[NRSKarenRN]

Found at Comcast.net:

Emergency medical care listed in critical condition

By Robert Davis, USA TODAY

Wed Jun 14, 2006

The nation's emergency medical system — from the 911 centers that take phone calls for help to the emergency rooms that have become primary treatment centers for millions of Americans — is in a dangerous state of crisis, says a new series of landmark reports.

The Institute of Medicine on Wednesday released the Future of Emergency Care reports, which were prepared by a 40-member board after a two-year investigation. The IOM advises the government on science, medical and health issues.

The reports warn that the U.S. lifesaving system is not only failing to handle daily emergencies but also could break down in the face of national disasters, including hurricanes, disease outbreaks or terrorist attacks....

Among the Institute of Medicine's recommendations:
• Establish a lead federal agency for emergency care.
• End emergency room diversions of ambulances.
• Fund improvements in emergency pediatric care.
• Regulate medical performance of air ambulances in each state.
• Create evidence-based indicators of EMS performance.
• Promote accountability for emergency care systems.
• Increase funding for EMS-related disaster preparedness.
Read the full report at www.national-academies.org

Key Findings and Recommendations (pdf file)

[oramar]

I hope congress does not get it into it's collective head to pass a law that says "starting such and such a date no more ambulance diversions". What is really needed is a step by step program for ending diversions. Right now no one really knows how to do that.

[Roy Fokker]

Funding









Nothing more needs to be said. Any change or implementation is going to need funding - and lots of it. It's nice to release reports- finding (and worse implementing) solutions is a lot harder.

Cracking-at-the-seams EDs are just a symptom of a disease that's afflicting our heathcare industry in general.

[Dewgrl]

I've worked in an er and seen first hand the over-crowding issue. We had to put a man having chest pain in a hall bed just to get an ekg and start labs, iv, etc..which is protocol for chest pain...Minutes later, and long before a doc got to him, he coded in our hallway. Not a fun day.
I think several issues could be addressed to ease over crowding
1-An er has to see anyone who walks through the door-why can't urgent care centers be funded by the gov't the same way-allowing toothaches and other minor issues to be seen promptly in a less acute setting-freeing up space in the er
2-Universal healthcare also might work- Doctors often won't see the majority of our pt's becuase the know they can't pay. If insured perhaps people would see a regular doc instead of treating the er doc's as their own.
3-Work on mental health services for our "regulars" who are looking for attention, a meal, or are just bored. We had a squad go out in a snowstorm, get stuck, have a second unit respond, to bring in a regular with thumb pain in the worst snowstorm of the year. BTW-nothing wrong-sat in lobby rest of the night becuase no taxi's were running-inclimate weather..

I know theses aren't perfect,just ideas, but I really feel we must re-examine the way we do business or run the risk of going out of business

[shaddow18]

ER overcrowding is a nationwide problem. We didn't need the government to tell us this. With fewer and fewer doctors going into family practice not to mention the number of uninsured and underinsured people in this country the ER has become the primary care clinic. For the government to tell the the hospitals that they can not go on divert at all is insane. Obviously the gov't does not understand that first off the hospitals do not want to go on divert because each pt not coming to them means lost revenue. I agree that changes need to be developed to reduce the amount of diversion hours of hospitals like the recently adopted plan in L.A. county which so far has worked. The local EMS agencies along with the recieving facilities need to work on the diversion policies without the federal gov't rearing its ugly head here.

[Empress]

My 2 cents is this.

1. Improve EMS as a whole.

EMS should be seperated from fire departments, and funded as well as fire departments. Care should be taken not become like fire departments where it super physically-competive/old-boy networking. The reason I think they should be seperated is because many fire departments use it as "punishment area," where new firefighters or people out of favor go. People passionate about EMS should work EMS, people passionate about fire fighting should work fire. There is no reason they should have to do both, they're wildly different jobs and mindsets.

Personnel should be trained as extensively as RNs, and treated and paid (!!!) as professionals. Physical standards should be meet but not as stringently as fire, it is more important for someone to be a competent EMS care provider and know their protocols. All areas of the country, even rural, should be staffed with paid paramedics 24/7.

911 should be held to a very high standard as well. There should be no communication breakdown at anytime, and there should be backup protocols in case primary and secondary communication systems fail.

Extensive emergency disaster drills should be done often, and coordination between all EMS, fire, police, and hospital should be hammered out before. This should be a federal mandate, and a city and state would face heavy penalties if they cannot provide proof that this is not done. I think the events of Katrina has shown that many areas do not have this done.

2. EMTALA needs to be amended. People should be able to seek emergency care even if they cannot pay for that, but there is a limit when people who are non-emergent are impeding the care of the emergent patients.

Triage protocols need to be examined. A physician/NP/PA should be in triage to determine whether or not the person should be in the ER, urgent care, or given a referral to a free clinic for care.

That would mean all hospitals should have on-site an 24 hour urgent care, and staff a free outpatient clinic. Radical idea, but I think if someone sat down and figured out how much they are losing with uninsured patients using the ER as primary care and the liabilty they have from not effectively treating emergent patients, it may actually be cheaper.

But who knows, I may just be talking out of my behind.