejected. They then tried to get the show greenlit at rival networks before returning to NBC, who this time around ordered a pilot.

The script used to shoot the pilot was virtually unchanged from what Crichton had written in 1974. The only substantive changes made by the producers in 1994 were that a male character was changed to a female character (Susan Lewis) and the Peter Benton character's race was changed to African-American. The running time was shortened by about 20 minutes in order for the pilot to air in a two-hour block on network TV. Because of a lack of time and money necessary to build a set, the pilot episode of ER was filmed in the former Linda Vista Hospital in Los Angeles, an old facility that had ceased operating in 1990. A set modeled after Los Angeles County General Hospital's emergency room was built soon afterward at the Warner Bros. studios in Burbank, California, although the show makes extensive use of location shoots in Chicago, most notably the city's famous "L" train platforms.

Littlefield was impressed by the series: "We were intrigued, but we were admittedly a bit spooked in attempting to go back into that territory a few years after St. Elsewhere." With Spielberg attached behind the scenes, NBC ordered six episodes. "ER premiered opposite a Monday Night Football game on ABC and did surprisingly well. Then we moved it to Thursday and it just took off," commented Littlefield. ER's success surprised the networks and critics alike, as David E. Kelley's new medical drama Chicago Hope was expected to crush the new series, airing directly opposite ER in the Thursday 10:00 pm time slot over on CBS.

Crichton was credited as an executive producer until his death in November 2008, although he was still credited as one throughout that entire final season. Wells, the series' other initial executive producer, served as showrunner for the first three seasons. He was the show's most prolific writer and became a regular director in later years. Lydia Woodward was a part of the first season production team and became an executive producer for the third season. She took over as showrunner for the fourth season while Wells focused on the development of other series, including Trinity, Third Watch, and The West Wing. John Wells continued to serve as the primary Executive Producer for the remainder of the series. Lydia Woodward left her executive producer position at the end of the sixth season but continued to write episodes throughout the series run.

Joe Sachs, who was a writer and producer of the series, believed keeping a commitment to medical accuracy was extremely important: "We'd bend the rules but never break them. A medication that would take 10 minutes to work might take 30 seconds instead. We compressed time. A 12- to 24-hour shift gets pushed into 48 minutes. But we learned that being accurate was important for more reasons than just making real and responsible drama."

Woodward was replaced as showrunner by Jack Orman. Orman was recruited as a writer-producer for the series in its fourth season after a successful stint working on CBS's JAG. He was quickly promoted and became an executive producer and showrunner for the series' seventh season. He held these roles for three seasons before leaving the series at the end of the ninth season. Orman was also a frequent writer and directed three episodes of the show.

David Zabel served as the series' head writer and executive producer in its later seasons. He initially joined the crew for the eighth season and became an executive producer and showrunner for the twelfth season onward. Zabel was the series' most frequent writer, contributing to 41 episodes. He also made his directing debut on the series. Christopher Chulack was the series' most frequent director and worked as a producer on all 15 seasons. He became an executive producer in the fourth season but occasionally scaled back his involvement in later years to focus on other projects.

Other executive producers include writers Carol Flint, Neal Baer, R. Scott Gemmill, Joe Sachs, Dee Johnson, Lisa Zwerling, and Janine Sherman Barrois. Several of these writers and producers had background in healthcare: Joe Sachs was an emergency physician, while Lisa Zwerling and Neal Baer were both pediatricians. The series' crew was recognized with awards for writing, directing, producing, film editing, sound editing, casting, and music.

Broadcasting
Following the broadcast of its two-hour pilot on September 19, 1994, ER premiered Thursday, September 22 at 10pm. It remained in the same Thursday time slot for its entire run, capping the Must See TV primetime block. ER is NBC's third longest-running drama, after Law & Order and Law & Order: Special Victims Unit, and the second longest-running American primetime medical drama of all time, behind ABC's Grey's Anatomy. Starting with season seven, ER was broadcast in the 1080i HD format, appearing in letterbox format when presented in standard definition. On April 2, 2008, NBC announced that the series would return for its fifteenth season. The fifteenth season was originally scheduled to run for 19 episodes before retiring with a two-hour series finale to be broadcast on March 12, 2009, but NBC announced in January 2009 that it would extend the show by an additional three episodes to a full 22-episode order as part of a deal to launch a new series by John Wells titled Police, later retitled Southland. ER's final episode aired on April 2, 2009; the two-hour episode was preceded by a one-hour retrospective special. The series finale charged $425,000 per 30-second ad spot, more than three times the season's rate of $135,000. From season 4 to season 6 ER cost a record-breaking $13 million per episode. TNT also paid a record price of $1 million an episode for four years of repeats of the series during that time. The cost of the first three seasons was $2 million per episode and seasons 7 to 9 cost $8 million per episode.

Cast and characters

The original starring cast consisted of Anthony Edwards as Dr. Mark Greene, George Clooney as Dr. Doug Ross, Sherry Stringfield as Dr. Susan Lewis, Noah Wyle as medical student John Carter, and Eriq La Salle as Dr. Peter Benton. As the series continued, some key changes were made: Nurse Carol Hathaway, played by Julianna Margulies, who attempts suicide in the original pilot script, was made into a regular cast member. Ming-Na debuted in the middle of the first season as medical student Jing-Mei "Deb" Chen, but did not return for the second season; she returns in season 6 episode 10. Gloria Reuben and Laura Innes would join the series as Physician Assistant Jeanie Boulet and Dr. Kerry Weaver, respectively, by the second season.

In the third season, a series of cast additions and departures began that would see the entire original cast leave over time. Stringfield was the first to exit the series, reportedly upsetting producers who believed she wanted to negotiate for more money, but the actress did not particularly care for "fame." She would return to the series from 2001 until 2005. Clooney departed the series in 1999 to pursue a film career, and Margulies exited the following year. Season eight saw the departure of La Salle and Edwards when Benton left County General and Greene died from a brain tumor. Wyle left the series after season 11 in order to spend more time with his family, but would return for two multiple-episode appearances in the show's twelfth and final seasons. Alex Kingston as Dr. Elizabeth Corday, Paul McCrane as Dr. Robert Romano, Goran Višnjić as Dr. Luka Kovač, Maura Tierney as Nurse Abby Lockhart, and Mekhi Phifer as Dr. Greg Pratt all joined the cast as the seasons went on. In the much later seasons, the show would see the additions of Parminder Nagra as medical student Neela Rasgotra, Scott Grimes as Dr. Archie Morris, Linda Cardellini as Nurse Sam Taggart, Shane West as Dr. Ray Barnett, John Stamos as Paramedic Tony Gates, David Lyons as Dr. Simon Brenner, and Angela Bassett as Dr. Cate Banfield.

