The Future of Emergency Care in the United States

Arthur Kellermann, MD, MPH


August 11, 2006


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America's emergency care system is in critical condition. The signs are unmistakable:

  • Emergency room (ER) crowding: Over the last decade, ER visits increased 26%. Meanwhile, the number of ERs declined 9% and hospitals closed 198,000 beds. Do the math. ER crowding was inevitable.

  • Ambulance diversion: When crowding reaches dangerous levels, ERs divert inbound ambulances. In 2003, diversions happened half a million times -- an average of once per minute.

  • Uncompensated care: Americans are legally entitled to emergency care, but no funding is provided to pay for it. This contributes to the closure of many ERs and trauma centers.

  • Fewer "on-call" specialists: The rising costs of uncompensated care and fear of legal liability have led more specialists to opt out of taking ER call.

  • Inadequate emergency preparedness: If ERs and trauma centers are already jammed with patients, how could they respond to a disaster or a terrorist strike?

These challenges are highlighted in 3 new reports from the Institute of Medicine (IOM).[1,2,3]

Among the IOM's recommendations, 4 stand out:

  1. Congress should designate a lead agency to coordinate federal support for emergency and disaster care.

  2. Federal agencies should develop a focused program of emergency care research.

  3. States should regionalize delivery of emergency care to create a seamless delivery system.

  4. Hospitals, CMS, and the Joint Commission (JCHAO) must end ER crowding and ambulance diversion to restore access to emergency care.

The IOM envisions a coordinated, regionalized, and accountable emergency care system. It is up to us to make that a reality. When your life is on the line, you want your doctor, not your ambulance, to go the extra mile.

That's my opinion. I'm Dr. Art Kellermann, Professor of Emergency Medicine at Emory University.

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