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IOM Reports Highlight Cracks in Emergency Care System

June 14, 2006 -- Cracks in the nation's emergency medical care system could lead to a national crisis—especially if disaster strikes—according to three reports released on Wednesday by the Institute of Medicine (IOM).

The reports examine three topics in emergency care: hospital-based care, emergency medical services, and emergency pediatric care. According to key findings from the reports, the emergency care system in the United States faces a host of serious issues, such as overcrowded emergency departments, diversion of ambulances to other hospitals, longer patient wait times, lack of access to specialists, and a fragmented emergency response system.

On top of those concerns, many committee members at a public briefing on the reports Wednesday cited lack of preparedness for disasters—such as hurricanes, flu pandemic or terrorist attacks—as a large threat to emergency care in the United States. During committee deliberations, Hurricane Katrina struck the Gulf Coast, revealing "many deficiencies in our ability as a nation to respond," IOM President Harvey Feinberg said at the briefing.

"Every one of us here and every one of us in the country has a stake in the state of our emergency care services. . . . Yet as this series of reports makes clear, the emergency care that Americans receive can fall short of what they expect and deserve," Feinberg said.

In September 2003, IOM's Committee on the Future of Emergency Care in the United States Health System convened to conduct a comprehensive review of the issue. The 40-member committee, which also consists of three subcommittees, heard testimony from 60 individuals, wrote 11 commission papers, and held 19 meetings, resulting in the cumulative study, which cost almost $3 million. "As you can see, we've been busy over the last two years," said Gail Warden, committee chair and president emeritus of the Henry Ford Health System in Detroit.

According to IOM documents, the reports contain various recommendations for overcoming different issues within each topic. The recommendations, however, all fall under four basic themes: improving hospital efficiency and patient flow; coordinating and regionalizing the emergency care system while holding each part accountable; increasing resources; and taking into account pediatric patients while implementing these changes.

Because of differences in size, physiology, developmental stage,s and emotional needs, children respond differently to illness and injury, said Jane Knapp, professor of pediatrics at the University of Missouri, Kansas City, and a committee member. "Emergency care providers must have specialized knowledge and the equipment that they need in order to provide optimal care," she added. Another committee member, Marianne Gausche-Hill, added that many medications are prescribed off label to children because they haven't been tested or approved by the Food and Drug Administration for use in pediatric populations.

IOM documents say there is no "one-size-fits-all" solution to fixing emergency care in the United States. Several committee members called on Congress to implement various recommendations, such as establishing demonstration projects to promote regionalized care, or coverage that extends past what the committee members described as islands of excellent care in the United States. Other recommendations include increasing funding for "mission-critical" hospitals and adopting operations management techniques and health information technology in hospitals.

"This report should be alarming to the average American," said American College of Emergency Physicians President Rick Blum in a statement. "It shows that emergency departments are struggling with very limited resources in their critical role as America's health care safety net. If we are to be truly prepared for the next big disaster or epidemic or terrorist attack, we simply must get Congress to provide better support for our nation's emergency departments."

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