In addition to the main cast, ER featured a large number of frequently seen recurring cast members who played key roles such as paramedics, hospital support staff, nurses, and doctors. ER also featured a sizable roster of well-known guest stars, some making rare television appearances, who typically played patients in single episode appearances or multi-episode arcs.

Episodes
A typical episode centered on the ER, with most scenes set in the hospital or surrounding streets. In addition, most seasons included at least one storyline located completely outside of the ER, often outside of Chicago. Over the span of the series, stories took place in the Congo, Iraq, France, and Sudan. One early storyline involved a road trip taken by Dr. Ross and Dr. Greene to California and a season eight episode included a storyline in Hawaii featuring Dr. Greene and Dr. Corday. Beginning in season nine, storylines started to include the Congo, featuring Dr. Kovač, Dr. Carter, and Dr. Pratt. "We turned some attention on the Congo and on Darfur when nobody else was. We had a bigger audience than a nightly newscast will ever see, making 25 to 30 million people aware of what was going on in Africa," ER producer John Wells said. "The show is not about telling people to eat their vegetables, but if we can do that in an entertaining context, then there's nothing better." The series also focused on sociopolitical issues such as HIV and AIDS, organ transplants, mental illness, racism, human trafficking, euthanasia, poverty and gay rights.

Some episodes used creative formats, such as the 1997 "Ambush," which was broadcast live twice, once for the east coast and again three hours later for the west coast, and 2002's "Hindsight," which ran in reverse time as it followed one character, Dr. Kovač, through the events of a Christmas Eve shift and the Christmas party that preceded it.

Crossover with Third Watch
The episode "Brothers and Sisters" (first broadcast on April 25, 2002) begins a crossover that concludes on the Third Watch episode "Unleashed" in which Dr. Lewis enlists the help of Officers Maurice Boscorelli and Faith Yokas to find her sister and niece.

Ratings
U.S. seasonal rankings based on average total viewers per episode of ER on NBC are tabulated below. Each U.S. network television season starts in late September and ends in late May, which coincides with the completion of May sweeps. All times mentioned in this section were in the Eastern and Pacific time zones. Ratings for seasons 1–2 are listed in households (the percentage of households watching the program), while ratings for seasons 3–15 are listed in viewers.

In its first year, ER attracted an average of 19 million viewers per episode, becoming the year's second most watched television show, just behind Seinfeld. In the following two seasons (1995–1997), ER was the most watched show in North America. For almost five years, ER battled for the top spot against Seinfeld, but in 1998, Seinfeld ended and then ER became number one again. The series finale attracted 16.4 million viewers. The show's highest rating came during the episode "Hell and High Water" with 48 million viewers and a 45% market share. It was the highest for a regularly scheduled drama since a May 1985 installment of Dallas received a 46. The share represents the percentage of TVs in use tuned in to that show.

Critical reception
Throughout the series ER received positive reviews from critics and fans alike. It scored 80 on Metacritic, meaning "generally favorable reviews," based on 21 critics. Marvin Kitman from Newsday said: "It's like M*A*S*H with just the helicopters showing up and no laughs. E.R. is all trauma; you never get to know enough about the patients or get involved with them. It's just treat, release and move on." Richard Zoglin from TIME stated that it's "probably the most realistic fictional treatment of the medical profession TV has ever presented."

Critical reactions for ER's first season were very favorable. Alan Rich, writing for Variety, praised the direction and editing of the pilot while Eric Mink, writing for the New York Daily News, said that the pilot of ER "was urban, emergency room chaos and young, committed doctors." However some reviewers felt the episodes following the pilot did not live up to it with Mink commenting that "the great promise of the "E.R." pilot dissolves into the kind of routine, predictable, sloppily detailed medical drama we've seen many times before."

NBC launched the show at the same time that CBS launched its own medical drama Chicago Hope; many critics drew comparisons between the two. Eric Mink concluded that ER may rate more highly in the Nielsens but Chicago Hope told better stories, while Rich felt both shows were "riveting, superior TV fare." The Daily Telegraph wrote in 1996: "Not being able to follow what on earth is going on remains one of the peculiar charms of the breakneck American hospital drama, ER."

In 2002, TV Guide ranked ER No. 22 on their list of "TV's Top 50 Shows," making it the second highest ranked medical drama on the list (after St. Elsewhere at No. 20). Also, the episode "Love's Labor Lost" was ranked No. 6 on TV Guide's 100 Greatest Episodes of All-Time list having earlier been ranked No. 3. The show placed No. 19 on Entertainment Weekly "New TV Classics" list. Empire ranked it No. 29 in their list of the "50 Greatest TV Shows of All Time" and said the best episode was "Hell and High Water" where "Doug Ross (George Clooney) saves a young boy from drowning during a flood." In 2012, ER was voted Best TV Drama on ABC's 20/20 special episode "Best in TV: The Greatest TV Shows of Our Time." In 2013, TV Guide ranked it No. 9 in its list of The 60 Greatest Dramas of All Time and No. 29 in its list of the 60 Best Series. In the same year, the Writers Guild of America ranked ER No. 28 in its list of the 101 Best Written TV Series of All Time.

Awards and nominations
ER has won 126 industry awards from 433 nominations, including the George Foster Peabody Award in 1995, TCA Award for Program of the Year in 1995, and Primetime Emmy Award for Outstanding Drama Series in 1996. It was also nominated for 124 Primetime Emmy Awards (with 23 wins), 25 Golden Globe Awards (with one win), 18 Screen Actors Guild Awards (with eight wins), 5 Writers Guild of America Awards (with one win), 12 Directors Guild of America Awards (with four wins), 3 Producers Guild of America Awards (with two wins), and 8 TCA Awards (with two wins).

Home media
Warner Home Video has released all 15 seasons in Region 1, Region 2, and Region 4.

In the United Kingdom (Region 2), The Complete Series boxset was released on October 26, 2009. On September 12, 2016, the series was re-released in three box sets, Seasons 1–5, Seasons 6–10, and Seasons 11–15.

