As a paramedic in a major metro area... The ED in the larger hospital near me where we take most of our patients (a Level 2 Trauma Center which, for the benefi

As a paramedic in a major metro area... The ED in the larger hospital near me where we take most of our patients (a Level 2 Trauma Center which, for the benefit of simplification is essentially a Level 1, without teaching facilities attached) about 8 years ago (say 2-3 before COVID) had 4 "pods", A-D, A and B on one side, registration, waiting, intake, in the middle, and C and D on the other (they formed something of a horseshoe around the intake area). Each pod had 10 rooms (they don't have ward style multiple patients to a room). It used to be that C and D pods were "peak hours only", and after 3 or 4pm, there were no patients, and the lights were down. Then things changed. C and D pods run 24/7 now. And there are 24 "hallway beds" which are typically lower acuity patients literally on gurneys in the halls, one in front of each room. Then the psych holding area (5 secured rooms) started overflowing. Patients are now given gowns and scrubs based on their needs. A shocking number of the hallway beds are brown scrubs, which indicates mental health, often with a hold in place (i.e. they are not "free to leave", until evaluation and treatment plan has been determined, as a threat to themselves or others). Oftentimes this means finding an inpatient bed elsewhere. I have, tragically, watched frequent fliers with severe mental illness wait multiple days on a hallway bed. Nothing to read, watch, look at. No rest. No pause from the chaos. At least in a room, you can have a curtain drawn, lights dimmed. Not in the hallway. 24/7 we're wheeling patients by you as EMS, conversations at nursing stations. For me, perfectly "sane", that would drive me to the brink, to someone already in crisis ... The only "solution" that is compatible with that environment is sedation. (To be clear, it is not a solution, just the only one compatible then and there). > hospitals' tendency to prioritize elective surgeries (these make more money). At least this hospital, and a couple of others I know in the near region, hospitals have expanded their outpatient surgery and elective surgery, already in its own building, to include inpatient, too, so those patients are not taking up room for admissions out of the ED.