The Status of the Nation

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The Status of the Nations Emergency Management
System
The National Emergency Management Summit March 5,
2007
Gail L. Warden Chair, Committee on The Future of
Emergency Care in the United States Health
System President Emeritus, Henry Ford Health
System
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Overview

• Statement of Task
• Hospital-Based Emergency Care
• Key problems
• Emergency Medical Services
• Key problems
• Emergency Care for Children
• Emergency Preparedness
• Issues impacting hospitals
• Emergency medical services considerations
• Pediatric disaster preparedness
• Recommendations

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Statement of Task (In Brief)

• The objectives of this study were to
• (1) examine the emergency care system in the
  U.S.
• (2) explore its strengths, limitations, and
  future challenges
• (3) describe a desired vision of the
  emergency care system and
• (4) recommend strategies required to achieve
  that vision.
• The study also examined the unique challenges
  associated with the provision of emergency
  services to children and adolescents, and
  evaluate progress since the publication of the
  IOMs 1993 report, Emergency Medical Services for
  Children
• In addition, the study examined prehospital EMS
  and included an assessment of the current
  organization, delivery, and financing of EMS
  services and systems, and assess progress toward
  the EMS Agenda for the Future

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Key Problems

• Overcrowding 40 percent of hospitals report ED
  overcrowding on a daily basisBoarding patients
  waiting 48 hours or more for an inpatient bed
• Ambulance Diversion Half a million ambulance
  diversions in 2003
• Uncompensated Care results in financial losses
  and closures for EDs and trauma centers
• Inefficiency Limited use of tools to address
  patient flow to reduce crowding

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Key Problems (continued)

• On-Call Specialists unavailability of
  specialists to provide emergency and trauma
  consultation
• Inadequate Emergency Preparedness surge
  capacity, training, planning, and personal
  protective equipment
• Fragmentation limited coordination of the
  regional flow of patients
• Accountability lack of system performance
  measurement public reporting financial
  incentives
• Research Inadequate funding and infrastructure

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Key Problems

• Fragmentation Lack of coordination between local
  service providers between EMS and public safety
  and between EMS and air medical services.
• Uncertain Quality Little or no performance data
  lack of national standards for training and
  credentialing.
• Disaster Preparedness Inadequate training,
  equipment, funding.
• Evidence Base limited understanding of
  effectiveness.

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State of Pediatric Emergency Care

• Only 6 percent of EDs have all essential
  pediatric supplies and equipment needed for
  managing pediatric emergencies.
• Many emergency providers receive little training
  in pediatric emergency care.
• Many medications prescribed to children are off
  label.
• Disaster preparedness plans largely overlook the
  needs of children.

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Emergency Preparedness
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Issues Impacting Hospitals

• SURGE CAPACITY
• Most operating at full capacity
• Insufficient space and equipment
• Availability of specialists
• Lack of agreement to transfer
• PLANNING AND COORDINATION
• Lack of communication system
• Need for coordination between hospitals,
  ambulances, EMS, and public safety agencies
• Inadequate planning for disaster events
• Need for coordination between local, state,
  regional and federal agencies

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Issues Impacting Hospitals (continued)

• TRAINING
• Disaster response requires specialized training
  in the clinical management of disaster victims
  and in appropriate institutional procedures in a
  disaster environment
• Disaster drills are infrequent and not
  well-coordinated with other agencies
• PROTECTING THE STAFF
• Little guidance is provided to hospitals about
  what personal protection equipment should be
  available
• There is a need for substantial training in
  disease recognition, decontamination and
  containment procedures

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Emergency Medical Services Considerations

• Cities and regions are often served by multiple
  9-1-1 call centers
• EMS agencies do not effectively coordinate their
  services with emergency departments and trauma
  centers
• Communication between EMS and public agencies is
  fragmented, often on different radio frequencies,
  and they lack common operating procedures
• There are no national standards for training EMS
  personnel
• EMS agencies lack protective equipment to
  effectively respond to chemical, biological or
  nuclear threats

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Pediatric Disaster Preparedness

• Minimize parentchild separation
• Improve the level of pediatric expertise on
  disaster response teams
• Address pediatric surge capacity
• Develop specific medical and mental health
  therapies, as well as social services, for
  children
• Conduct disaster drills for a pediatric mass
  casualty incident

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Recommendations

• Create a Coordinated, Regionalized Accountable
  System
• All participants from EMS, to ED, to governmental
  agencies fully coordinate their activities and
  integrate communication to ensure a seamless
  system
• Develop performance metrics for the various
  elements of the system and report them to the
  public
• Create a lead agency in the federal government to
  insure their success

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Recommendations (continued)

• Hospitals Should Reduce Crowding and Create Surge
  Capacity
• Improve hospital efficiency and patient flow
  through operational management methods and
  information technologies
• The JCAHO should re-instate strong standards to
  require implementation

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Recommendations (continued)

• Funding
• Increase funding for research to determine the
  best ways to organize and deliver emergency
  services, particularly EMS service
• Increase reimbursement for safety-net hospitals
  who carry large uninsured case burdens
• Increase funding for disaster preparedness at all
  levels of the emergency care system, particularly
  for training, personal protective equipment and
  planning
• Increase funding for pediatric emergency care

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Recommendations (continued)

• Enhance Pediatric Personnel in Emergency Care
• EDs and EMS agencies should see that there are
  pediatric coordinators to ensure appropriate
  equipment, training and services for children
• Conduct research to determine the appropriateness
  of many medical treatments, medications and
  medical technologies for the care of children.
  Once determined, plans should ensure their
  availability

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Summary/Conclusion
The future of our Nations emergency management
system is highly dependent upon the improvement
of the emergency care system for our country.