From: Reuters
Published May 5, 2008 06:23 PM

Hospital ERs overwhelmed, one-day study finds

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - A one-day snapshot of emergency room conditions at 34 U.S. hospitals shows they are all overwhelmed and none is prepared to handle a big event like a disaster or attack.

The report from the House of Representatives Oversight and Government Reform Committee, released to coincide with a hearing on Monday, shows emergency rooms in Washington and Los Angeles operating over capacity on an ordinary day. None could have handled a surge of new patients.

Henry Waxman, a California Democrat who heads the committee, used the report to illustrate why he opposes President George W. Bush's proposed cuts to the federal Medicaid program.

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Bush says states need to pay more of the costs of maintaining emergency services and has proposed $18.2 billion in cuts to Medicaid over five years.

"The proposed Medicaid regulations will directly result in further reductions in hospital and ED (emergency department) capacity and, ironically, specifically target trauma centers and teaching hospitals -- the very institutions whose surge capacity we must maintain if they are to function in the time of disaster or terrorist attack," Dr. Roger Lewis of the University of California Los Angeles Medical Center told the hearing.

The survey included seven major cities -- New York, Los Angeles, Washington, Chicago, Houston, Denver and Minneapolis.

They were all inspected on Tuesday, March 25 at 4:30 p.m. local time.

"Both of the emergency rooms in the Level I trauma centers surveyed in Washington, D.C., were operating above capacity," the report reads. That means new patients must wait in hallways, waiting rooms or offices.

On average, the emergency rooms in all seven cities were 15 percent over capacity.

COMPARISONS TO MADRID

The report looked at what would happen if someone launched an attack equivalent to the 2004 bombing of commuter trains in Madrid that killed 191 people.

"After the Madrid attack, 966 victims were transported to 15 hospitals, and 270 victims arrived at a single hospital for emergency care," the report reads.

"Not one of the seven cities had sufficient treatment spaces in emergency rooms of their Level I trauma centers to handle the volume of victims seen at a single Madrid hospital."

And hospitals are not prepared for the most likely form of attack -- a suicide bomber, said Bruce Hoffman of Georgetown University.

Hoffman said suicide bombing victims often have multiple types of injuries: "penetration wounds from small projectiles that damage soft tissues and vital organs; fracture bone and sever arteries and nerves; blast effects on lungs, ear drums, and other organs, and severe burns."

"The best way to save as many lives as possible after a terrorist bombing or suicide attack is for physicians and other health care workers to undergo intensive training and preparation before an attack," he recommended.

Several of the experts told the committee the Medicaid cuts would not allow for such training and, in fact, stepped-up funding is needed.

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