Emergency! Emergency!

If you've spent any time in an emergency room at a U.S. hospital lately, it was probably not hard to tell that it was near the breaking point. This is no small matter considering America's vulnerability to a major epidemic or terror attack.

The ER crisis is outlined in chilling details in three reports issued by the Institute of Medicine, a unit of the National Academy of Sciences. The reports noted that

Half a million times a year ambulances are diverted from ERs that are full and sent to others farther away. ER patients who need admission to the hospital often spend eight hours or more — sometimes even two days or more — on gurneys in the hallways, waiting for a hospital bed to open up.

The ER crisis has many causes, but among the primary ones are that:

* The number of people seeking treatment has jumped sharply from 90 million in 1993 to 114 million in 2003.

* Over the same period, some 700 hospitals with almost 200,000 hospital beds and 425 ER departments closed.

* The result is severe crowding made worse by a huge increase in poor people seeking routine care who are either uninsured or on Medicaid but unable to find doctors willing to treat them.

The institute proposed several solutions for easing the crisis, including new regional systems to improve the flow of patients to the least crowded ERs to funding unpaid emergency care.

As a close observer of the health-care scene, I'm not hopeful that the crisis will abate anytime soon since it is usually the poor who are most affected and they have no voice.