Early in civilization, as individual family units developed into societies, Hippocrates wrote of medical details we now call nursing tasks. ⁹ From one generation to the next, technical aspects of medicine and nursing were passed on, usually through oral teachings and direct observation. In European history, accounts of establishing hospitals for the ill and injured occur in the twelfth century and describe categories of nursing staff. Although accounts of specialized training do not exist, it can be assumed that some training existed in a more coordinated process. Greek history provides reports of emergent care during wars of the fourteenth and fifteenth centuries. ¹⁶ Other commentaries from this era describe nursing care delivered by monks and nuns. By the 1600s the French Sisters of Mercy was one of the first organized nursing orders that responded to care for epidemic victims. ⁸

At the beginning of the nineteenth century the first reports of organized trauma care during the Napoleonic wars were described. Casualties were treated in the field, and a system of evacuation by ambulances was created. ¹⁵ Within this new military medical model, an organization of caregivers also had to be created from male soldiers, who were assigned to the work. Later in the century, in reporting the American Civil War, many sources cite the role of Clara Barton and Dorothea Dix in organizing voluntary nurses to care for wounded solders. Barton’s nursing experiences on the front lines of battle are well chronicled. ^{6. and 13.} Less than 10 years earlier, Florence Nightingale had led her nurses to the Crimea to support the British Army. Throughout her career, Nightingale recognized the foundation of the nursing role: individualized attention to the ill and injured, cleanliness, provision of good food and water, pain relief, and the importance of human caring touch. It was Nightingale who defined modern nursing with scientific process, quality control measures, and formal education. ⁶

In the early twentieth century American nursing was becoming organized and recognized as a profession. Hospital-based schools of nursing, based on Nightingale’s design, combined the art of nursing with developing scientific principles. Wars and epidemics continued to give nurses the experience of caring for the emergently ill and injured. Over 23,000 nurses served in World War I according to the Red Cross. ¹⁷ As the war ended and the Spanish influenza pandemic increased, the Red Cross nurses transitioned from caring for the wounded to caring for victims of the influenza disaster. ¹ In World War II professional nurses became part of the military, and specific training programs on caring for the injured were taught to nurses. The Vietnam War led to further recognition of trauma as a leading cause of death and disability. Experiences gained from advances in trauma care, development of antibiotics, and improvement of triage contributed to better postwar civilian emergency care. ⁶

After World War II the practice of medicine and the focus of hospitals were changing. Because most of the care was delivered in the community and prehospital care was ill defined at the time, private hospital emergency departments (EDs) were underutilized and staffed on an “as-needed” basis. Only public hospitals that served predominately indigent patients devoted staff resources to their EDs. Interns and resident physicians in training provided a majority of the medical care. During the 15 to 30 years after World War II, the increase in use of EDs was due to the changing dynamics of health care. The prewar medical practice of the “family doctor” primary care provider model was changing into a more specialty-based model, which led to less availability of primary care providers. The practice of medical providers being available continuously to their patients changed into directing patients to EDs for after-hours care. Hospitals were changing into community sources of help and information instead of institutions only for the seriously ill and injured. ¹⁸ As more patients arrived in EDs, hospitals were forced to assign increasing numbers of nursing staff to provide care. Even though the role was not well defined, only the most experienced nurses were selected for ED “duty” because of the unexpected, episodic nature and acuity of patient care.

At the same time as EDs were becoming more recognized as prominent care delivery areas in hospitals, transport of patients to hospitals for care was also gaining attention. Community leaders and the medical community realized that the lessons learned from World War II and the Korean conflict about triage, field care, and rapid transport could be translated into civilian practice. The military had developed training programs for field medics to initiate care and had refined transport strategies. In addition to ground ambulances, helicopter transport of injured soldiers was initiated in Korea. Legislation was created in the 1960s to establish community and educational programs leading to modern emergency medical services. Development of space-age technology, such as telemetry and portable defibrillators, also contributed to the growth of emergency care. As a result of these historical dynamics, emergency medicine and nursing became recognized specialties.

By definition, emergency nursing is the care of individuals of all ages with perceived or actual physical or emotional alterations of health that are undiagnosed or require further interventions. Emergency nursing care is episodic, primary, usually acute and occurs in a variety of settings. ²

Alliance or affiliation with a specific body system, disease process, care setting, age-group, or population defines most specialty nursing groups. In contrast, emergency nursing is defined by diversity of knowledge, patients, and disease processes. Emergency nurses care for all ages and populations across a broad spectrum of diseases and injury prevention, lifesaving, and limb-saving measures. Emergency nursing practice requires a unique blend of generalized and specialized assessment, intervention, and management skills. The multiple dimensions of emergency nursing specify roles, behaviors, and processes inherent in the practice and delineate characteristics unique to the specialty. Practice area, patient population, and the variety of those who provide care are as diverse in emergency nursing as in the nursing profession as a whole. Emergency nursing practice is systematic and includes nursing process, nursing diagnosis, decision making, and analytic and scientific thinking and inquiry. Professional behaviors inherent in emergency nursing practice require acquisition and application of a specialized body of knowledge and skills, accountability and responsibility, communication, autonomy, and collaborative relationships with others.

The scope of emergency nursing practice encompasses assessment, diagnosis, treatment, and evaluation. Resolution of problems may require minimal care or advanced life support measures, patient and/or family education, appropriate referral, and knowledge of legal implications. Care delivery occurs where the consumer lives, works, plays, and goes to school. Box 1-1 identifies multiple practice areas for emergency nursing.