The Status of the Nation’s Emergency Management System

The Status of the Nation’s Emergency Management System

Gail L. WardenGail L. WardenChair, Committee on The Future of Emergency Chair, Committee on The Future of Emergency

CareCare in the United States Health Systemin the United States Health System

President Emeritus, Henry Ford Health President Emeritus, Henry Ford Health SystemSystem

The National Emergency The National Emergency Management SummitManagement Summit

March 5, 2007March 5, 2007

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

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 IOM’s 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

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

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

Key ProblemsFragmentation: 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.

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.

Emergency Preparedness

Issues Impacting HospitalsSURGE CAPACITY:

Most operating at full capacityInsufficient space and equipmentAvailability of specialistsLack of agreement to transfer

PLANNING AND COORDINATION:Lack of communication systemNeed for coordination between hospitals, ambulances, EMS, and public safety agenciesInadequate planning for disaster eventsNeed for coordination between local, state, regional and federal agencies

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 environmentDisaster 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 availableThere is a need for substantial training in disease recognition, decontamination and containment procedures

Emergency Medical Services ConsiderationsCities 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

Pediatric Disaster PreparednessMinimize parent–child 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

RecommendationsCreate 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

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

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

Recommendations (continued)

Enhance Pediatric Personnel in Emergency Care:ED’s 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

Summary/Conclusion

The future of our Nation’s The future of our Nation’s emergency management emergency management

system is highly dependent system is highly dependent upon the improvement of the upon the improvement of the

emergency care system for our emergency care system for our country.country.