WASHINGTON — Although the federal government should play a key role in repairing the nation's emergency health care system, much of the job of reform may fall on the emergency care community itself, according to health experts, lawmakers, and federal officials who met at the Institute of Medicine's final workshop on the future of emergency care.
Following previous regional workshops in Salt Lake City, Chicago, and New Orleans, the IOM conducted its fourth stop on a nationwide tour to disseminate the findings from this summer's three landmark reports on the state of emergency care.
“As we went around the country, we heard that this [IOM] report may be the most important report on emergency medicine since 1966 to avoid accidental death and disability and neglected disease in modern society,” said Dr. A. Brent Eastman, chief medical officer of Scripps Health, San Diego, and a member of the IOM Committee on the Future of Emergency Care in the United States Health System.
Discussions from the first three workshops were overwhelmingly supportive of most of the recommendations that address the major issues facing the emergency care system: overcrowding of emergency departments, shortcomings in pediatric emergency care, lack of disaster preparedness, and disadvantaged emergency care research.
One primary area, however, fostered disagreement from workshop attendees: the IOM's recommendation that Congress establish a single lead agency to oversee and manage emergency and trauma care. Such an agency would consolidate resources currently spread throughout different agencies, such as the Department of Health and Human Services and the Department of Homeland Security.
The workshops' attendees, however, have strongly opposed a single-agency approach, Dr. Eastman said.
“The overall message that we heard was that we absolutely must unite to collectively move forward with the IOM agenda,” he said. Yet, “it cannot be done by one agency, one region of the country, or by one individual.”
There has been consensus that the emergency care community cannot wait for an act of Congress to institute change, Eastman added. Workshop attendees acknowledged that many of the IOM's findings were targeted to providers and provider organizations, and most have concluded that change was needed “from within.”
An Act of Congress
Congress has, however, given some attention to the matter of disaster preparedness. The House and Senate passed—and the president signed into law—the Pandemic and All-Hazards Preparedness Act of 2006, which aims to speed up emergency medical response, explained Ms. Jennifer Bryning of the Senate Committee on Health, Education, Labor and Pensions.
“To the IOM finding that there is a lack of disaster preparedness, we hope this bill will addresses this point,” said Ms. Bryning.
“We are aware that it doesn't cure all the problems, but it's a step in the right direction.”
The law reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and names the secretary of Health and Human Services as the lead federal official responsible for public health and medical response to emergencies. It also reauthorizes more than $1 billion per year in federal funding through grants from HHS for state and local public health and medical preparedness.
The workshop also gave officials of federal agencies an opportunity to discuss how their offices can assist in adopting the IOM recommendations.
In response to the finding that the emergency department system is poorly equipped to handle a disaster, Dr. Jeffrey W. Runge, the Department of Homeland Security's chief medical officer, conceded that the United States is not giving the emergency care situation the attention it deserves.
“How well we are able to treat patients every single day is exactly how we will treat patients in case of a disaster,” said Dr. Runge. “In cases of disaster or emergency, people call 911, not CMS and not FEMA …so we need people in emergency rooms who are expertly trained to treat our citizens.”
Emergency care in this country is a “victim of its own success,” Dr. Runge said. For the past 3 decades, he explained, emergency physicians have done a tremendous job of improving emergency care and fulfilling a need.
He also stressed that the word “crisis” might be overused in defining the current state of emergency care.
“It's not a crisis until people feel it,” Dr. Runge said. “Until the American public feels their system is breaking down, I'm not real hopeful there is going to be huge systemic change. We need to prevent this crisis before it's actually a crisis.”
A View From the Hill
In his keynote address, Rep. Pete Stark