An Emergency In Our
Emergency Rooms

From Patricia Doyle, PhD

Hello Jeff - This report should come as no surprise. Our nation's emergency rooms are having a hard time dealing with normal patient loads so, how will they deal with a pandemic? Answer: They won't.
I think that, should a pandemic or terrorist attack take place, ERs in the area of attack or hard hit by pandemic patients will close in 8 hours.
8 hours or less, that would be it.
Patricia Doyle
An Emergency In Our Emergency Rooms
Report Faults ER Care
U.S. system is ill-prepared to deal with a large-scale crisis, according to a panel of experts.
By Kylene Kiang
Cox News Service
""Being forced to provide unlimited amounts of unfunded care can put a doctor and even a hospital out of business."
--Arthur Kellermann, Emory University
WASHINGTON -- American emergency rooms are stretched to the breaking point and are "ill-prepared to handle large-scale emergencies, the National Academies, Institute of Medicine reported Wednesday.
"You,'ve got to ask yourself: If our 911 services are struggling to handle our daily and nightly 911 calls, how in the world are they going to handle a mass-casualty event, a terrorist strike, an outbreak of infectious disease or a natural disaster? asked Arthur Kellermann, chairman of emergency medicine at Emory University.
The system,s failures, the report said, have led to a situation in which patients at many overcrowded emergency departments wait hours for treatment or are turned away altogether.
The problems, it said, grow out of the need for emergency rooms to provide routine care for millions of uninsured patients, a shortage of nurses and medical specialists, and failure to use modern methods to manage the flow of patients.
Kansas City area hospitals frequently open and close their emergency rooms to new cases as patients are discharged and new ones arrive, said Matt May, emergency services planner for the Mid-America Regional Council.
"Some hospitals do it pretty routinely, he said.
But it is rare for all emergency rooms in one part of the metropolitan area to close at the same time, forcing ambulances to travel longer distances, May said. Such situations trigger an order to those hospitals to reopen their emergency rooms.
The construction of new hospitals, such as the recently opened St. Luke,s East in Lee,s Summit, also has helped ease emergency room crowding, May said.
The national report offered hope that the problems can be overcome.
It cited a case study involving Grady Health Systems, a large public hospital in Atlanta where satisfaction with emergency room services fell to a historic low in 2002 amid severe overcrowding.
With a program of staff training, changes in diagnostic procedures and the creation of a special unit to assess patients who didn,t need immediate care, Grady cut in half the average time it took to place patients in hospital beds.
The solutions found at Grady are echoed in the 19 recommendations offered Wednesday by a committee of more than three dozen leading medical officials appointed in 2003.
Many of the recommendations were aimed at Congress, which the panel said should:
* Quickly approve $50 million in extra funding for hospitals that provide uncompensated care to uninsured patients.
* "Significantly increase funding for disaster preparedness in hospitals.
* Establish an agency in the Department of Health and Human Services for emergency and trauma care, and create a demonstration program to promote a coordinated regional approach to emergency care.
It also said:
* Hospitals should end the practice of "boarding patients in emergency departments until beds become available and diverting ambulances to alternative hospitals, practices that the panel called "antithetical to quality medical care.
* Medicare and Medicaid should end restrictions on reimbursing lower-risk patients placed in "observation units like those used at Grady.
* Emergency departments should adopt a range of information and communication technologies that would allow quicker and safer handling of patients.
Gail Warden, president emeritus of the Henry Ford Health System in Detroit and chairman of the panel, said that even though there is sometimes a "disconnect between what the public perceives as emergency department problems and the reality, there is truly "a crisis underneath the surface.
Deficiencies in the emergency room system itself are compounded by the presence of nearly 46 million uninsured Americans whose primary source of care is the emergency room, panelists said.
"We value emergency care in this country so much that it is the only medical care to which Americans have a legal right, Kellermann said. "But we value it so little that we,re not willing to pay for it.
"It is, in the congressional parlance, an unfunded mandate.
Lack of federal funding and government oversight were cited as the root of the problem. In 2002 and 2003, out of the $3.38 billion issued by the Department of Homeland Security for preparedness efforts, only 4 percent was allocated to bolster emergency medical care.
"What this study shows is that the system in its current state cannot handle some of the routine demand, so when a crisis occurs we,re starting way behind the curve in our capacity to respond, said Jeff Levi, executive director of Trust for America,s Health, a Washington-based public health advocacy group.
The shortage of nurses is not helping the outlook for emergency care.
As the baby boom generation ages, intensive care from nurses will be in even greater demand. That means now is the crucial time to address the work force shortage in emergency nursing, said Nancy Bonalumi, president of the Emergency Nurses Association based in Chicago.
More than 147,000 potential nurses were turned away from nursing schools last year because of diminished capacity in U.S. nursing schools, according to the National League for Nursing.
In addition, more specialty doctors are leaving the business from fear of rising legal liabilities increases in uncompensated care, Kellermann said. "Being forced to provide unlimited amounts of unfunded care can put a doctor and even a hospital out of business, he said.
In 2003, 501,000 ambulances were turned away from emergency departments because of overcrowding.
Moreover, the number of emergency rooms is shrinking. In 2003, 113.9 million people sought care in emergency rooms, a 26 percent increase from the 90.3 million visits made in 1993. Over the same period, the number of emergency departments has decreased about 14 percent, according to a report last year by the Centers for Disease Control and Prevention.
The reports are the first extensive studies of emergency care in the past 40 years. Between 2003 and 2006, 40 health care and public policy experts compiled the latest report and gathered information from interviews, emergency department visits, and 11 commissioned research papers.
The $3 million study was delivered to Congress on Tuesday. The panel plans follow-up activities, but no schedule has been set, National Academies spokeswoman Christine Stencel said.
Patricia A. Doyle DVM, PhD
Bus Admin, Tropical Agricultural Economics
Univ of West Indies
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Zhan le Devlesa tai sastimasa
Go with God and in Good Health



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