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Sunday 23rd October 2016

US emergency care in collapse

21st June 2006

10052006_blood_pressure1.jpgA two-year study by the U.S. Institute of Medicine has found that the emergency medical care in the United States is on the verge of collapse, as fewer emergency rooms grow dangerously overcrowded and increasingly unable to care for critically ill patients.

Fixing the problems will likely require billions of dollars and leadership from a new federal agency, according to three new reports by the National Academy of Science's Institute of Medicine. The U.S. emergency care system lacks stability, consistent quality of care, and the capacity to respond to large-scale disasters or epidemics, the study said.

Patients are waiting longer and longer for treatment, and ambulances sometimes idle for hours as they wait to offload patients, it said. After admission to hospital, patients sometimes wait as long as two days to be admitted to a hospital bed. As a system, U.S. emergency care lacks internal stability and has no capacity to respond to large disasters or epidemics, according to 25 experts who conducted the study. Regional planning and standard measures of outcomes are required to fix major problems in hospital care and ambulance services, they said.

The 24,000-member American College of Emergency Physicians (ACEP) immediately embraced the reports' findings. ACEP president Dr. Rick Blum said the reports call for an end to gridlock in emergency departments and envisage a more patient-focused system in the future.

The reports also found that a small fraction federal government funding for emergency preparedness since the terrorist attacks of September 2001 has been spent on medical preparedness. Emergency services received only 4 percent of U.S. $3.38 billion distributed by the Homeland Security Department for emergency preparedness in 2002-2003 and only 5 percent of funding from the Bioterrorism Hospital Preparedness Program. 

Hospital emergency departments are meanwhile caring for more patients without medical insurance and without access to medical care, the reports found. From 1993-2003, emergency hospital visits increased from 90.3 million to nearly 114 million, ACEP said, even as the number of hospitals in the United States decreased by 703, and the number of hospital beds dropped by 198,000.

The IOM convened a committee in September 2003 on the Future of Emergency Care in the United States Health System. Charged with creating a vision for the future of emergency care, the committee looked at hospital-based emergency care, pre-hospital emergency medical services, and the special challenge of providing emergency care for children.


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