- 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:
- 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
- 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,
- 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
- 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
- "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
- 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,
- 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
- 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
- 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