The DVD box sets of ER are unusual in the fact that they are all in anamorphic widescreen even though the first six seasons of the show were broadcast in a standard 4:3 format. ER was shot protecting for widescreen presentation, allowing the show to be presented in 16:9 open matte (leaving only the title sequence in the 4:3 format). However, as the production of the show was generally conceived with 4:3 presentation in mind, some episodes feature vignetting or unintended objects towards the sides of the frame that would not be visible when presented in the 4:3 format. These episodes also appear in the widescreen format when rerun on TNT HD, Pop and streaming services.

In 2018, Hulu struck a deal with Warner Bros. Domestic Television Distribution to stream all 15 seasons of the show. The show arrived on HBO Max in January 2022.

Soundtrack
In 1996, Atlantic Records released an album of music from the first two seasons, featuring James Newton Howard's theme from the series in its on-air and full versions, selections from the weekly scores composed by Martin Davich (Howard scored the two-hour pilot, Davich scored all the subsequent episodes and wrote a new theme used from 2006–2009 until the final episode, when Howard's original theme returned) and songs used on the series.

 * 1) Theme From ER – James Newton Howard (3:02)
 * 2) Dr. Lewis and Renee (from "The Birthday Party") (1:57)
 * 3) Canine Blues (from "Make of Two Hearts") (2:27)
 * 4) Goodbye Baby Susie (from "Fever of Unknown Origin") (3:11)
 * 5) Doug & Carol (from "The Gift") – composed by James Newton Howard and Martin Davich (1:59)
 * 6) Healing Hands – Marc Cohn (4:25)
 * 7) The Hero (from "Hell And High Water") composed by James Newton Howard and Martin Davich (1:55)
 * 8) Carter, See You Next Fall (from "Everything Old Is New Again") (1:28)
 * 9) Reasons For Living – Duncan Sheik (4:33)
 * 10) Dr. Green and a Mother's Death (from "Love's Labor Lost") (2:48)
 * 11) Raul Dies (from "The Healers") (2:20)
 * 12) Hell and High Water (from "Hell And High Water") – composed by James Newton Howard and Martin Davich (2:38)
 * 13) Hold On (from "Hell And High Water") (2:47)
 * 14) Shep Arrives (from "The Healers") (3:37)
 * 15) Shattered Glass (from "Hell And High Water") (2:11)
 * 16) Theme From ER – James Newton Howard  (1:00)
 * 17) It Came Upon a Midnight Clear – Mike Finnegan (2:30)

Other media

 * An ER video game developed by Legacy Interactive for Windows 2000 and XP was released in 2005.
 * In the Mad episode "Pokémon Park / WWER", the show was parodied in the style of WWE.
 * A recurring sketch called "Toy ER" in the Nickelodeon comedy series All That parodies the show, featuring Dr. Malady (Chelsea Brummet), Dr. Botch (Giovonnie Samuels), and Dr. Sax (Shane Lyons) "treating" damaged toys.
 * A book about emergency medicine based on the TV series, The Medicine of ER: An Insider's Guide to the Medical Science Behind America's #1 TV Drama was published in 1996. Authors Alan Duncan Ross and Harlan Gibbs M.D. have hospital administration and ER experience, respectively, and are called fans of the TV show in the book's credits.
 * An episode-by-episode rewatch podcast called Setting the Tone: An ER Retrospective launched in 2019, and has featured numerous cast and crew interviews, including Gloria Reuben, Abraham Benrubi, Noah Wyle, Lydia Woodward, Laura Innes, Carol Flint, John Frank Levy, Paul McCrane, and others.

Foreign adaptations
In March 2012, Warner Bros. International Television announced that they would sell the format rights to ER to overseas territories. This allowed foreign countries to produce their own version of the series.

In June 2013, Warner Bros. International Television and Emotion Production announced a Serbian version of ER. Urgentni Centar premiered on October 6, 2014, on TV Prva. As of 2023, four seasons of the show have been filmed.

In January 2014, Warner Bros. International Television with RCN, Fox International Channels and TC announced a Colombian version of ER.

In March 2014, Warner Bros. International Television and StarLight Films announced a Ukrainian version of ER.

In February 2015, Warner Bros. International Television and Medyapım announced a Turkish version of ER.

title: ER (TV series)


text:
Mod

Mod, MOD or mods may refer to:

Places

 * Modesto City–County Airport, Stanislaus County, California, US

Music

 * Mods (band), a Norwegian rock band
 * M.O.D. (Method of Destruction), a band from New York City, US
 * The Mods (band), a punk rock band from Toronto, Canada

Other uses in arts, entertainment, and media

 * Manufactured on demand for CD, DVD distribution
 * Mod (film), 2011
 * The Mods (film), 2014
 * Mod (video games), unofficial modifications
 * Mòd, a Scottish Gaelic festival
 * Media-on-demand
 * MuchOnDemand, a Canadian TV program

Brands and enterprises

 * Mod Club Theatre, Toronto, Canada
 * MOD Pizza, US

Organizations

 * MoD, Ministry of defence of some countries
 * MoD (UK), Ministry of Defence
 * Masters of Deception, a US hacker group
 * Ministry of Development (Brunei)

Computing and Internet

 * Mod, a module for Apache HTTP Server
 * Case modding of a computer
 * Forum moderator, of an online forum
 * Module file, a music file format
 * MOD (file format), the first module file format
 * Modula-2 source code file extension
 * Video game modding, a modification of a computer game

Mathematics

 * Mod n cryptanalysis, a partitioning attack applicable to block and stream ciphers
 * Modulo (mathematics)
 * Modular arithmetic
 * Modulo operation
 * Modular exponentiation

Other uses in science and technology

 * MOD., a science museum at the University of South Australia, Adelaide
 * MOD and TOD, camcorder recording formats
 * Modchip, a chip modifying an electronic system
 * Model organism database, a biological database
 * Moving object detection, a computing technology related to image processing
 * Multiple organ dysfunction syndrome, a medical condition
 * Pod mods, a type of electronic cigarette

Other uses

 * Mod (subculture), 1960s British youth subculture
 * Mod revival, late 1970s
 * Honour Moderations, Oxford exams
 * Maximum operating depth in scuba diving
 * Mod Cup, a shinty trophy
 * A module in modular scheduling
 * Multicultural organization development
 * Content moderation

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Mod


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New National Party (South Africa)

The New National Party (NNP) was a South African political party formed in 1997 as the successor to the National Party, which ruled the country from 1948 to 1994. The name change was an attempt to distance itself from its apartheid past, and reinvent itself as a moderate, mainstream conservative and non-racist federal party. The attempt was largely unsuccessful, and in 2005 the New National Party voted to disband itself.

