Beat the clock: saving--or losing--a patient is often just a matter of minutes in UNC Hospitals' emergency department.

• Author: Vora, Nirav
• Position: Picture this

It may have been his first ride on a helicopter. But, unconscious after driving his truck over an embankment the height of a three-story building, he won't remember his noisy landing on the roof of the hospital. Another patient--a paralyzed stroke victim--makes his way by ambulance, with its siren screaming an urgency that he can't.

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More than 51,000 patients a year--nearly 140 a day--come to the emergency department of UNC Hospitals in Chapel Hill. Some walk in with nothing more than sniffles. "You no longer get admitted to figure out what you have," says Dr. Judith Tintinalli, chair of emergency medicine. "We have it all figured out in the emergency department."

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For many, though, this is where speed and technology mean life or death, where survival depends on the golden hour--the first 60 minutes after a heart attack, stroke or serious injury. "About 85% of our patients," Tintinalli says, "are placed in an examination room within 30 minutes of triage," the process of sorting cases by their severity. Sometimes that's simple. Often, one of the nearly 20 specially trained emergency-medicine doctors who rotate through the emergency department may simply be treating a feverish infant whose parents have nowhere else to turn.

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Frequently, the cases are more critical. Tintinalli and Wes Wallace, another emergency-medicine specialist, bend over a young worker rushed into the hospital after a tree he was cutting fell on his chest. Tintinalli and Wallace describe his injuries as a classic flail chest, in which ribs--front and rear--are smashed. A lung has collapsed. His condition is grim.

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Sights and sounds fill the night. Phones ring. Doctors huddle with relatives in hall-ways. A balding man on a gurney stares glumly, breathing oxygen through a clip in his nose. He complains of chest pains. Souvik Sen, director of the hospital's stroke...