WASHINGTON — Almost nothing has been done in the year since the Institute of Medicine called on Congress to help enact a comprehensive overhaul of the nation's emergency medicine system, two emergency physicians and a trauma surgeon told a U.S. House committee.
“I'm absolutely shocked that more hasn't been done to fix this in the last year,” Dr. William Schwab, chief of the division of trauma and surgical critical care at the University of Pennsylvania Medical Center in Philadelphia, testified at a House Committee on Oversight and Government Reform hearing.
Dr. Schwab was a member of the IOM's Committee on the Future of Emergency Care in the U.S. Health System, which issued its report in June 2006.
So far, the only congressional action has been the introduction of the Access to Emergency Medical Services Act (H.R. 882), which would increase payments to physicians through an emergency medicine-specific trust fund and create a commission to study potential solutions. A companion bill has been introduced in the Senate (S. 1003).
Dr. Schwab and his colleagues told House committee members that if anything, emergency departments have become more crowded and overburdened, and that it is becoming increasingly difficult to find specialists such as orthopedic surgeons or neurosurgeons who will accept on-call assignments.
Leaving his written testimony behind, Dr. Schwab told the committee members that a recent experience at his hospital more fully revealed the crisis. On one of his days off, a partner in his practice called and said he was needed to help attend to a department bursting at the seams from a multivehicle accident. Upon arrival, Dr. Schwab instead was diverted to a gunshot victim. He performed an emergency thoracotomy, and when he was done, he looked up and realized that the accident patients had been watching from just 40 feet away because the trauma bay was so crowded.
The burden is not limited to big-city facilities, said Dr. Schwab, noting that his brother-in-law, a transplant patient on dialysis who had become very ill, recently had been refused initial admittance through the ED at Rodney Strong Hospital in Rochester because of overcrowding. Eventually, he was seen.
Dr. Ramon Johnson, director of emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, Calif., agreed that the crisis did not respect demographic boundaries. “Even in my sleepy suburban community,” the emergency department is “understaffed, underfunded, overworked, and overcrowded,” said Dr. Johnson, who also related anecdotes in place of his written testimony. He spoke of having to scramble to find an open bed for a child who was brought in—blue and choking—by his mother. Staff removed a less-ill patient from a bed, which was quickly occupied by the choking child. Dr. Johnson then reached into the child's trachea to fish out the offending apricot pit. But he had a moment where he thought he'd have to tend to the child on the floor.
“We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment,” echoed Dr. Robert E. O'Connor, incoming chair of emergency medicine at the University of Virginia, Charlottesville.
At the hearing, the physicians were well received by Democrats and Republicans.
“The fact of the matter is that we have a crisis in emergency care, and it is nationwide,” said acting panel chairman Elijah Cummings (D-Md.). “This begs the question: With a national emergency and trauma care system as fragile as ours, how would we manage the very real threats of a terrorist bombing, a natural disaster, or an outbreak of pandemic flu? Where is the surge capacity?”
Rep. Tom Davis (R-Va.) also questioned whether many of the nation's emergency departments are ready to handle a surge from a multiple-casualty highway crash, much less a terrorist event. The crisis has many roots, said Rep. Davis. “Legal, financial, and demographic trends have converged to punish the success of hospital emergency departments transformed by federal law into the de facto primary care provider for millions of the under- and uninsured,” he said.
Several committee members asked whether the 2006 Pandemic and All Hazards Preparedness Act had benefited emergency care. The answer: a resounding no.
“I don't think we could track a dime to actual practice at the bedside,” said Dr. Schwab.
But he and the other physicians emphasized that just throwing more money at emergency medicine would not be a panacea. “There's no way a simple solution can fix this,” said Dr. Schwab.
Rep. Cummings and other committee members took the Department of Health and Human Services to task for not ensuring that more of the Pandemic law's money made it directly to hospitals.