Institute of Medicine: Emergency care at breaking point

The nation's emergency medical system as a whole is overburdened, underfunded, highly fragmented, and ill-prepared to handle surges from disasters, according to a series of reports released June 14 by the Institute of Medicine (IoM). The IoM's recommendations for resolving these problems include regionalization of emergency services to mitigate overcrowding and reduce costs.

Among the key findings in the IoM's reports:

• Many emergency departments (EDs) and trauma centers are overcrowded - ED visits grew by 26% between 1993 and 2003, while the number of hospital beds declined by 198,000.
• Emergency care is highly fragmented - Emergency medical services (EMS) agencies do not coordinate effectively with EDs and trauma centers, resulting in poor patient flow.
• Critical specialists are often unavailable to provide emergency and trauma care - Three quarters of hospitals report difficulty finding specialists to take ED and trauma calls.
• The emergency care system is ill-prepared to handle a major disaster - There is little surge capacity for a major event, and EMS received only 4% of Department of Homeland Security first-responder funding in 2002 and 2003.
• EMS and EDs are not well equipped to handle pediatric care - Children make up 27% of all ED visits, but only 6% of EDs have all of the necessary supplies for pediatric emergencies.

• Create a coordinated, regionalized, accountable system
• Create a lead agency to consolidate functions within the Department of Health and Human Services
• End ED boarding and diversion
• Increase funding for emergency care
• Enhance emergency care research
• Promote EMS workforce standards by requiring accreditation of paramedic education programs and adopting common EMS certification levels
• Enhance pediatric presence throughout emergency care

To read the IoM's reports, click here.