ATLANTA -- At this city's main trauma hospital, lines of waiting patients clog the hallways _ even on slow days. Doctors say they probably couldn't handle a major plane crash or any other incident with more than 20 or 30 severe injuries.
"It's a struggle to meet the nightly demand of 911 calls," said Dr. Arthur Kellermann, an ER physician at the hospital, Grady Memorial.
"But somehow we're supposed to deal with a ... terrorist bombing? Or a new strain of influenza?"
Trauma centers and emergency departments similarly are strained in many U.S. cities, experts say.
"Trauma systems are never more than a couple of minor incidents from being overwhelmed," said Larry Gage, president of the National Association of Public Hospitals and Health Systems.
Hurricane Katrina destroyed New Orleans' only trauma center. A few years ago, funding problems nearly closed primary trauma centers in Detroit and Los Angeles, and more than a dozen other U.S. hospitals have phased-down or shuttered their trauma units since.
That trend, along with a growing U.S. population, is making it harder for many hospitals to quickly and adequately handle severe emergencies.
"Across the country, the level of crowding at emergency departments has reached levels that are unprecedented in America's history," said Dr. Kathleen Clem, chief of emergency medicine at Duke University Medical Center.
Trauma and emergency care is a money loser, serving many patients without health insurance. It's also expensive to maintain a round-the-clock staff of specialized surgeons and trauma-care medical workers.
In Atlanta, hospitals often pay subspecialists around $1,000 per day to take calls for trauma care.
For those reasons, many hospitals have gotten out of trauma care, increasing the load on those that have stayed in that business, industry experts say.
Grady Memorial is Atlanta's primary emergency care center, with about 200,000 visits a year, and it's been getting busier.
