Even Without a Flu Epidemic, ERs Are in Crisis
It is extremely likely that your local emergency room is overcrowded and not prepared for the sudden surges in cases that are seen with an epidemic such as the flu, a natural disaster such as an earthquake or a man-made disaster such as an act of terrorism.
More than two years after the most dreadful terrorist act in our nation’s history, emergency physicians in Los Angeles and around the country are concerned that their hospitals still do not have the capacity to respond effectively to extraordinary increases in patients.
ERs everywhere are experiencing the onset of one of the worst flu seasons in recent memory. Yet even before this onslaught began, many ERs were struggling with a lack of resources necessary to meet the demand of everyday medical emergencies.
This situation will only be aggravated by a growing uninsured population, which the Census Bureau just reported has increased by 2.4 million in one year. There are now 42 million Americans who do not have health insurance. Roughly one in seven of these “working poor” live in California, and almost half of those live in Los Angeles.
Many of these people are forced to use our ERs as their only source of health care. As the L.A. County public hospitals continue to downsize because of budgetary problems, more and more of these people will, by necessity, seek care at private hospital ERs, where by law they cannot be turned away.
The severest financial toll of the uninsured is falling on the nation’s emergency-care system, with more than half of emergency services going uncompensated. This has contributed to the closure of more than 1,000 ERs in the last 10 years, 60 of them in California.
At the same time, more people than ever before are visiting ERs, up to 108 million in 2001, according to the Centers for Disease Control and Prevention. Patients also are coming in sicker than ever before, with nearly 90% of emergency visits classified by the CDC in 2001 as conditions needing medical attention in two hours or less. This isn’t surprising; a March 2003 study of emergency physicians found the uninsured delaying or forgoing care until they become much sicker.
It is not a question of whether providing this care is the right thing to do. The question is how much longer can our ERs can provide the high level of lifesaving care all Americans have come to depend on and expect.
The American College of Emergency Physicians, representing nearly 23,000 doctors specializing in emergency medicine, recently conducted a national survey of its members about the state of emergency medicine. The findings are disturbing.
The ACEP’s survey found almost 90% of emergency physicians reporting that overcrowding was “severe” or “moderate” in their emergency departments; they identified the lack of staff and beds (43% and 51%, respectively) as a major contributor. Nearly half (45%) also said patients, on average, were being boarded two to seven days in their ERs, until regular hospital beds were found.
Our country’s 4,000 ERs have a federal mandate to treat all patients, regardless of their ability to pay or insurance status. But the health-care system is at the breaking point, and policy problems -- such as the boarding of admitted patients ( because of a lack of inpatient beds and a shortage of nurses) and the increasing number of uninsured -- are threatening the ability of emergency physicians to provide timely care to all patients, often at times when every moment counts.
These problems will not be solved in the emergency department alone. However, in a post-Sept. 11 environment, the need for rapid access to emergency care for all Americans should be a nonnegotiable priority.
