NANCY NEEDHAM/Acorn Newspapers COMFORT AND CARE--Los Robles Hospital emergency room technician Hanna Carway does what she can to make sure that ER patients have clean, comfortable places to rest. Carway also assists the staff of doctors and nurses who treat about 3,000 patients per month in the ER. Patients seek treatment for ailments that range from colds and cuts and flu to life-threatening heart attacks. It's safe to say that no one is hoping for a reason to rush himself or a loved one to an emergency room.

Bad things do, however, happen. Cars crash. Children fall off swings. Soccer players sometimes kick other players instead of the ball. Hearts fail. Lungs collapse. People need blood and oxygen to survive.

Here's what to expect at the local emergency room:

Ambulances with sirens blaring may speed past other East County hospitals to hurry patients to Los Robles Hospital if the person on the stretcher shows specific signs of having a heart attack. A study by Ventura County Emergency Medical Services determined Los Robles is one of the facilities that can give cardiac patients a better chance of a positive outcome, Los Robles Emergency Service director Dianne Freeman said.

Other patients coming to the emergency room might be moms and dads who leave work at 5 p.m., pick up their children from daycare and realize later in the evening that one of their children or they themselves have an illness that needs to be treated by a doctor, according to Jim Sherman, Los Robles chief executive officer.

"Our busiest time seems to be from 5:30 to 10 p.m."

And, according to Freeman, "No one is ever turned away."

If it means they have to line gurneys in the hallways to serve everyone, the hospital staff will do whatever is necessary to take care of everyone who comes in, night or day, Freeman said.

"By law we have to see everyone who presents to the ER--we can't suggest they wait and see their doctor in the morning or go to an urgent care," Los Robles spokesperson Kris Carraway-Bowman said.

Even if the emergency room is packed with trauma patients who have to be seen first, she said, no one at Los Robles will tell someone with a cold that can be treated only with over-the-counter medicine and common sense to just go home and get some sleep. They are welcomed and allowed to wait to see a doctor, while those with more urgent problems are treated on a priority basis.

An uninsured patient treated at the hospital for an ear infection would be charged about $300, Carraway-Bowman said. Those who need more care could be billed by the hospital as well as by everyone who helped them--the pathologist who read their lab reports, the radiologist who looked at their X-rays, an anesthesiologist if they needed one, and their own physician if he or she came to the hospital to treat them.

The ER visit begins with an experienced nurse giving every patient a screening exam to decide the priority of care. This is called triage. The closer the patient is to a life-threatening situation, the faster they get to see a doctor. The majority of doctors are on duty from 2 p.m. to 2 a.m., with three on duty at a time, Freeman said. Only one doctor is on duty from 3 to 7 a.m., she said.

Most of the 3,000 patients the emergency room averages each month are considered level four or five patients. They are the ones who walk in on their own and have illnesses that can be dealt with in a short time and sent home, Freeman explained. These patients could have been seen in a doctor's office or clinic. When possible, the emergency room staff tries to run two separate systems of care so level four and five patients can be in and out more quickly.

The hospital hopes to have a dedicated clinic called a "fast track" with its own beds and staff for such levels of care in about a year, Sherman said.

Without such a clinic at this time, "we average a two-hour wait," Carraway-Bowman said.

The wait, of course, may be much longer. That's true at any hospital, Freeman said. She's had to wait in the ER at Cedars-Sinai Medical Center, a hospital in Los Angeles with a worldwide reputation, for seven hours, she said.

"Populations have risen and emergency rooms have closed. This is something all hospitals have to face," Sherman said.

Most counties assign hospitals rating levels. Although Ventura County is the only county in California that hasn't assigned levels that rate a facility's emergency care ability, Los Robles considers itself to be what Los Angeles County would rate as level two, Freeman said. A level-one center would have immediate surgical options available upon a patient's arrival.

Los Robles will have a surgeon on site within 30 minutes and be ready for surgery within one hour, she said.

Officials said the 38-year-old hospital is constantly trying to improve and is currently undergoing construction that began in 2004 and should be completed this spring.

The 265-bed acute care facility was built in 1968. The current $120-million expansion program will add a 200,000-square-foot patient wing with 90 private patient rooms, a two-story lobby and other updates that include an MRI machine. Until then patients will continue to be transported by ambulance a short distance down the road to have an MRI, Carraway-Bowman said.

The emergency room lobby is also to be revamped. Right now, those who walk in will find chairs and a TV mounted high on a wall in the corner. Better bring a book and some patience.