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U.S. hospital emergency rooms in crisis, three studies conclude.

The Institute of Medicine recently released three reports warning that this country's emergency medical system was "overburdened, under-funded and fragmented." The Institute, an independent body that advises the federal government on health-care matters, noted that although no widespread failures in the emergency care system have yet to occur, that could all change if the system had to deal with a pandemic flu, a bioterrorist attack, or a major natural disaster.

The reports, which were published by the National Academy of Sciences, made a number of key findings. Although the demand for emergency care grew by over 25% between 1993 and 2003, the number of emergency departments and hospital beds declined during that same period. As a result, sick and injured individuals are required to wait for up to 48 hours in an emergency department for an inpatient bed to become available. Additionally, ambulances are diverted from one hospital to another on the average of once every minute. 75% of hospitals report problems with recruiting specialists trained for emergency and trauma patients. The reports also noted that the emergency medical system is particularly unequipped to handle pediatric cases. Despite the fact that children constitute 27% of all emergency room visits, a vast majority are not seen at children's hospitals; rather, they receive emergency treatment at general hospitals, which lack the expertise, equipment, supplies and policies to properly treat children. Finally, the reports found that emergency departments are not prepared for major disasters, lacking the proper equipment and training to deal with such situations. (Emergency medical services received only 4% of the Department of Homeland Security's first responder funding in 2002 and 2003.)

The reports also made a number of specific recommendations to fix these problems, most of which called for additional funding. For example, it was recommended that Congress increase funding to a federal program for emergency care of children to $37.5 million for five years. It was also recommended that Congress appropriate $50 million to hospitals that are not compensated for emergency care provided because so many patients have no health insurance. It was also recommended that Congress spend $88 million over five years to better coordinate emergency care. The reports also said that states should require greater accreditation for emergency medical providers.

Sources: Institute of Medicine, National Academy of Sciences

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