WASHINGTON The nation's emergency medical system from the
911 centers that take phone calls for help to the emergency rooms
that have become primary treatment centers for millions of
Americans is in a dangerous state of crisis, says a new series of
landmark reports.
The Institute of Medicine on Wednesday released the Future of
Emergency Care reports, which were prepared by a 40-member board
after a two-year investigation. The IOM advises the government on
science, medical and health issues.
The reports warn that the U.S. lifesaving system is not only
failing to handle daily emergencies but also could break down in
the face of national disasters, including hurricanes, disease
outbreaks or terrorist attacks.
"We are not prepared," says Brent Eastman, a board member and chief
medical officer at Scripps Health in San Diego. "We struggle to
survive day-to-day."
Nels Sanddal, board member and president of the Critical Illness
and Trauma Foundation in Bozeman, Mont., agrees. "To ramp up" to
treat high numbers of patients, he says, "we have to have
backbone."
The reports say that, on average, in every minute of every day an
ambulance carrying a patient is turned away from a hospital on
"diversion," when an emergency room says it's too full to take more
patients.
That must end, says Arthur Kellermann, director of the Center for
Injury Control at Emory University School of Medicine in Atlanta.
"We cannot let the most time-sensitive portal in the hospital get
gridlocked."
The IOM reports detail how hundreds of thousands of lives are
affected every year by EMS deficiencies that are not obvious. "What
the public perceives and what is real, in many cases, there is a
disconnect," says Gail Warden, president emeritus of the Henry Ford
Health System in Detroit, who chaired the panel. "In most
communities, there is a crisis under the surface."
Many emergency rooms barely can handle their daily patient loads,
children don't always get good care, and the quality of rescue
services is erratic, the reports say.
And geography determines survival.
"There is a wide disparity," says Shirley Gamble, a United Way
board member in Austin. She cited a 2003 USA TODAY probe that found
a 10-fold difference between major cities in cardiac arrest
survival rates.
The reports say that by following the lead of those cities that
save more lives, entire regions can raise the quality of their
care.
Improvements to emergency medical services, Eastman says, "should
be built on islands of excellence that exist today."
(http://www.usatoday.com/news/health/2006-06-14-er-care-report_x.htm)
