Are Emergency Departments at Risk?

Sometimes something that we are familiar with are without a doubt taken for granted. I am speaking of emergency departments (ED) and emergency medical services (EMS), including ambulances.

But what if they did not exist? What would happen if the emergency department and the ambulance vanished from existence? Why would these things go away? I'm not saying they will, but due to overcrowding, abuse of the service and underpayment by private and public health insurance organizations, they might. 

Let's pretend for a moment that a local emergency department decided to change its trauma rating from handling major trauma to handling only minor injuries. Would that be significant? And if the ED I speak of can change how and who it treats trauma-wise, could they also reduce medical services? Before I attempt to answer these questions, let's talk about the history of Emergency Medical Services (EMS).

In and around the year 1793, a French military surgeon, Domonique Jean Larrey, noticed the swiftness at which the artillery carriages moved across the battle field. He thought that if artillery carriages could move that fast, so could a carriage for the wounded. And it was at this time that the first M.A.S.H. Unit was developed. I suppose you can argue that others, Romans and the like, patched wounds in the battle field and moved their wounded by wagon or chariot, but Domonique Jean Larrey is widely considered the father of emergency medicine.

Skip forward several hundred years and in the first half of the 20th century, trauma patients had a very low survival rate. This was due to many factors such as unsafe cars and no seat belts, but one of the biggest problems was emergency rooms were not staffed with doctors who specialized in emergency medicine.

The emergency rooms, if a hospital had one, was staffed by family doctors, dermatologists and hospitalists (hospital-based doctors) that would be called to the ED if a particularly bad patient came in. The luckiest trauma victims were brought to a hospital that, by the luck of the draw, had a surgeon leaving for the night and who stayed to see if he could help. It was these surgeons that figured out that when they got to a patient fast enough they could do some good. It was also these surgeons who came home from the Korean War (conflict) and experienced the impact helicopters made on survival rates.

The last paragraph covered up to the 1960s. It was in the 60s that saw prehospital care improve due to a “White Paper” Accidental Death and Disability: The Neglected Disease of Modern Society. This white paper put pressure on local government officials to improve emergency trauma care specifically the care received prehospital. Also in the 60s modern CPR helped with survival rates and defibrillators became small enough to become portable. Ambulances in Belfast, Ireland used CPR and defibrillators and increased out of hospital cardiac arrest saves. It wasn't until the 1970 that the U.S. began training paramedics and cities across the country embraced the new technology and highly trained prehospital providers.

This brings us to modern day emergency medicine. Hospital emergency departments are staffed with highly trained emergency medicine doctors and registered nurses who specialize in trauma and acute medical emergencies. And 911, which, if called, will bring to your house paramedics, advanced life support firefighters and police trained sometimes to EMT and paramedic levels. Due to these advances in emergency care many lives are saved. However, and this is important, our emergency departments are endangered.

Hospitals across the country have been closing due to the high number of uninsured patients and low reimbursement rates of health maintenance organizations. Some hospitals reduce trauma services; others do not accept ambulance patients such as in the case of Linda Vista Community Hospital in Los Angeles, CA. Before they closed they were treating a large number of gunshot and stabbing victims. These victims rarely had insurance if they survived past the emergency department, surgical services and intensive care services are costly and the small community hospital could only absorb so much. In the end, the hospital was forced to close its doors.

So to answer one of my original questions: What if a hospital closes? Those in the community would have to drive further for emergency treatment and ambulances have to drive further possibly risking a life. The United States has one of the best emergency care systems in the world but it is at risk.

Most people who use the emergency department do not need the expensive equipment and highly trained staff. They could get cared for by their family physician or an urgent care center. Urgent care centers are opened to relieve some of the overcrowding in emergency departments.

Next time you think you or a loved one needs to go to the hospital think about it for a minute. Is this injury or medical issue life threatening? If so, call 911.

Is your pain or illness chronic or on going?Try to get an appointment with your family doctor.

Are you on medication from your private physician for this issue? If so, call your internist or family doctor.

Is this illness or injury minor and did you just notice it? You can go to your family doctor or choose an Urgent Care.

Is it after hours for your Doctor? Go to an urgent care center. Urgent care centers are typically less expensive than an emergency department and have short wait times.

The truth is you have many options to choose from for your family's health care.  Try not to use emergency departments as your primary care physician.  Keep the emergency department open for the truly critical patients.

Using your family doctor or an urgent care will cost far less and the waiting time for care will usually be under an hour.