Emergency Systems Ailing

By Ceci Connolly
Washington Post Staff Writer
Tuesday, January 10, 2006

Few states are equipped to handle emergency medical crises such as a terrorist attack, a natural disaster or an influenza outbreak, according to an analysis being released today by the American College of Emergency Physicians.

The organization gave an overall grade of C-minus to emergency care in the 50 states and the District of Columbia, with more than half earning below-average scores in areas dealing with the availability of hospital beds and emergency specialists, immunization rates, injury-prevention programs, malpractice laws and sophistication of 911 telephone systems.

"A C-minus is horrible," said Angela Gardner, chair of the task force that prepared the first-ever analysis of emergency medical systems. "When my children come home with a C-minus, they get grounded."

Emergency care specialists such as Gardner said they expected to find some deficiencies in a field that has seen budget cuts and rising demand. But the panel was startled at how poorly prepared the nation is as a whole to manage trauma, whether in individual patients or in the event of a large-scale disaster.

"We have no capacity to handle a Hurricane Katrina or an avian flu outbreak," Gardner said in an interview yesterday. "We can barely handle a regular flu outbreak."

Analyzing publicly available data, the task force gave each state and the District an overall letter grade and ratings in four categories: access to emergency care, quality and patient safety, medical liability environment and public health and injury prevention.

No state received an A overall. California, Massachusetts, Connecticut and the District scored the highest, with overall ratings of B. "More than 80 percent of the states earned poor or near-failing grades," the report concluded. At the bottom, earning D grades, were Arkansas, Idaho and Utah, while Virginia scored a D-plus and Maryland got a B-minus.

Locally, the report illustrated how government action -- and inaction -- affect health care. The District nearly failed in the category of public health, largely because it lags far behind in government-funded programs for infants, the elderly and injured workers. Virginia's low grade overall was attributable primarily to a state malpractice system that has sent specialists fleeing to friendlier legal environments, Gardner said.

The report supported what many Americans have experienced directly -- long waits in overcrowded emergency rooms, loss of health insurance, and specialist shortages in areas such as neurosurgery and obstetrics. Many patients are facing higher bills and traveling longer distances to receive needed care, the authors found.

"Even if you are educated, have insurance and have a doctor, you can have an emergency," Gardner said. "You better hope the big red sign out front doesn't say 'No vacancy.' "

"What we need are beds, doctors and nurses," especially doctors and nurses with special training in trauma care, she said.

From 1990 to 1999, hospitals nationwide eliminated 107,000 beds, 7,800 of which were critical-care beds, according to the report. At the same time, more and more people have sought care. Emergency department visits have increased by 5 million a year, hitting 114 million patient visits in 2003, the last year for which data were available.

In many instances, states with wealthier residents fared better than lower-income states. But the task force found exceptions as well. South Carolina and West Virginia, two of the poorest states in the nation, received above-average grades "If the emergency medical system gets a C-minus on an average day, how can it ever be expected to provide expert, efficient care during a natural disaster or terrorist attack?" asked Gardner.

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