IOM Asks Congress to Rescue Emergency Care

“Right now, all the incentives are to leave the patient in the ED so that they can keep admitting electives,” he said.

The IOM committee also concluded that the emergency care system is not equipped to cope with a large-scale emergency.

“You've got to ask yourself, 'If our emergency departments are struggling to handle their daily and nightly load of 911 calls, how in the world are they going to handle a mass casualty event following a terrorist strike, an outbreak of infectious disease, or a natural disaster?” Dr. Kellermann said.

Federal funding for emergency preparedness has been and remains inadequate, the committee found. In 2002 and 2003, emergency care providers received 4% of $3.38 billion in first-responder funding distributed by the Department of Homeland Security–although emergency medical services personnel make up one-third of first responders.

Time to Act

The committee's findings show that emergency departments cannot continue to operate without more financial support, said Dr. Rick Blum, president of the American College of Emergency Physicians.

“Hospitals must be reimbursed for the significant amounts of uncompensated emergency and trauma care they provide,” he said in a statement.

Dr. Blum called for Congress to hold hearings on the state of emergency medicine and to pass the Access to Emergency Medical Services Act, introduced in the House last September and in the Senate in May 2006. The legislation targets several problems addressed in the report, including boarding, the lack of on-call specialists, and poor reimbursement for emergency care services.

While emergency care on the whole is deeply troubled, the IOM committee found that there are islands of excellence–a select few facilities that have developed innovative approaches to dealing with the problems that all emergency departments face.

“Our goal should be for these islands to coalesce and eventually blanket the United States with an emergency care system that has no holes,” Dr. Eastman said.

The panel envisioned a new regionalized system to coordinate care, so that patients are only taken to facilities that are appropriate and prepared to care for them, he said.

“Where there is no vision, the people perish,” Dr. Kellermann said. “Our committee has described a vision for a coordinated, regionalized, and accountable emergency care system. It's time to act.”