[Emergency Room, a strategic resource for population health]

In Italy, 609 active hospitals with Emergency Rooms or first and second-level Emergency Departments (DEA) see attend to approximately 20 million people annually. The number of visits to the Emergency Department per 1,000 inhabitants varies significantly from region to region, as do the main indicators of functioning and outcome. After several decades of organizational and professional growth, culminating in the activation of the Schools of specialization in emergency medicine, the Italian emergency departments are currently going through a period of crisis that has worsened following the Covid-19 pandemic. The demanding and risky characteristics of this work environment along with the impossibility of carrying out freelance activities have pushed young doctors to prefer other disciplines, leaving approximately 75% of the specialization grants unfilled. The workload of the Emergency departments is directly related to the crisis of territorial medicine which is proving increasingly unsuitable to respond to the health needs of citizens in an era of tumultuous epidemiological and technological changes, and to the heavy reduction in hospital staff and bed capacity number of beds throughout the country. This review aims to briefly retrace the recent history of the Italian PS, underline the importance of its performances, both in response to the most serious conditions of clinical emergency and in support of the most fragile segments of the population, and propose some lines of intervention that could support a health institution of fundamental public interest.