Developing Advanced Emergency Units in Remote Areas (in Jordan)– Concept Inspired by Freestanding EDs (USA)
Developing Advanced Emergency Units in Remote Areas (in Jordan)– Concept Inspired by Freestanding EDs (USA)
Key notes :
• Freestanding Emergency Departments (Freestanding EDs) are independent 24/7 emergency facilities located outside hospitals, yet equipped with hospital-level diagnostic capabilities.
• Developed in the United States to address ED overcrowding, improve access in remote areas, and accelerate diagnosis of time-critical emergencies such as chest pain and stroke.
• This model is rapidly expanding in the U.S., representing ~11% of all emergency departments nationwide.
Core Structure and Diagnostic Capabilities
• Designed to manage 80–90% of common emergency presentations, while severe cases are transferred to larger hospitals.
• Typical diagnostic tools include:
– ECG
– Emergency laboratory testing (troponin, CBC, electrolytes)
– X-ray
– Ultrasound / POCUS
– CT imaging in many centers
• CT capabilities often include:
– Non-contrast CT
– Contrast CT angiography for emergencies, including:
– Stroke
– Pulmonary embolism (CTPA)
– Aortic dissection
– Trauma
• CT imaging is crucial because three life-threatening conditions require rapid exclusion:
– Stroke
– Pulmonary embolism
– Aortic dissection
• Patients needing PCI, surgery, or intensive care are rapidly transferred to tertiary hospitals.
Potential Adaptation (for Jordan)
• The Freestanding ED concept could be adapted into advanced emergency units in remote areas, integrated with EMS and PCI centers within the National Chest Pain Protocol.
• Such units could also function similarly to Chest Pain Units or early Stroke assessment centers.
• This approach may significantly reduce emergency department crowding in major cities such as Amman.
Strengths Supporting Implementation in Jordan
• Well-developed network of cardiac catheterization centers.
• National EMS system operated by Civil Defense.
• Growing use of clinical protocols and national registries.
• Meanwhile, hospital EDs in major cities frequently experience overcrowding and delays, particularly during peak hours.
Potential Clinical Roles
Rapid Chest Pain Assessment
• Evaluation of suspected acute coronary syndrome using:
– ECG
– High-sensitivity troponin testing
– CT imaging when needed.
• Low-risk patients may be safely discharged.
• High-risk patients transferred directly to PCI-capable hospitals.
Stroke Assessment
• CT imaging allows rapid identification of:
– Ischemic stroke
– Hemorrhagic stroke
• Eligible patients can be transferred quickly for thrombolysis or thrombectomy.
EMS Integration
• Civil Defense EMS could transport patients to the nearest appropriate emergency unit, reducing congestion at tertiary hospitals.
Potential Benefits for (Jordan)
• Reduced overcrowding in major hospital emergency departments.
• Faster diagnosis of cardiovascular and neurological emergencies.
• More efficient use of hospital beds and specialized centers.
• Improved patient access and shorter waiting times.
• Better triage and rapid transfer of critical patients.
• Supports national initiatives such as the Jordanian Chest Pain Protocol and STEMI transfer networks.
Key Considerations Before Implementation
• Establishing a regulatory framework for independent emergency facilities.
• Integration with EMS transport systems.
• Clear transfer agreements with referral hospitals.
• Adoption of standardized clinical protocols.
• The Freestanding ED model represents an efficient, protocol-driven emergency care system combining rapid diagnostics, early triage, and targeted transfers.
• With careful planning and integration into existing EMS and hospital networks, this model could offer a practical and cost-effective strategy to strengthen emergency cardiovascular care (in Jordan), especially in remote or underserved regions.
