Many U.S. emergency rooms get poor reviews

WASHINGTON (Reuters) - America's emergency medical system is barely prepared for a real emergency, with overcrowded facilities and poor staff training, experts said on Tuesday.

The report from the American College of Emergency Physicians adds to a growing list of complaints that a lack of a cohesive health care system means U.S. residents get different care depending on where they live, and that emergency response in general is lacking in the United States.

"Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly this isn't the case," said ACEP President Dr. Frederick Blum.

"Our report found the nation's support for emergency medical care is mediocre or worse. Most Americans would not accept mediocre treatment or mediocre medicines; they also should not accept mediocre support of an emergency medical system that they expect to be of the highest quality when their lives hang in the balance."

The ACEP panel graded U.S. states in four broad areas: access to emergency care, quality and patient safety, public health and injury prevention, and the medical liability environment.

No state was considered outstanding, but overall, California came out as the best-prepared state, followed by Massachusetts, Connecticut, and the District of Columbia, the report found.

Arkansas, Idaho and Utah had the weakest support for emergency care, according to the analysis, which used data from sources including the American Medical Association, the American Nurses Association, the Henry J. Kaiser Family Foundation and the U.S. Department of Health and Human Services.

THROUGH THE CRACKS

Most states fell short of what would be considered a basic, acceptable level of preparedness, the report found. "It shows that in every category, some states are making progress and some are lagging far behind," said Dr. Angela Gardner, an emergency physician in Texas and chair of the task force that wrote the report.

"If the emergency medical system gets a C-minus (a just below average grade) on an average day, how can it ever be expected to provide expert, efficient care during a natural disaster or terrorist attack?"

The report shows that while health care spending is up, and spending on homeland security is up, emergency medical care often falls through the cracks, said public health and infectious disease expert Mike Osterholm of the University of Minnesota.

"I think of all the federal dollars that were provided following 9/11 (the September 11 attacks) for local preparedness...only a very limited amount ended up going to the emergency medical system," Osterholm said in a telephone interview.

A report issued on Tuesday showed that total U.S. health-care spending reached $1.87 trillion in 2004, nearly doubled from a decade earlier. Health care comprised 16 percent of the nation's gross domestic product in 2004.

Experts have been complaining for years that U.S. emergency rooms are overcrowded and overused.

"We do a pretty good job of maintaining the status quo during routine disease problems in the community but as soon as we see even seasonal increases in things like influenza, we see situations where emergency rooms have to go into emergency diversion status because they are overflowing at the doors," said Osterholm, one of those experts.

Osterholm has been advocating for strengthened public health spending. "The system, like all of health care, is really a just-in-time, no surge capacity kind of system," he said in a telephone interview.