U.S. Emergency Medicine Fails Patients
STEVE INSKEEP, host:
If there is another terrorist attack in this country, commentator Arthur Kellerman worries there won't be enough emergency rooms to handle it. He's a member of the Institute of Medicine's Committee on the Future of Emergency Care in the U.S., and he says many E.R.s are already overwhelmed.
Dr. ARTHUR KELLERMAN (Department of Emergency Care, Emory School of Medicine): America's emergency care system is critically ill. In just over a decade, the number of Americans visiting an emergency room has grown to more than 114 million per year, a 26 percent increase.
Meanwhile, the number of E.R.s has dropped by 9 percent, and hospitals have closed nearly 200,000 inpatient beds. Do the math. Emergency physicians and nurses are very capable, but we can't provide safe care when every exam room, hallway and broom closet is stuffed with severely ill or injured patients. When an E.R. becomes dangerously overloaded, inbound ambulances are often diverted to other facilities that may be overloaded as well.
In Metro Atlanta, we've had as many as nine hospitals diverting ambulances at the same time. It's a health-care equivalent of a rolling blackout. Overcrowding delays treatment and increases the risk of medical errors. It also promotes the spread of disease.
In 2003, a patient with pneumonia spent the night in an E.R. in Toronto waiting for an inpatient bed. He turned out to have SARS. Over the course of his E.R. stay, he infected two adjoining patients, who later died of the disease, and several E.R. staff members. The SARS outbreak that followed brought one of North America's most medically sophisticated cities to its knees.
Imagine what would happen if someone with SARS or pandemic influenza entered a crowded American E.R. tonight. Crowding not only harms patients, it's a matter of national security. E.R.s must be prepared at all times to receive a sudden influx of casualties from a terrorist strike or a natural disaster.
How can we do this when our departments are already packed with ill and injured patients? U.S. News & World Report once ran a cover story entitled Crisis in the E.R.: Turnaways and Delays are a Recipe for Disaster. The date of the issue: September 10, 2001.
Six months ago, a committee at the Institute of Medicine released three reports on emergency care in the U.S. They described an overburdened system that has reached the breaking point. The committee called for urgent action at the federal, state and local level and still, nothing has been done. No one can predict where or when the next emergency or major disaster will strike.
But one thing is certain: When your life is on the line, you want your doctor to go the extra mile, not your ambulance.
INSKEEP: Commentary from Arthur Kellerman. He's professor of emergency medicine at Emory School of Medicine in Atlanta.
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