Foundation and political platform
The NP entered the democratic era led by former president of South Africa F. W. de Klerk, the winner with Nelson Mandela of the Nobel Peace Prize for his role in dismantling apartheid. He was succeeded by Marthinus van Schalkwyk until the eventual disbanding and merger of the party with the African National Congress (ANC). Van Schalkwyk renamed the party towards the end of 1997. In February 1996, the party had announced that it would become a nonracial, Christian-Democratic political organization, and Van Schalkwyk sought to build on this in his efforts to rebrand the NNP as a nonracial, value driven party.

But the New National Party had some difficulty carving out a political base in post-apartheid South Africa. On the one hand, it still had the legacy of its role under apartheid. On the other hand, it seemed uncertain about its relationship with the government led by the ANC and seemed unable to decide whether it was in a political alliance with the ANC or in opposition. These two issues led to defections to the Democratic Party (DP), which had a historical legacy of being anti-apartheid and was clearly an opposition party to the ANC. It also lost support to other parties.

Election results and alliances
The NNP fared poorly in the general election of 1999. With 6.87% of the vote, the party lost votes both to the DP and ANC as well as its status as the official opposition nationally and in most provinces. But it remained influential in the Western Cape province, where it was the party of government, despite being pushed into second place there by the ANC. The party faced comparatively smaller losses in the province in large part due to the retention of most of its coloured support, but it also fared better with white voters than in most other provinces. 50% of its voter base now came from this one province, and despite retaining representation in all nine provincial legislatures, it was seemingly becoming a regional political force.

The party remained in power in the Western Cape through a coalition with the Democratic Party. The two then began to plan a merger in 2000, under the name Democratic Alliance (DA). By 2001 the party had broken away from the DA before the merger could be completed, and instead entered close co-operation with the ANC. In December 2001, the NNP formed a new provincial coalition with the ANC in the Western Cape, and members of the NNP were appointed to the national cabinet.

During the general election of 2004, the NNP was almost eliminated from parliament. Much of its support deserted the party, due to unhappiness with its alliance with the ANC, and its share of the national vote dropped from 6.87% in 1999 to 1.65%, having been 20.4% under the National Party name in 1994. The party was all but wiped out in most provinces and retained only limited pockets of large support in the Western Cape, where it was pushed into a distant third place behind the DA in its former stronghold.

Dissolution and merger with the ANC
With the former governing party now only the sixth-largest in the country, questions were asked about its long-term future, and the leadership of Van Schalkwyk. Despite his party's poor performance in the polls, Van Schalkwyk was given the cabinet post of Minister of Environmental Affairs and Tourism, seen as a reward for aligning the NNP with the ANC.

At its assembly on 9 April 2005, the NNP's Federal Council voted by 88 to 2 to disband. It also settled its outstanding debt of R5.2 million to the Absa Group Limited, in preparation for dissolution.

With effect 5 August 2005, all NNP members of parliament became members of the ANC, in accordance with the system of crossing the floor in South Africa, which allowed politicians, elected on one party ticket, to defect to other parties or becoming independents. This system was repealed in 2009.

title: New National Party (South Africa)


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Free Zone (Scientology)

Free Zone, Freezone, and Independent Scientology are umbrella terms for the groups, organizations, and individuals who practice Scientology beliefs and practices independently of the Church of Scientology (COS). Such practitioners range from those who closely adhere to the original teachings of Scientology's founder L. Ron Hubbard, to those who have adapted practices far from COS beliefs and practices.

The International Freezone Association, the group whose name became adopted as a generic term for independent Scientology, was not the first independent Scientologist group; the California Association of Dianetic Auditors, the oldest breakaway group still in existence, claims a founding date of December 1950, predating the Church of Scientology itself.

Skeptic Magazine described the Free Zone as: "a group founded by ex-Scientologists to promote L. Ron Hubbard's ideas independent of the Church of Scientology". A Miami Herald article wrote that ex-Scientologists joined the Free Zone because they felt that Church of Scientology leadership had "strayed from Hubbard's original teachings".

Introduction
The term "Free Zone" or "Freezone" is used for the loose grouping of Scientologists who are not members of the Church of Scientology. Often called "freezoners", some prefer to describe their practices as "Independent Scientology" because of the associations that the term "Free Zone" has with Ron's Org;

Key to the Free Zone is what scholar of religion Aled Thomas called its "largely unregulated and non-hierarchical environment". Within the Free Zone there are many different interpretations of Scientology; Thomas suggested Free Zone Scientologists were divided between "purists" who emphasize loyalty to Hubbard's teachings and those more open to innovation. Free Zoners typically stress that Scientology as a religion is different from the Church of Scientology as an organization, criticizing the latter's actions rather than their beliefs. They often claim to be the true inheritors of Hubbard's teachings, maintaining that Scientology's primary focus is on individual development and that that does not require a leader or membership of an organization. Some Free Zoners argue that auditing should be more affordable than it is as performed by the Church, and criticise the Church's lavish expenditure on buildings.

The Church has remained hostile to the Free Zone, regarding it as heretical. It refers to non-members who either practice Scientology or simply adopt elements of its technology as "squirrels", and their activities as "squirreling". The term "squirrels" was coined by Hubbard and originally referred only to non-Scientologists using its technology. The Church also maintains that any use of its technology by non-Church members is dangerous as they may not be used correctly. Free Zoners have also accused the Church of "squirrelling", maintaining that it has changed Hubbard's words in various posthumous publications. Lewis has suggested that the Free Zone has been fueled by some of the Church's policies, including Hubbard's tendency to eject senior members whom he thought could rival him and the Church's "suppressive persons" policy which discouraged rapprochement with ex-members.

After interviewing 16 Free Zoners in Denmark, Elizabeth Tuxen Rubin noted that they had not renounced the belief system of Scientology despite distancing themselves from the Church of Scientology. James R. Lewis suggests that these "sincerely-held beliefs of Free Zone Scientologists [...] offer the best evidence that Scientology is a religion in the legal sense of that contested term".

