Seacoast fire chiefs support freestanding ERs: Expanding emergency care in New Hampshire

As first responders, fire and EMS teams meet people on some of the worst days of their lives. When someone is experiencing chest pain, stroke symptoms, difficulty breathing, or another medical emergency, the most important things we can provide are speed, clinical capability, and a clear path to the right level of care.

That is why it is important to educate our communities about freestanding emergency rooms (FSERs) and the role they play in the emergency care system. The concept is simple: a freestanding emergency room is an emergency room. These facilities are open 24 hours a day, seven days a week, staffed by board-certified emergency physicians and emergency-trained nurses, and equipped with on-site laboratory services and imaging. They are designed to evaluate and treat emergency conditions, and when a higher level of care is necessary, patients can be stabilized and transferred safely to a hospital.

Before 2017, emergency care in New Hampshire generally meant transport to a hospital emergency department. Patients may have had preferences, but in many communities, there were limited options for receiving emergency-level care close to home. That changed in June 2017, when HCA Healthcare opened the state’s first freestanding emergency room in Seabrook. It introduced a new model that brought emergency care directly into the community. Since then, additional freestanding emergency rooms have opened in Dover and Plaistow, with another planned for Nashua.

From the perspective of those of us working in the field, the greatest benefit is clear: time matters. Freestanding emergency rooms can reduce travel times for patients who live farther from a traditional hospital emergency department. That can mean faster access to evaluation and treatment, and less time spent in an ambulance on the road. For families, it also offers peace of mind in knowing that emergency care is available nearby, day or night.

FSERs also help support a more efficient emergency care system overall. Hospital emergency departments must always prioritize the most critical patients, including those in cardiac arrest, suffering major trauma, experiencing severe strokes, or facing life-threatening bleeding. That is exactly how the system should work. But it can also mean that patients with serious, painful, or frightening symptoms that are not immediately life-threatening may face longer waits in a hospital setting. Freestanding emergency rooms provide another access point for emergency-level care, helping ease pressure on hospital emergency departments and improving access across the system.

“Every minute counts in an emergency. Patients are transported to the most appropriate available facility based on their status. Freestanding emergency rooms can be a part of that care, reducing transport and turnaround times for first responders.” Russell Osgood, President, Seacoast Fire Chiefs Mutual Aid District.

In many cases, patients have a say where they receive emergency care. Major trauma however is an exception where EMS must follow trauma protocols and transport to the closest appropriate trauma center, since not every emergency department is equipped for that level of injury. In non-trauma situations, patients often could choose whether they want to go to a freestanding emergency room or a hospital emergency department, and in many cases which hospital system they prefer. If a transfer is later needed from an FSER to a hospital for more specialized care, patients can also share their preference for where that care continues.

That is how it should be.

Freestanding emergency rooms were designed with the patient in mind: to bring emergency care closer to home, reduce strain on hospital emergency departments, and ensure patients can be stabilized and transferred efficiently when a higher level of care is required. With freestanding emergency rooms now operating in Seabrook, Dover, and Plaistow, and another expected soon in Nashua, New Hampshire residents have more emergency care options than ever before.

For those of us who answer the call, that is a good thing. It means more access points for emergency care, quicker access for patients, and a stronger ability to deliver what matters most in a crisis: the right care, in the right place, at the right time, while honoring the patient’s needs and choice.

The Seacoast Chief Fire Officers Mutual Aid District, representing 51 fire chiefs across Seacoast communities, including 38 in New Hampshire