HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Wednesday, June 14, 2006

Emergency-Care Shortage

The Institute of Medicine issued several reports on its recent major investigation concerning the nation's emergency-care system and concluded the system is "at its breaking point."  From the Institute's website:

The Institute of Medicine's Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision.  Their findings and recommendations are presented in three reports::

  1. Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers.
  2. Emergency Medical Services At the Crossroads describes the development of Emergency Medical Services (EMS) systems over the last forty years and the fragmented system that exists today.
  3. Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children.

The Associated Press summary of the reports states:

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.

The report states that the demand for emergency care has increased dramatically over the past decade while the number of ambulance services, hospital capacity and emergency workers dropped.

I am not hopeful that Congress will act on this report -- seems that flag burning prevention is a bigger priority  -- but perhaps I will be pleasantly surprised.  [bm]

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