Ron's Org
Bill Robertson had been a Sea Org member with the Church of Scientology on the flag ship Apollo. In the early 1980s, Robertson left the Church and founded Ron's Org, a loose federation of Scientology groups operating outside the Church. Headquartered in Switzerland, Ron's Org included affiliated centers in Germany, Russia, and other former parts of the Soviet Union. Robertson claimed that he was channeling messages from Hubbard after the latter's death, through which he discovered OT levels above the eight being offered by the Church. Although Ron's Org founding members were formerly part of the Church, many later Ron's Org members never had any prior involvement with the Church.

Advanced Ability Center
David Mayo founded Advanced Ability Center in the Santa Barbara, California area. Mayo had been the highest-ranking technical officer in Scientology, but was removed in the early 1980s by David Miscavige. Several years of harassment and litigation followed. In 1985, the Church of Scientology succeeded in getting an injunction against Mayo selling Scientology services, and in 1986 the center went bankrupt and closed.

Marty Rathbun
Marty Rathbun rose in the Church of Scientology to the post of Inspector General of the Religious Technology Center, He defected in 2004 and disappeared for several years before reappearing and offering to provide Scientology auditing services. Reitman called Rathbun's activities a "virtual church" because of the sermonizing on his website. He audited people in his home in Texas, and coined the term "Independent Scientology". But then years of fair game harassment followed. In 2013, Rathbun stated he was "no longer a Scientologist, independent or otherwise", and Rathbun's wife filed a suit against the Church of Scientology in 2013. After winning several legal bouts, the case was dropped in 2016. Rathbun then started to criticize other prominent former Scientologists, including making videos against them which appeared in Church of Scientology advertisements, leading strongly to the conclusion that Rathbun had made some agreement with the Church.

Haifa, Israel
In 2012, a Scientology center in Haifa, Israel, defected from the Church.

Others
As well as these organizations, there are also small groups of Scientologists outside the Church who meet informally. Some avoid establishing public centers and communities for fear of legal retribution from the Church. There are also Free Zone practitioners who practice what Thomas calls a "very individualized form of Scientology", encouraging innovation with Hubbard's technology.

Perception by German government authorities
Scientology Commissioner Ursula Caberta in Hamburg said that the Free Zone is a type of "methadone program for Scientologists", and, in any case, "the lesser evil". According to the Free Zone conglomerate, Ron's Org, the Verfassungsschutz Baden-Württemberg (State Office for the Protection of the Constitution) has stated that there is no need to keep Ron's Org under observation "as the Ron's Org has no anti-constitutional goals". There is some cooperation between members of the Ron's Org and state authorities who observe the Church of Scientology and investigate their activities.

The Church of Scientology and the Free Zone
The COS labels all practitioners of and believers in Scientology without its sanction "squirrels"—a term Hubbard coined to describe those who alter Scientology technology or practice it in a nonstandard fashion. Among Scientologists, the term is pejorative, and comparable in meaning to "heretic". In practice, the hierarchy of the Church of Scientology uses it to describe all of those who practice Scientology outside the Church.

As of 2016, many of the major courses and publications in the Church have been altered or deleted altogether. This is a main protest and action point for Free Zone Scientologists. Major courses, such as the Class VI and Class VIII auditor training courses, which had very high enrollment in the 1970s, have been shut down. Additionally, Scientology critics in the Free Zone movement have claimed that alterations have been made to Hubbard's original writings in Church policies and even more so in technical bulletins, with parishioners never made aware of the changes to these writings.

The Church of Scientology has used copyright and trademark laws against various Free Zone groups. Accordingly, most of the Free Zone avoids the use of officially trademarked Scientology words, including Scientology itself. In 2000, the Religious Technology Center unsuccessfully attempted to gain the Internet domain name scientologie.org from the World Intellectual Property Organization (one of the 16 specialized agencies of the United Nations) in a legal action against the Free Zone.

The "Ron's Org Committee" (ROC) and the "True Source Scientology Foundation" (STSS, "Stichting True Source Scientology") have documented the argument that Scientology materials written by L. Ron Hubbard are in the public domain if certain assumptions are made. In addition the ROC has documented a legal battle over the trademark "Ron's Org".

One Free Zone Scientologist, identified as "Safe", was quoted in Salon as saying: "The Church of Scientology does not want its control over its members to be found out by the public and it doesn't want its members to know that they can get Scientology outside of the Church of Scientology".

Portrayal in media
A 2006 Channel 4 documentary presented by Sikh comedian Hardeep Singh Kohli, The Beginner's Guide to L. Ron Hubbard, explored Scientology with the "Ron's Org" Free Zone group after the Church of Scientology declined to take part.

A 2017 episode of the docuseries Believer hosted by religious scholar Reza Aslan focused on Scientology; however, Aslan was unable to get in contact with any Church of Scientology officials so instead the episode featured an array of independent scientologists. Aslan has compared the Free Zone to other schisms in religious history, such as the Protestant Reformation.

Alternative auditing practices
Several alternatives to Dianetics were developed in the early years of the Free Zone.

Synergetics is a self-help system developed by Art Coulter in 1954. American businessman, Don A. Purcell, Jr., joined Synergetics in 1954 after he had financially bailed out Hubbard and his Dianetics foundations and was later sued by Hubbard. In 1976, Coulter published Synergetics: An Adventure in Human Development; he later founded the Synergetic Society, which published a journal through 1996.

Idenics is a personal counseling method not affiliated with any religion, that was developed by John Galusha beginning in 1987. Galusha researched for Hubbard during the 1950s, and was one of the founders of the first Church of Scientology in 1953. Galusha claimed that all personal issues can be addressed by thoroughly looking over the problem at hand, without judgment. The counselor asks a series of questions until the solution is considered found, by the client. Mike Goldstein, the owner of Idenics methodology and author of the book, Idenics: An Alternative to Therapy, claims that the method is as effective over the telephone as in person.

