Emergency Room

Squalls of injury and illness had, for nine hours, swept through the Dover General Hospital emergency room, buffeting Walt McConnell, the sole physician on duty, nonstop until, at 4:20 a.m., there was a pause. Somewhere out in the night, an ambulance carrying an apparent heart attack victim, condition unknown, raced toward McConnell. But so far, he had faced no deaths. Only pain and fear, such as: A writhing 94-year-old woman with blocked intestines. A pregnant, 15-year-old mother with amnesia from a kick to the head.

In South Jersey and across the nation, emergency rooms are filling beyond capacity, creating a crisis situation for physicians, nurses and patients. "It's a problem all over," said Debbie Apollonia, nurse manager at John F. Kennedy Memorial Hospital in Cherry Hill. In many instances, she said, people visit emergency rooms for problems that could be handled by a family doctor. Still, the patients keep coming. Kennedy's Cherry Hill Division treated more than 17,000 emergency patients last year.

Crozer-Keystone Health System will close the emergency room at its Community Hospital Division here on June 26, a move that is already drawing fire from community activists. Reacting yesterday to the impending move, the activists said at a news conference that seriously injured or ill people who would have used Community Hospital would now have to travel three miles to Crozer-Chester Medical Center in Upland. Community Hospital, at Ninth and Engle Streets in Chester, now has the closest emergency room for people who live on Chester's West End and in southwest Delaware County.

Usually the casualties of weekend brawls come to the emergency room of Kennedy Memorial Hospitals/Cherry Hill Division after they've been in a fight. But this fight was in the emergency room. Six people, including two police officers, were injured early yesterday morning after a free-for-all erupted in the waiting area of the emergency room, Cherry Hill police said. Several chairs were broken, a potted plant was damaged, and three people were booked on assault charges. According to the police account, the hospital staff called for help around 2:45 a.m. after John McArdle, 24, of the 400 block of East Park Street, Maple Shade, began shouting and cursing because he had been unable to see his brother in the emergency room.

As physicians across Pennsylvania continued for a second day their protest of the high cost of malpractice insurance, some patients seeking routine medical care found doctors' offices closed. Hospitals across the region reported no major problems and many reported emergency-room volume was normal, but in some places crowds in emergency departments were higher. Nearly 300 Chester County physicians marched to the county courthouse in West Chester, calling on the governor and state legislators to ease the malpractice crisis they say is forcing some of them to leave the state or stop performing high-risk procedures.

After dropping her boyfriend off for treatment at West Jersey Hospital- Camden's emergency room yesterday morning, an unidentified woman walked back to her car, took out a pipe bomb, and nonchalantly handed the device to a security guard, saying, "Here's the bomb. " The woman's spontaneous offering set off a whirlwind, resulting in the evacuation of the immediate area and ultimately in the detonation of the device by the Camden County Sheriff's Department's bomb squad. The metal pipe, which police said the boyfriend had intended to use for the Fourth of July, was wrapped in silver duct tape.

The Cumberland County hospitals whose emergency rooms were shut down by the state for three days last month will be monitored for at least two more months, based on an inspection this week that showed the hospital system had not put into place some improvements promised when health officials permitted the ERs to reopen. But the South Jersey Hospital Systems also won a reprieve yesterday when a federal agency that had deemed the emergency rooms at the system's Bridgeton and Millville Divisions dangerous and had initially threatened to cut off funds by tomorrow if improvements weren't made extended that deadline to March 10. The hospital system will be under state scrutiny until that time, when the federal Health Care Financing Administration will decide whether to continue Medicare and Medicaid funds - without which hospital officials have said the system would be forced to close.

Dr. Dudley Giles, eager for a few hours of sleep, keeps his eyes on the hospital clock ticking toward 4 a.m. "Four o'clock is my magic hour," says Giles. "If I can make it till 4 o'clock, I figure I'm pretty safe. " Giles is a trauma doctor in the emergency room at Temple University Hospital, the place where they try to plug the holes and sew up those who are stabbed, beaten and shot on the streets outside the automatic doors. Though violence is a round-the-clock affliction in Philadelphia, prime time tends to run from about 10 p.m. until 4 a.m. The victims are whisked off the streets by ambulances and rushed to emergency rooms with little notice.

Area hospital administrators said yesterday that they found last-minute solutions to avoid a New Year's Day shutdown of emergency room and trauma center services because doctors could not get malpractice insurance. St. Mary Medical Center, the only trauma center in Bucks County, and Brandywine Hospital, the only one in Chester County, said they would continue to provide services to seriously injured patients after their doctors got insurance. And administrators at other area hospitals, including Roxborough Memorial Hospital in Philadelphia and Riddle Memorial Hospital in Delaware County, said their emergency rooms would be adequately staffed today.

Breaking news: Physicians around the region aren't getting many swine flu visits. Therapists aren't seeing panicky patients. Emergency room visits were down slightly Tuesday and up slightly yesterday - allergies were the likely culprit. Experts say the seeming calm could change quickly if swine flu hits harder or closer to home. All the local connections so far - seven "probable" cases in New Jersey, 10 in Delaware and one in Philadelphia, the state's only case - were mild and remain unconfirmed.