WASHINGTON -- Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation's emergency medical system as a whole is overburdened, underfunded, and highly fragmented, says a new series of three reports from the Institute of Medicine of the National Academies. As a result, ambulances are turned away from emergency departments once every minute on average, and patients in many areas may wait hours or even days for a hospital bed. Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, bombings, or disease outbreaks, said the committee that wrote the reports.

Congress should allocate significant funds to ensure that America's emergency departments (EDs), trauma centers, and medical first responders are fully equipped and ready to provide prompt and appropriate care, the reports say. The committee also called for actions to reduce crowding of emergency rooms, boost the number of specialists involved in emergency care, and get all emergency medical services in an area to work collaboratively to steer patients to the most appropriate facilities.

"Most of us need emergency services only rarely, but we assume that the system will be able to provide us rapid, skilled care when we do," said committee chair Gail L. Warden, president emeritus, Henry Ford Health System, Detroit. "Unfortunately, the system's capacity is not keeping pace with the increasing demands being placed on it. We need a comprehensive effort to shore up America's emergency medical care resources and fix problems that can threaten the health and lives of people in the midst of a crisis."


Inadequate Funding Plagues System

Insufficient funding and uncompensated care have sapped the capacity of the U.S. emergency medical system, the committee found. Since federal funds for emergency medical response services declined abruptly in the early 1980s, first responder services have been left to develop haphazardly across the country. Many ambulance services use antiquated communications equipment and do not have adequate means to coordinate with hospitals and other first responders in their areas. In 2003, EDs received nearly 114 million patients -- a 26 percent increase in volume over the previous decade -- but the country experienced a net loss of 703 hospitals and 425 EDs during the same 10-year period. Hospital EDs provide a growing amount of safety net care for uninsured patients, a significant proportion of which goes uncompensated. They also must play key roles in disaster response, although they have received scant funding for these efforts, the committee found. For example, emergency medical services received only 4 percent of the $3.38 billion distributed by the U.S. Department of Homeland Security for emergency preparedness in 2002 and 2003.

More Industry Headlines