Nation’s Emergency Care System is Fragmented and Unable to Respond to Disasters, says Institute of Medicine

Washington, DC – The Institute of Medicine (IOM) recently released three new reports, which find the nation’s emergency care system is fragmented and stretched to the breaking point, as well as severely compromised in its ability to handle disasters. As a result, the nation’s emergency departments are less able to serve as the safety net for the country’s troubled medical care system and to handle future natural or man-made disasters.

Dr. Rick Blum, president of the American College of Emergency Physicians (ACEP), said the reports call for an end to the gridlock in emergency departments and envision an emergency care system of the future that is more patient focused.

Nearly three years in the making, the reports confirm that only a tiny fraction of federal funding for emergency preparedness since 9/11 has been spent on medical preparedness. Although emergency service providers are a crucial part of the response to any disaster, they received only 4 percent of $3.38 billion distributed by the Homeland Security Department for emergency preparedness in 2002 and 2003 and only 5 percent of the funding from the Bioterrorism Hospital Preparedness Program.

“Congress must convene a hearing on the state of emergency medicine in this country and dedicate funding to the emergency care system to support disaster preparedness,” said Dr. Blum. “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. Hospitals must also be able to end the practice of boarding patients in emergency departments. When our beds are full of admitted patients waiting on inpatient hospital beds, we have only a very limited ability to see new patients, let alone have the surge capacity to deal with a disaster or epidemic.”

Dr. Blum said the Access to Emergency Medical Services Act (H.R. 3875 and S. 2750) would be a first step to begin to address three of the major problems that are identified in the IOM reports the practice of “boarding” admitted patients in emergency departments until inpatient beds become available, which causes medical care gridlock (2) the liability risk of caring for emergency patients, which is deterring many medical specialists from being on-call to emergency departments, and (3) the continuing decline in payments for emergency medical care that threatens the entire emergency care infrastructure.

The report says many of the problems in today’s emergency care system are related to its fragmented nature. It calls for a seamless coordination of services from a patient’s point of view, which will require continuous communication and coordination among 9-1-1 and dispatch, ambulance and EMS workers, hospital emergency departments and trauma centers, and the medical specialists that support these facilities.

The report also describes the increasing responsibilities of hospital emergency departments, which are caring for patients without medical insurance and for insured patients unable to access their physicians. Between 1993 and 2003, the number of visits to emergency departments increased from 90.3 million up to nearly 114 million. At the same time, the number of hospitals in the United States decreased by 703, and the number of hospital beds dropped by 198,000.

“The report calls on hospitals to improve efficiency and patient flow using tools developed from engineering and operations research, such as systems that track and coordinate patient flow,” said Dr. Blum. “It also calls for greater accountability and public reporting of performance, as well as panels to develop evidence based protocols for EMS, emergency and trauma care of adult and pediatric patients.”

The pediatric emergency care report found only 6 percent of U.S. hospital emergency departments have all the supplies necessary for handling pediatric emergencies and only half of departments had 85 percent of the essential supplies. It says the needs of pediatric patients should be taken into account in developing standards and protocols for triage and transport of younger patients.

The EMS report calls for increased funding, especially for EMS-related disaster preparedness; enhanced training for EMS workers; improved coordination among EMS agencies; and for EMS agencies and hospitals to integrate family-centered care into practice.

According to the IOM, the emergency care system of the future should be highly coordinated, regionalized, and accountable, with one lead federal agency consolidating many of the government programs that deal with emergency and trauma care.

“The nation’s emergency physicians and nurses stand ready to provide the care the nation needs in any time of trouble, but they must have the basic tools, processes, and capacity to do so,” said Dr. Blum.

The IOM in September 2003 convened a committee on the Future of Emergency Care in the United States Health System to identify the most important issues facing emergency patients and make recommendations on how best to deal with those issues. Charged with creating a vision for the future of emergency care, the committee looked at hospital-based emergency care, prehospital emergency medical services(EMS) and the special challenge of providing emergency care for children.

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