The word "Scientology"
Disagreement over the origins of the word Scientology has been used by Free Zone groups to contest Scientology's trademarks. A German book entitled Scientologie, Wissenschaft von der Beschaffenheit und der Tauglichkeit des Wissens was published in 1934 by Anastasius Nordenholz. The groups have argued that because Scientologie was not written by L. Ron Hubbard, the Church is unfairly monopolizing control over its practice. The trademark rights to the use of Dianetics and the E-meter (invented and created by Volney Mathison) was allowed to lapse into the public domain in 1976 by Hubbard.

title: Free Zone (Scientology)


text:
Messerschmitt Me 210

The Messerschmitt Me 210 was a German heavy fighter and ground-attack aircraft of World War II. Design started before the war, as a replacement for the Bf 110. The first examples were ready in 1939, but they proved to have unacceptably poor flight characteristics due to serious wing planform and fuselage design flaws. A large-scale operational testing program throughout 1941 and early 1942 did not cure the type's problems. The design entered limited service in 1942, but was soon replaced by the Messerschmitt Me 410 Hornisse, a further development of the Me 210. The failure of the Me 210's development program meant the Luftwaffe was forced to continue operating the Bf 110 after it had become outdated, despite mounting losses.

Design and development
Messerschmitt designers had started working on an upgrade of the Bf 110 in 1937, before the production version of the Bf 110 had even flown. In late 1938, the Bf 110 was just entering service, and the RLM started looking ahead to its eventual replacement. Messerschmitt sent in their modified Bf 110 design as the Me 210, and Arado responded with their all-new Ar 240.

The Me 210 was a considerable departure from the 110, but used many of the same parts. The main differences were a modified nose area that was much shorter and located over the center of gravity, an internal bomb bay, an all-new wing designed for higher cruise speeds and a highly advanced remote-control defensive armament system that gave the gunner a far wider field of fire. On paper, the Me 210's performance was impressive: It could reach 620 km/h (390 mph) on two 1,350 PS (1,330 hp, 990 kW) Daimler-Benz DB 601F engines, making it about 80 km/h (50 mph) faster than the Bf 110, and nearly as fast as single-engine fighters of that era.

The Me 210's main landing gear followed some of the design philosophies that had resulted from the main change in the earlier Ju 88's main landing gear design, where each main gear had a single gear strut that twisted through 90° during retraction, to bring the main gear wheel resting atop the lower end of the main strut when retracted rearwards into the wing. Unlike the Ju 88, however, the Me 210's main gear wheels were inboard of the main gear struts when fully extended, whereas the Ju 88's were outboard of the struts.

The Bf 110 carried its ordnance externally beneath the wings and fuselage, but this created drag; the Me 210 avoided this problem by housing the bombs in an enclosed bomb bay, in the nose of the aircraft. The Me 210 could carry up to two 500 kg (1,100 lb) bombs. The Me 210 had dive brakes fitted on the tops of the wings, and a Stuvi 5B bombsight ("Stuvi"-Sturzkampfvisier, dive-bombing sight) in the nose, for shallow-angle dive bombing. In the fighter role, the bomb bay was fitted with four 20 mm cannons.

For defence, the Me 210's rear gunner was armed with two 13 mm (.51 in) MG 131 machine guns. Each of these was fitted into half-teardrop-shaped Ferngerichtete Drehringseitenlafette FDSL 131/1B turrets mounted on each side of the aircraft, and was remote-controlled from the gunner's position in the rear of the glazed cockpit area with a unique gun-aiming setup. This unit had a pivoting handgun-style grip, trigger and gunsight at its center, to aim the guns vertically—with both turrets elevating and depressing together when operated - and horizontally, in pivoting each gun separately, outward away from the fuselage side when aimed to one side or the other. The rear of the cockpit canopy's lower side glazing panels were bulged out to allow the gunner to see in almost any rearward-facing direction. The guns were electrically fired, and an electrical contact breaker acted as a form of "interrupter" as used on many forms of multi-engined, turret-armed WW II aircraft, preventing the gunner from shooting off the Me 210's tailplane.

An order for 1,000 Me 210s was placed before the prototype had flown. In time, this would prove to be a major error. The first prototype flew with DB 601B engines in September 1939, and was considered unsafe by test pilots. Stability was bad in turns, and it tended to oscillate, even while flying level. At first, the designers concentrated on the twin-rudder arrangement that had been taken from the 110, and replaced it with a new and much larger single vertical stabilizer. This had almost no effect, and the plane continued to "snake". The Me 210 also suffered from terrible stalls. With the nose up or in a turn, the stalls whipped into spins when the automatic leading-edge slats opened. The second prototype, Me 210 V2, was lost this way in September 1940, when the pilot could not get out of the resulting spin and had to abandon the aircraft. The chief test pilot commented that the Me 210 had "all the least desirable attributes an aeroplane could possess." It took 16 prototypes and 94 preproduction examples to try to resolve the many problems. Nevertheless, the RLM was desperate to replace the Bf 110s currently in service, and ordered full production in early 1941. The type exhibited grossly inadequate handling characteristics, and as a result, several elements of the airframe were redesigned, including lengthening the rear section of the fuselage by 92 cm (36-1/4 inches), designated as lang ("long"). The Me 210C was built with DB 605 engines, as well as incorporating the changes to the airframe. The Hungarian authorities were satisfied with the Me 210C in its current state, and purchased a production license for the type, to fill the role of the Varga RMI-1 X/H, designated Me 210Ca (a = ausländisch or 'foreign') as well as for its DB 605 engines. Several airframes were also purchased, to be completed in Hungarian factories for practice while the assembly lines were set up. Production started in the Dunai Repülőgépgyár Rt. (Danubian Aircraft Plant) as the Me 210Ca with the DB 605B engine, under an agreement where the Luftwaffe received two of every three produced.

The Me 210 was eventually developed into the Messerschmitt Me 410, with DB 603 engines.

Operational history
Deliveries to frontline units started in April 1942 and the plane proved to be even less popular with pilots. Production was stopped at the month's end by which time only 90 had been delivered. Another 320 partially completed airframes were placed in storage. In its place, the Bf 110 was put back into production. Although the Bf 110 was now equipped with the newer DB 605B engines and greater firepower, it was still an outdated design.

The Luftwaffe started receiving their Hungarian-built planes in April 1943, and the Hungarians in 1944; when they entered service they were more than satisfied with them. Production ended in March 1944, when the factory switched over to produce the Bf 109G. By that time, a total of 267 Me 210C had been built, 108 of which had been given to the Luftwaffe. The Me 210s of the Luftwaffe operated mostly in Tunisia and Sardinia and were quickly replaced by the Me 410.

Variants

 * Me 210 A-0
 * Pre-production aircraft.

