To address these deficiencies, Congress should establish a pool of at least $50 million to reimburse hospitals for uncompensated emergency and trauma care, the reports conclude. Lawmakers also should significantly increase funding to provide hospitals with resources needed to handle disaster situations. In addition, Congress should allocate $88 million to be disbursed as grants over five years for projects designed to test ways to promote greater coordination and regionalization of emergency care. And it should appropriate $37.5 million each year for the next five years to the Emergency Medical Services for Children Program, to address deficiencies in pediatric emergency care. Even though children make up more than a quarter of all ED and trauma patients, according to one survey, only 6 percent of hospital EDs have all of the supplies deemed essential for managing pediatric emergencies.

Ending Overcrowding and Ambulance Diversions


Hospitals need to tackle problems with the flow of patients and end the practices of diverting ambulances and "boarding" patients in halls or exam rooms until beds become available, the committee said. According to a recent study, ambulances were diverted 501,000 times in 2003 because of overcrowding in EDs. Federal programs should revise their reimbursement policies to reward hospitals that appropriately manage patient flow and penalize those that fail to do so, the reports say. The committee recommended that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reinstate strong guidelines to reduce crowding, boarding, and diversion, and called on the Centers for Medicare and Medicaid Services to convene a working group to develop standards to address these problems.

Crowding and ambulance diversions also occur because of lack of coordination among emergency medical response teams and hospitals, which is the result of incompatible communications systems and other practical impediments, as well as entrenched professional interests, the reports say. Some of the nation's emergency medical services are municipally managed, while others are privately owned; some are organized as part of fire departments, while others are operated by area hospitals or other medical organizations. Few emergency medical services around the nation coordinate patient transport to medical facilities effectively, the committee found.

Regionalization as a Remedy

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