The Society for Academic Emergency Medicine heard a series of presentations that painted a scary picture of the situation in the nation's emergency health system.

``In Arizona we have the perfect storm, a disaster situation where a combination of things makes you take on water so fast you can't fix it,'' said Todd Taylor, vice president for public affairs at the Arizona College of Emergency Physicians.

``Most Americans still have no idea how dangerous it has become to be ill or injured and go to an emergency room. The chance of surviving a heart attack now depends more on the time of day, the day of the week and your type of insurance than any other factor,'' he said.

Taylor asked his audience of doctors and nurses to raise their hands if they had direct experience of patients dying of heart attacks while waiting for treatment in an emergency room. About half the hands in the room went up.

The emergency symposium was called in response to a report last year by the Institute of Medicine . It concluded that the health safety net was ``in a state of serious jeopardy.''

Researchers say several factors have contributed to the crisis, including the continuing rise in the numbers of Americans without health insurance -- now more than 44 million. The uninsured use hospital emergency rooms as their sole source of treatment and typically receive no preventive care.

Managed Care Pressure

Also cited were constant pressure from managed care agencies to cut costs, rising immigrant populations, most of whom lack insurance, hospital closings and a dire lack of nursing staff.

``Things could get even worse. The economy could take a dip, and it is taking a dip. Guess who will take the hit,'' said John Billings, director of the Center for Health and Public Service Research at New York University.

He presented figures showing that in New York, 50 percent of children had no contact with any medical personnel in the first 30 days of their lives. But 50 percent showed up in emergency rooms during their first year.

President Bush promised to invest $5 billion in the health safety net during last year's presidential campaign. But Billings said Bush's proposed budget, with its tax cuts of more than $1 trillion, contained no net increase in federal funding for emergency health care.

``The glass is almost empty,'' he said.

In 1988, there were 81 million visits to U.S. emergency rooms, according to the National Center for Health Statistics. Ten years later, the number rose above 100 million while the number of emergency departments fell from about 5,200 to just over 4,000.

Under federal law, emergency rooms are required to allow all patients access to care 24 hours a day, regardless of ability to pay. But waits have become so long that substantial numbers give up and leave before they are seen.

Patients Must Wait Hours

Karin Rhodes, an emergency physician at the University of Chicago hospital, recounted how a patient died last week of cardiac arrest after waiting for five hours with chest pains without being examined.

Rhodes said research in Chicago suggested that 15 percent of those who went to an emergency room left without being seen or treated.

Ula Hwang, chief resident of emergency medicine at the Mount Sinai School of Medicine in New York, cited a study showing that of those who left before seeing a doctor, 11 percent needed to be hospitalized in the subsequent week.

Even more worrisome is the amount of time emergency rooms declare themselves ``on diversion,'' meaning they will no longer accept patients being brought in by ambulance.

In Northern Virginia, according to Dr. J.B. Orenstein writing in the Washington Post last month, the area's 13 emergency rooms placed themselves ``on diversion'' for more than 4,000 hours in January.

``Almost half the time back in that icy January, if you needed an ambulance to get to an ER you were SOL; severely out of luck,'' he wrote.

The situation in emergency rooms is driving away nurses because working conditions are so stressful and unpleasant, the conference heard. As a result, the average age of nurses is rising and some emergency rooms do not have even minimum staff much of the time.

Copyright © 2001 Reuters Limited

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