Crisis declared in U.S. emergency care


ORLANDO, Fla. -- The nation's emergency medical system is in crisis, with crowded ERs turning away ambulances, patients waiting hours to be treated and a shortage of on-call specialists.

A three-volume report published yesterday found that the system is barely able to meet daily demands, let alone the potential onslaught of patients from a disease outbreak or terrorist attack.

The Institute of Medicine, which spent two years investigating the problems, found gaping holes in the "safety net" for the critically ill and injured.

"You may not be caught and saved when your life depends on it," said Dr. A. Brent Eastman, a member of the institute's emergency-medicine committee and chief medical officer for ScrippsHealth in California.

In its report, the institute documented the crisis nationally, noting that hospital emergency departments received nearly 114 million patients in 2003, for a 26 percent increase in volume during the past decade. During that period, the country lost 425 emergency departments.

In releasing the document in Washington, committee members said they spent nearly $3 million, commissioned 11 studies, visited hospitals, held hearings and interviewed many experts. The institute is part of the private, nonprofit National Academy of Sciences, which advises the federal government on medical, scientific and technical matters.

For this report, the institute focused on three areas: hospital emergency departments; the special needs of pediatric patients in emergency medicine; and EMS or emergency-medical services provided by paramedics and other first-responders.

In many communities, the institute found multiple EMS providers, with private ambulance services, public agencies, fire departments and other groups treating patients at the scene and transporting them to hospitals. The report said agencies can't coordinate well because of incompatible communication systems and, at times, entrenched rivalries.

"As citizens, we all assume that [the emergency-medical system] is similar to what we see on television, but the reality is that could be much different than that," said Nels D. Sanddal, a member of the institute's committee and president of the Critical Illness and Trauma Foundation in Montana. "It can be a system that is fraught with inefficiencies and plagued with infighting between agencies."

Sanddal and others said that national standards must be developed for EMS care and that the practices of first-responders need to be studied to determine what works best in helping patients survive.

Looking inside hospital emergency departments, the institute documented rising problems with overcrowded ERs, which often force hospitals to turn away ambulances. The diversion of patients from one hospital puts added stress on others in the community, said Dr. Arthur Kellerman, a committee member and chairman of emergency medicine for Emory University School of Medicine.

He said ERs are taxed by the nation's 45 million uninsured, who often have nowhere else to turn. Hospitals end up losing millions annually in uncompensated care, which contributes to the shuttering of emergency departments, Kellerman said.

Robyn Shelton writes for the Orlando Sentinel.

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