 * Me 210 A-1
 * Two-seat twin-engined fighter-bomber and heavy fighter.

 * Me 210 A-2
 * Two-seat twin-engined dive bomber and heavy fighter.

 * Me 210C
 * Improved airframe, DB 605 engines.

 * Me 210 Ca-1
 * Hungarian-licensed production version of the Me 210C with Daimler-Benz DB 605B engines.

 * Me 210 Ca-1 (40 mm)
 * Some Hungarian Me 210 Ca-1s were modified to carry a 40 mm Bofors autocannon in the lower fuselage in order to destroy Allied bombers. In addition, these aircraft could carry 152 mm rockets (modified version of the Hungarian copy of Nebelwerfer 41) for ground attack. The 44M Lidérc anti-bomber acoustic proximity fused air-to-air rocket was under development for the Me 210, but the project was not finished before the fall of Budapest.

 * Me 210D
 * Improved Me 210C, project only

Operators

 * 🇩🇪 Germany
 * Luftwaffe operated 90 German-built Me 210A and 108 Hungarian-built Me 210 Ca-1.
 * Eprobungsgruppe(A) 210 (first testing unit)
 * Versuchstaffel 210
 * 3./SKG 210
 * 16./KG 6
 * 1.,2.(F)/Aufkl.Gr.122 (Me/DAF 210C-1 user)
 * FAGr 122
 * Stab/AG 22
 * II.,III.,7.,8.,9./ZG 1 'Wespe' (Me/DAF 210C-2 [Ca-1] user)
 * 10./ZG 26 (Me/DAF 210C-2 [Ca-1] user)
 * I.,II./NJG 1
 * NJG 101
 * 🇭🇺 Hungary
 * Royal Hungarian Air Force operated 179 Hungarian-built Me 210 Ca-1. The type was relatively successful against Soviet aircraft and the last Me 210s were destroyed by their crew at Parndorf (Hungarian: Pándorfalu) after the fall of Hungary in March 1945 due to the lack of fuel and spare parts.
 *  1° and 2° RKI Század "Villám" (Evaluation wing), RKI (Hungarian Aviation Institute)
 * 5/1.Légi Század "Bagoly" (NF Sqn)
 * 102.Gyorsbombázó, 102/1.Század "Sas"
 * 102.Gyorsbombázó, 102/2.Század "Tigris"
 * 102.Gyorsbombázó, 102/3.Század "Villám"

 * 🇯🇵 Japan
 * Imperial Japanese Army Air Service
 * received one aircraft (Me 210A-2 W.Nr.2350) bought in Germany for tests and delivered by U-boat. It was operated by the Testing unit of the First Tachikawa Air Army Arsenal.

title: Messerschmitt Me 210


text:
The Golden Hour (Maiya Williams novel)

The Golden Hour is a children's novel by Maiya Williams. It was first published in 2004 and is the first of the Golden Hour time travel series. It tells the story of Rowan Popplewell and his sister, Nina, who, while emotionally disturbed by the death of their mother, travel back in time to the French Revolution.

Plot summary
The Golden Hour tells the story of Rowan and Nina's adventures the summer after their mother's death. Thirteen-year-old Rowan's life is at an all-time low: his father has turned to drinking, the family business is becoming a financial disaster, they have had to move from their house to a small apartment, and his musically talented ten-year-old sister Nina has become withdrawn. When his two great aunts invite Rowan and Nina to spend the summer with them in Owatannauk, Maine, a small (fictional) town on the tip of the state, Rowan anticipates a very boring summer with the two elderly women. But when he arrives he finds strange things starting to happen: the aunts run a curio shop stocking some items so curious they even compel Nina to start speaking again.

Rowan and Nina meet two twins, Xanthe and Xavier Alexander, who tell them about an old abandoned resort that appears to be haunted. Instead, the resort turns out to be an elaborate time machine. Nina seems interested in using the machine to escape her troubled life, especially when Rowan tells her about the Enlightenment, a period of European history when superstition and church dogma began giving way to logic and reason, art and science made tremendous strides, and truth and beauty were celebrated. When Nina disappears the next morning, the older kids rush to the resort: as they suspect, she has used the time machine. But Rowan discovers that he has told his sister the wrong dates for the Enlightenment, and instead of directing her to Enlightenment France he has sent her into the middle of the violent French Revolution. Rowan, Xanthe and Xavier time-travel to the French Revolution to save Nina, meeting various historical characters along the way, and Nina ends up in New York at their bakery visiting their mom.

Characters

 * Rowan Popplewell: Rowan is a young man dealing with a great amount of stress. Because of his mother's death he has had to move with his father and sister to a small apartment where he has no room of his own. Before his mother died Rowan had many friends and a decent social life, but he now loses himself in video games to forget his problems. He describes himself as having a chest like a barrel, and being the kind of boy girls do not notice.

 * Nina Popplewell: Nina is Rowan's younger sister and, according to Rowan, "was a firecracker, always jumping with ideas." She has wild, uncontrollable black hair which tumbles over her shoulders and face.  Nina is also a musical prodigy, able since the age of three to play tunes she had heard from the radio on the piano.  After her mother's death, Nina "shut down".  She stopped speaking and became dormant to the point of Rowan claiming that "I have no sister". It is also indicated from the text that she is highly intelligent.

 * Xanthe Alexander: Xanthe is described as having many shoulder-length braids and almond-shaped eyes. It is indicated that she is highly attractive. She is intrigued by native cultures, living close to the land, but also things that are mystical, symbolic and mysterious. She is homeschooled, because she and her brother are too intellectually gifted to be accommodated with the public school system. She is described as highly logical.

 * Xavier Alexander: Xavier is also described as attractive, and is a born liar. He remakes himself to suit whatever purpose is at hand, he loves to embellish the truth and he has an ego the size of a barn. Xavier also seeks freedom, independence and adventure, themes resonant with the spirit of the Gold Rush. He, like his sister, is homeschooled due to his advanced intelligence. He and Xanthe are fraternal twins, and he is the comedian of the two.

 * Agatha Drake: Agatha is a very short and plump woman who Rowan thinks resembles a pumpkin. She has light brown hair that is always messy, likes to dress in bright colors, and it is implied that she can read minds. Agatha lives with her friend Gertrude Pembroke in Owatannauk, Maine, where she uses The Owatannauk's alleviators (time machines) to travel through time collecting various items for her and Gertrude's curio shop. It is noted in the book that she enjoys word games like Scrabble. She is a nun.

