However, these findings have been tempered by a number of barriers. Not all EDs have access to the same equipment, and ability to monitor hemodynamic parameters invasively varies widely [74] . Another unresolved issue is that not all ED physicians have the necessary resuscitation skills to administer optimal treatment, as observed in ICUs [75] . Additionally, a number of recent reports have identified the fact that EDs are increasingly overburdened. This can compromise the quality of care delivered to patients, especially those who require highly technical care that many ED physicians do not have time to practice because of everincreasing numbers of patients [76] [77] [78] .