U.S. Emergency Rooms Not Prepared for Crises

U.S. emergency rooms are understaffed, overwhelmed and unable to cope with a crisis, whether a pandemic, attack or natural disaster, according to reports released Wednesday.

Americans rely heavily on emergency departments and emergency medical services to save their lives when sudden illness or disaster strikes, yet these services are not properly funded and often do not live up to expectations, the reports from the independent Institute of Medicine found.

"We are definitely not prepared for the onslaught we would receive today in the event of an emergency [such as] a hurricane, bioterrorist attack ... or a pandemic," Dr. Brent Eastman, the chief medical officer of Scripps Health in San Diego, said during a news conference. "We hope that this report will astonish the nation."

The institute, an independent body that advises the federal government on health matters, issued three reports on the fragile status of emergency care in the United States. It noted that emergency services are the primary source of healthcare for many uninsured people or on evenings and weekends when most clinics are closed.

"Each year in the United States approximately 114 million visits to emergency departments occur, and 16 million of these patients arrive by ambulance. In 2002, 43% of all hospital admissions in the United States entered through the ED," one of the reports found.

Despite increasing attention placed on emergency and disaster preparedness in the United States after the Sept. 11 attacks, emergency services received only 4% of the $3.38 billion distributed by the Homeland Security Department for emergency preparedness in 2002 and 2003, the institute said. The report did not give figures for 2004 or 2005.

"The result is that few hospital and EMS professionals have had even minimal disaster preparedness training," one report said. "Even fewer have access to personal protective equipment. Hospitals, many already stretched to the limit, lack the ability to absorb any significant surge in casualties; supplies of critical hospital equipment, such as decontamination showers ... ventilators, and intensive care unit beds, are wholly inadequate."

Experts say none of the complaints are new and yet little has been done to address the problem, perhaps because the U.S. healthcare system relies heavily on private enterprise.

"Hospitals must be reimbursed for the significant amounts of uncompensated emergency and trauma care they provide. To do otherwise threatens to destroy the critical emergency care infrastructure that all Americans depend on," said Dr. Rick Blum, president of the American College of Emergency Physicians.

State and federal governments must also work to ensure that hospitals and emergency medical services can communicate with police and fire departments and other emergency responders -- something many cannot do now.

Some of the nation's emergency medical services are municipally managed; others are privately owned. Some are organized under fire departments, while others are operated by hospitals or other medical organizations, and they all need to coordinate better, the panel said.

It recommended that Congress allocate $88 million for projects to make improvements.


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