Few places in Burlington are open 24-7, but the emergency department (ED) at University of Vermont Health-UVM Medical Center is one of them. “It’s an incredible community resource,” said Ernie Pomerleau, an outspoken ED advocate. “We need to do everything we can to support it and ensure it’s there for all of us when we need it the most.”
Dr. Julie Vieth, medical director and vice chair of clinical operations, says staff see people “on their worst day.”
Anyone who has sat in the waiting room knows the other side: the wait. The team doesn’t make excuses. They’ve worked for years to improve timely access, and it’s paying off.
Vieth and nurse manager Matt Looft, RN, gave us a behind-the-scenes tour of the state’s only Level I Trauma Center. Vieth arrived in hot pink scrubs and sparkly clogs, radiating positivity; Looft, calm in standard blue, quipped, “I’m usually dressed in lumber casual.”
Looft, a UVM graduate and former EMT, has been at the hospital since 2007. Vieth, an EMT turned nurse turned physician, worked through the worst of the COVID-19 pandemic in a rural New York ED that saw a death every day, and came to UVM Medical Center in 2022. Taped beside her office door is a picture of Noah Wyle as Dr. Robby from “The Pitt,” reminding everyone to wash their hands. She hasn’t watched the show, since it would bring back too many memories, but hears it’s the most accurate medical drama on TV.
Making it Work
The current ED was built in 2005 for 40,000 visits a year. In 2025, it saw 70,000, thanks to continuous innovations that maximize every square foot. Overall, the patients who come through the ED are older and sicker, reflecting Vermont’s aging population and the nation’s worsening health care affordability crisis that causes too many people to delay care. Further, more and more patients arrive experiencing a mental health crisis, struggling with substance use or without a place to live.
During the pandemic, staff turned storage space into a patient area with curtained beds. “It’s not ideal, but it’s still better than a hallway,” Vieth said. Two nurses share desks in a windowless former shelf space: “They literally function in a closet,” Vieth said. Today the ED has 65 beds and sees 200 to 225 patients a day, up to 117 at once. “We have no more walls we can break down,” according to Vieth.
Working on the Wait
Every improvement has had to fit inside the ED’s current, finite space. Even so, patient numbers are up, which in turn can increase wait times. It’s a constant challenge to reimagine how patients could move through the department more efficiently.
- Vertical care (launched April 2026): Patients who are well enough to sit up, such as those with a possible broken wrist, a bad cut or abdominal pain, are treated in recliners instead of waiting for a room. This helps them be seen faster and keeps beds open for the sickest patients. For everyone in between, it means being seen sooner, with more privacy than a waiting room, and bloodwork, medications and imaging can start more quickly. “We knew we needed to try something different,” Vieth said.
- Pediatric waiting area: Funded by philanthropy, this quieter, private space with Minions on the walls and Disney Channel on TV keeps sick or hurt kids away from adults in crisis. Pediatrics-trained physicians, nurses and a child life specialist support kids and their families.
- Community partnerships: Social workers, on hand 16 hours each day, work with nursing homes and community agencies so patients ready to leave have somewhere to go. The ED research team and Turning Point Center bring mental health and substance-use disorder services to the bedside.
“Patient volumes are increasing, patient complexity is increasing, and we live in an aging state,” Vieth said. “More space would allow us to see more patients, more efficiently and more comfortably.”
No One Turned Away
On any given day, 50 to 70 people work in the ED, from nurses, doctors and techs to security, pharmacists, social workers and environmental services staff. Whether patients arrive by ambulance (as 20 to 30 percent do) or on foot, expert triage nurses assess stability and assign a severity score. “Ideally, we don’t want anyone to wait, but we know many will need to. The triage system helps us determine who we think can safely wait,” Looft said.
Critical patients follow a red line to the trauma and acute care area; others follow green and yellow lines to semiprivate rooms. At the calm core of the ED, security monitors the department while the charge nurse tracks arrivals and departures like an air traffic controller.
The team strives to see every patient as a friend, neighbor or loved one, focusing not just on what’s wrong but also on what the patient is experiencing. That care often extends past the ED’s doors. On the coldest nights last winter, some people came in just to get warm, and staff members often send patients off with donated coats, boots, socks, sleeping bags and even tents. “We fill in those gaps,” Looft said. This August, emergency providers and community paramedics also launched a Street Medicine program with a philanthropically funded mobile clinic.
One of a Kind
UVM Medical Center is both an academic medical center treating the region’s most complex cases and the community hospital for greater Burlington. Few hospitals play both roles, and the ED is where they meet. The same team that treats a neighbor’s sprained ankle takes in critically ill and injured patients from smaller hospitals and rescue squads across 40,000 square miles, serving 1.2 million people, from northwestern New Hampshire to the Adirondacks.
“There is no other hospital emergency department like this one,” Looft said. All the more reason to keep it going strong.
Where to go when you need care
- Emergency Department or 911: Chest pain, trouble breathing, signs of stroke, severe bleeding, serious injury or mental health crisis.
- Urgent care: Minor injuries and sprains, minor cuts, flu-like symptoms, ear infections, and other problems that can’t wait but aren’t life-threatening.
- Primary care provider: Ongoing conditions, prescription refills and health questions.
- Telemedicine: Colds, rashes and other minor concerns you can handle from home.
This article appears in Winter Preview • 2026.
