U.S. Emergency Medicine DOA

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Probe says U.S. emergency care in trouble By LAURAN NEERGAARD, AP

Medical Writer Wed Jun 14, 11:05 AM ET

WASHINGTON - Half a million times a year — about once every minute —

an ambulance carrying a sick patient is turned away from a full

emergency room and sent to another one farther away. It's a sobering

symptom of how the nation's emergency-care system is overcrowded and

overwhelmed, " at its breaking point, " concludes a major investigation

by the influential Institute of Medicine.

That crisis comes from just day-to-day emergencies. Emergency rooms

are far from ready to handle the mass casualties that a bird flu

epidemic or terrorist strike would bring, the institute warned

Wednesday in a three-volume report.

" If you can barely get through the night's 911 calls, how on earth

can you handle a disaster? " asked report co-author Dr. Arthur

Kellerman, Emory University's emergency medicine chief.

That ERs are overburdened isn't new. But the probe by the IOM, an

independent scientific group that advises the government, provides an

unprecedented look at the scope of the problems — and recommends

urgent steps for health organizations and local and federal officials

to start fixing it.

Topping that list is a call for coordinating care so that ambulances

don't waste potentially lifesaving minutes wandering from hospital to

hospital in search of an ER with room. The idea is to set up

regionalized systems that manage the flow much like airports direct

flight traffic. That also should direct patients not just to the

nearest ER but to the one best equipped to treat their particular

condition — making sure stroke victims go to stroke centers, for

example.

Other recommendations:

_Congress should establish a pool of $50 million to reimburse

hospitals for the unpaid emergency care they provide to the poor and

uninsured.

_Congress should ensure that more of the nation's disaster-

preparedness funding goes to the hospitals and emergency workers who

will provide that care. Typical government grants to hospitals for

bioterrorism preparation are $5,000 to $10,000 — not enough to equip

one critical-care room. When it comes to getting ready for a bird flu

outbreak, few hospitals even have the ventilation equipment needed to

isolate patients. And emergency medical services received only 4

percent of the $3 billion distributed by the Department of

Homeland Security in 2002 and 2003 for emergency preparedness.

_The board that accredits the nation's hospitals should establish

strong guidelines to reduce crowding and ambulance diversion.

At the root of the problem: Demand for emergency care is surging,

even as the capacity for hospitals, ambulance services and other

emergency workers to provide it is dropping.

There were almost 114 million emergency room visits in 2003, up from

90 million a decade earlier. During the same time, the total number

of U.S. hospitals decreased by 703, and the number of ERs by 425. And

the total number of hospital beds nationwide dropped by 198,000, as

hospitals strive toward more outpatient care — which in turn leaves

fewer beds for ER patients to move into when they're seriously ill.

Too often, busy ERs stabilize those patients and then have to leave

them lying on gurneys in the hallway for 48 hours or more until a

room becomes available and they can be admitted to the hospital.

That's not only a time of misery for the patient, but it means less

timely care and potentially poorer care, without the specialized

equipment and expertise available to inpatients, the report found.

Children have even scarcer help. They make up more than a quarter of

all ER visits, yet one survey found only 6 percent of emergency

departments had all the supplies needed, such as child-size

equipment, to treat them.

Before getting to the hospital, the EMS system — emergency medical

services that include ambulances and paramedics — is fragmented. How

well-trained and prompt local paramedics are varies greatly; there

are no nationwide standards. Many ambulance services can't even

effectively communicate with hospitals or other first responders

because of antiquated equipment.

The American College of Emergency Physicians called the report

groundbreaking but said Congress must heed recommendations to fund

the necessary improvements.

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