 * Gertrude Pembroke: Gertrude is a tall and gaunt woman with a deep, melodic voice. She lives with her friend Agatha Drake in Owatannauk, Maine. She is not as outgoing as her friend Agatha Drake, and often described as humorless. She dresses in more somber colors than Agatha does. It is noted that she enjoys the game of chess.

 * Otto: Otto is the robot from the Owatannauk's alleviators (time machines)

References to actual history, geography and current science
Parts of the novel's action are set during the French Revolution.

Publication history

 * 2004, United States, Amulet Books, ISBN 0-8109-4823-0, Pub date 1 April 2004, hardcover
 * 2006, United States, Harry N. Abrams Inc., ISBN 0-8109-9216-7, Pub date 1 April 2006, paperback

title: The Golden Hour (Maiya Williams novel)


text:
Emergency department

An emergency department (ED), also known as an accident and 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 provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the world's first specialized trauma care center was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky. It was further developed in the 1930s by surgeon Arnold Griswold, who 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 arrive 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 and 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. In such situations, the time in which the patient is treated is crucial. 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 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 recognized 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 (A&E) is deprecated in the United Kingdom but still in common parlance. It is also still in use in Hong Kong. Earlier terms such as 'casualty' or 'casualty department' were previously used officially and continue to be used informally. The same applies to 'emergency room', 'emerg', 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.

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.

In 2009, 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).

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.

Overuse and utilization management
Patients may visit the emergency room for non-emergencies, which typically costs the patient and the managed care insurance company more, and therefore the insurance company may apply utilization management to deny coverage. In 2004, a study found that emergency room visits were the most common reason for appealing disputes over coverage after receiving service. In 2017, Anthem expanded this denial coverage more broadly, provoking public policy reactions.

United Kingdom

All accident and emergency (A&E) departments throughout the United Kingdom are financed and managed publicly by the National Health Service (NHS of each constituent country: England, Scotland, Wales and Northern Ireland). The term "A&E" is widely recognised and used rather than the full name; it is used on road signs, official documentation, etc.

A&E services are provided to all, without charge. Other NHS medical care, including hospital treatment following an emergency, is free of charge only to all who are "ordinarily resident" in Britain; residency rather than citizenship is the criterion (details on charges vary from country to country).

In England departments are divided into three categories:
 * Type 1 department – major A&E, providing a consultant-led 24 hour service with full resuscitation facilities
 * Type 2 department – single specialty A&E service (e.g. ophthalmology, dentistry)
 * Type 3 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 were rising in the years leading up to 2020, and were hugely worsened during the COVID-19 pandemic that started in 2020.

In response to the year-on-year increasing pressure on A&E units, followed by the unprecedented effects of the COVID-19 pandemic, the NHS in late 2020 proposed a radical change to handling of urgent and emergency care, separating "emergency" and "urgent". Emergencies are. Urgent requirements are for. As part of the response, walk-in Urgent Treatment Centres (UTC) were created. People potentially needing A&E treatment are recommended to phone the NHS111 line, which will either book an arrival time for A&E, or recommend a more appropriate procedure. (Information is for England; details may vary in different countries.)

[Sudden] Cardiac Arrest
Cardiac arrest is a sudden (in most cases, unexpected) loss of heart function, breathing, and consciousness. This emergency usually results from an electrical disturbance in the heart that disrupts its pumping action, stopping blood flow to the rest of the body. It is different from a heart attack, where blood flow to a part of the heart is blocked. 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, Automated External Defibrillator (AED), and advanced life support as taught in advanced life support and advanced cardiac life support courses. Cardiac arrest is not a condition that can be self-diagnosed. It requires immediate medical attention and diagnosis by a healthcare professional.

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(es)
Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many U.S. 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 will be transferred to a psychiatric unit (in many cases involuntarily). In recent years, EmPATH units have been developed to relieve pressure on hospital emergency departments and improve the treatment of psychiatric emergencies.

Emergency departments are often the first point of contact with healthcare for people who self-harm. As such they are crucial in supporting them and can play a role in preventing suicide. At the same time, according to a study conducted in England, people who self-harm often experience that they do not receive meaningful care at the emergency department. Higher ambient temperature may also increase mental illness related emergency department presentations, particularly in females.

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 radiographers, 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, barriers to accessing care contribute to frequent emergency room use. The National Hospital Ambulatory Medical Care Survey looked at 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. However, subsequent studies have shown that identifying non-emergency visits based on discharge diagnoses is inaccurate because people commonly present for emergency care for other reasons and are assigned a diagnosis after testing and evaluation.

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. The probability of death increases each 3 minutes for 1% in case of major injuries in the abdomen part. (Journal of Trauma and Acute Care Surgery ) Equipment in emergency departments follows the prompt treatment principle with the least possible patient transfers from admittance to X-ray diagnostics. 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
A significant proportion of emergency patients are discharged after treatment, but many require admission for ongoing observation, treatment, or to ensure adequate social care before discharge. If patients requiring admission cannot be placed in inpatient beds swiftly, "exit block" or "access block" occurs. This often leads to crowding and can lead to delays in treatment for newly presenting cases ("arrival access block"). This is more common in densely populated areas and affects adult departments more than pediatric ones. Exit block can lead to delays for the patients awaiting inpatient beds ("boarding") and also for new patients arriving at an exit-blocked department. Proposed solutions include changes in staffing or increasing inpatient capacity.

Frequent users
Frequent emergency service users are individuals who present themselves at a hospital much more often than non-frequent presenters. Many frequent users are homeless individuals seeking shelter and food at the hospital. Federal laws and regulations in the United States, like EMTALA and HIPAA, limit the options of hospital personnel when an individual presents to the ER with a fabricated problem. These individuals do not account for a significant number of visits but typically require a disproportionate amount of hospital resources. 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 users and short-term housing for homeless patients recovering after discharge.

Telemedicine
A study found that telemedicine services in Saudi Arabia were effective in reducing emergency department overload by providing medical advice to patients with less urgent medical issues.

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 healthcare workers
According to a survey at an urban inner-city tertiary care center in Vancouver, 57% of health care workers were physically assaulted in 1996. 73% were afraid of patients as a result of violence, 49% hid their identities from patients, and 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

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.

title: Emergency department