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By Frank Parlato Jr.

Several years ago under the direction of Joseph Ruffolo, president of Niagara Falls Memorial Medical Center, a determination was made to improve the Emergency Department (ED).

According to hospital records, between 70 and 80 percent of admissions come into Memorial through the "front door," the ED, which is not unusual for hospitals similar in size and demographics to Memorial, a "safety net" hospital that serves mainly Medicaid, Medicare and uninsured patients.

Ruffolo decided that Memorial's ED should rival, if not surpass, more affluent hospitals.

He began by replacing the scheduling of doctors who worked various shifts to cover the Emergency Room (ER) and subcontracted instead with a physicians group called FDR Emergency Medical Services to provide physicians for the 24-hour coverage needed for the hospital's ER.

The medical director, Dr. Gerald Gorman, and his team brought an expertise that Memorial never had before. FDR physicians, unlike the staff at ERs at other hospitals in the area, are all residency and fellowship-trained in emergency medicine and are board-certified.

Emergency medicine has matured as a specialty, while previously it was considered to be the domain of moonlighters.

In the past at Memorial -- and it is still the norm in many hospitals -- ER doctors were often trained in other specialties. They might be orthopedists, family practitioners or internal medicine doctors who work an ER, sometimes as a second income, after having worked in private practice someplace else.

Ruffolo recognized that ER specialists were needed at Memorial, considering the challenging demographics of the population the hospital serves.

Even under the best of circumstances, ER doctors live on the edge. They are the kind of people who like to be in the middle of the action, who like to tackle tough challenges and expand their skill sets.

At any time, a patient can present with cardiac arrest, stroke, broken bones, blunt-force trauma, shotgun wounds, stabbing wounds, fractures, dislocations, lacerations, psychiatric problems, run-of-the-mill head bumps, a non-threatening stomachache, sore throat, chronic respiratory disease, asthma, chronic obstructive pulmonary disease or urgent chest pain.

The quick decision to refer a patient to intensive care might mean life or death.

When you walk into the ER at Memorial, you're going to be treated by a physician trained in Emergency Medicine as his specialty.

Under Ruffolo, the ER also expanded in size.

In early 2006, about the time Memorial completed its new building that included the Heart Center of Niagara, the entire first floor became the ER, with 22,000 square feet. The fast-track area has six rooms, 12 monitored rooms and the "Code Room," where people who are critical go. There are 20 beds total and stretchers in the hallway.

Ruffolo next sought and accomplished a series of improvements to the ER, making it, in spite of the fact that Memorial serves a poor population, an ER that indeed rivals the most well-funded in the nation, done without dedicated government funding, but through private grants and fundraising.

It is really quite a tale in this day of the nanny state and of our own spendthrift mayor, who doles out public money to campaign contributors and then raises our taxes. In this declining city -- which happens also to be the highest taxed in the country in proportion to the value of its residents' real estate -- a community-based, unfunded-by-government hospital like Memorial not only survives but offers superior services.

If Joe Ruffolo could lead a hospital to build an ER in the broke and desperate, obscenely overtaxed community that is Niagara Falls, N.Y. -- without, I remind you, government assistance -- then any one of us here can rise to some kind of excellence.

The ER has a portable ultrasound machine with built-in X-Ray -- so doctors can move machines to ailing patients, rather than vice versa -- and computers on wheels to do documentation at bedside.

Upstairs is the Heart Center, where Memorial provides 24-hours-a-day cardiac care to ER patients with two of the most advanced non-invasive diagnostic modalities available -- PET scanning and a CT scanner.

There may be no other hospital in the world with 24-hour cardiac care with these advanced technologies perched above an ER.

Emergency Room doctors at Memorial are able to call in a neurologist, an endocrinologist or a surgeon 24 hours a day.

Memorial's ER helped qualify the hospital to be first in Niagara County to become a New York State Certified Stroke Care Center. As services grew, so did the patients coming to the ER, jumping from 23,000 annually to close to 30,000 last year.

Whether it's emergency care, acute inpatient care, outpatient primary care or diagnostic services, Memorial offers programs and intervention to get appropriate help for patients. Memorial opened three physicians offices -- in Wheatfield, on 10th Street in Niagara Falls and on Grand Island -- to improve accessibility for patients to primary care.

One of the standout moves that helped make this ER a premier one was the appointment of Gerald Gorman as chief of emergency services.

A graduate of Cornell University and Georgetown University Medical School, Dr. Gorman completed his residency in Emergency Medicine at the University of Buffalo School of Medicine and Biomedical Sciences, and was an attending physician in the emergency department at Mercy Hospital, Buffalo.

Dr. Gorman told the Reporter that he chose ER work as opposed to potentially more lucrative private practice "for the medical challenges."

"Lives are saved in emergency rooms," he said. "It is also true that not every person who comes into the ER can be saved. The illnesses, accidents and injuries an ER must be prepared for every minute of the day are numerous and challenging, but the practice is rewarding."

Fortunately for residents of Niagara Falls, their hospital has a skilled and experienced staff trained in Emergency Medicine, and equipment and technology that hospitals in more affluent cities possess.

Niagara Falls Memorial Medical Center and its ER is a Niagara Falls success story.

Niagara Falls Reporter www.niagarafallsreporter.com April 19, 2011