June 15, 2006
It’s an Emergency

Here’s a disconcerting statistic: emergency rooms are turning away an average of one person a minute in the US because they’re too full. This according to USA Today, which has somehow morphed into a news outlet.

These numbers are scary enough; after all, if (!) there’s another terrorist attack, or the bird flu hits, where will people be heading? The article quotes

Arthur Kellermann, director of the Center for Injury Control at Emory University School of Medicine in Atlanta. “We cannot let the most time-sensitive portal in the hospital get gridlocked.”

Two additional suboptimal truths, according, again, to USA Today. First, with ERs overflowing, your survival chances vary drastically from one location to another. The paper claims to have found a ten-fold difference between major cities in survival rates of cardiac-arrest patients. Second, the article doesn’t tell you which cities are good and which are bad.

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Posted by Chuck Dupree at June 15, 2006 12:12 PM
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WaPo had a major article today, too. You'd think with all the billions the Department of Homeland Security has thrown up in the air, some progress could have been made toward preparing for a future epidemic.

For personal use of emergency rooms, call an ambulance rather than trying to get there yourself. You'll get priority over "walk-ins" and you'll probably get good preliminary assessment and treatment while you're on your way, plus that info will be transmitted to the ER people in medical language. And you won't be shunted first to the billing clerk to show your insurance credentials. If you can, take somebody with you who'll yell or track down a medical person if your IV falls out, your condition changes, whatever. If you can, tell your family physician's office you're in ER so they're ready to supply records as needed.

Unfortunately, I have a lot of consumer knowledge on this topic.

Posted by: Joyful Alternative on June 15, 2006 6:41 PM

Ms. Alternative is completely right under most circumstances. It also works to have a former member of the anesthesia department escort you in in her private car and begin to scream that she has a cardiac myoinfarction in the car when she hits the ER.

I wasn't there, but I heard the descriptions.

I was discussing the pitful state of ERs with friends the other day, and one person recounted the time she was in the ER and the guy next to her had sawed off a couple of fingers in his workshop, and -- there he was sitting quietly with his unattached fingers on ice in the plastic bag in his good (I assume) hand. The medical center where the fingers in a bag were observed is a regional center for reattachment surgery. It's also a regional trauma center in a small city where people shoot each other pretty regularly. Hint: don't saw off your fingers or lose other body parts on Friday or Saturday night.

The older I get, the happier I am that I'm an old crock who's lived a fairly satisfying life and won't mind going early just because I couldn't get ER care for something acute within 24 hours.

Posted by: Lucy from the House of Joy & Truckstop on June 16, 2006 12:27 AM

Regarding ambulance vs. walk-ins: Do note that when hospital ER's go "on diversion", they will refuse to accept ambulances while they are forbidden from refusing to accept walk-ins (though they might not actually *see* the walk-ins for quite some time). In the Phoenix metropolitan area last year, every single hospital in the city went "on diversion" multiple times, meaning that ambulances could do nothing but drive around the city aimlessly. No statistics on how many people died because of that, sorry :(.

So ambulance vs. walkin isn't always a slam dunk.

Personally, for anything where you actually have a choice of walkin vs. ambulance (i.e., it's not a heart attack or stroke), I'd recommend an "urgent care" center (the ubiquitous "doc-in-a-box" places), where you'll get examined by a young man just out of medical school, but it'll be fast and cheap.

My mother, a nurse for 40 years, blames insurance companies and for-profit hospital companies for the current woefull state of affairs. When she entered nursing, profit wasn't a consideration. Hospitals were locally-owned not-for-profit institutions and insurance companies were mutual companies, i.e., owned by their customers rather than by shareholders. Now it's all about profit, profit, profit, and patient care be damned... you have three hospitals in the area and their ER's average 70% full? Close one of them, and then you'll have the two remaining ER's at 95% full under normal conditions! Of course, during any sort of flu epidemic or other such public health emergency they'll be swamped, but public health be damned, there's a profit to be made here!

-BadTux the Medical Penguin

Posted by: BadTux on June 16, 2006 7:16 PM

BadTux, MD, in my area, even when a hospital's "on diversion," the ambulance must take you to the hospital of your choice when you insist, and the hospital must take you in (although you may lounge on your gurney in the hall for a long time).

You will have had the advantage of the care of the ambulance crew, which here is at least one EMT and may include a paramedic, in the meantime. Plus, your hospital of choice should be one where your primary care doctor is on staff; my primary care doctor is part of a large internists' group, one of whom is always on call and usually on site, and whichever of them is there serves my purpose of advocating for me and keeping me alive.

Where I used to live, the ambulance would, no matter what you said, take you to the "nearest hospital"* with an ER, which, in the suburbs, meant not much of an ER, unable to do all that much for a patient in bad shape. Which is why I think closing some ERs isn't all that bad an idea. (*In quotes, because from the same home address, two different ambulance crews insisted two different hospitals in opposite directions were closer.)

I've heard of someone being driven to an ER to be told to go home and call an ambulance to come back; they'd be seen faster that way.

I've often heard of doc-in-a-box but I've never actually seen one. Are they regional? And isn't Phoenix a little hot and dry for a penguin?

From another satisfied old crock

Posted by: Joyful Alternative on June 17, 2006 7:00 PM
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