Emergency Medical System In Crisis, USA

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Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance
Article Date: 15 Jun 2006 - 5:00 PDT


The Institute of Medicine (IOM) says the American emergency medical system is in crisis - it is seriously short of resources, fragmented and splitting at the seams. Ambulances are commonly turned away from emergency departments, it is not unusual for patients to have to wait for hours and/or days for a bed. The whole system would fall apart if it had to deal with disasters or outbreaks.

According to Dr. Rick Blum, President, American College of Emergency Physicians, the IOM report stresses issues which have been around for a long time. The main problem facing emergency medicine in the USA is reimbursement, overcrowding, ambulance diversion and lack of on-call specialists.

For 40 years there has not been an in-depth study of America's emergency medical system, said Gail Warden, head of the Hospital Based Emergency Care Committee, IOM.

Among the list of problems in the report, are:

-- Emegency rooms are seriously overcrowded
-- Patients have to wait for a long time to be admitted
-- Ambulances are often turned away from emergency departments
-- A chronic shortage of specialists to provide care many emergency rooms
-- Ambulance transport to emergency medical services is generally fragmented, chaotic and inconsistent
-- Emergency rooms are badly prepared for children

The report stresses that money has to be allocated for emergency departments so that the number of specialists can be boosted and overcrowding reduced. It also says emergency medical services need to cooperate more so that the whole system operates more like a team.

As the number of cases attended rises, the number of hospitals with emergency departments has been falling. In 2003 emergency departments received 114 million patients, 26% more than in 1993. However, in 1993 there were 703 hospitals and 425 emergency departments which were closed down by 2003.

Emergency departments have become the safety net for the growing number of America's uninsured. Emergency departments are often not paid for treatment carried out on uninsured people.

Although emergency departments do and are expected to play a major role in dealing with disasters, they only received 4% of the £3.3 billion the Dept of Homeland Security awarded in 2002.

As the number of uninsured people in the USA approaches the 50 million mark, emergency departments are having to care for a disproportionate number of uninsured cases. About 50% of emergency care is uncompensated. No other developed country has such a large percentage of its population without any medical cover at all. In the UK, for example, the number of people without medical cover is zero - the same in most of the European Union and Canada.

The situation in emergency departments has become so dire that health professionals and administrators are no longer concerned about long term issues and planning - all the focus is on coping with the day-at-hand as resources dwindle and patient number rise.

It is not uncommon in America today for hospitals to simply close down their emergency department - not to have one at all.

Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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