Emergency rooms confront a crisis of patient arrivals

How many people die as a result? The two-year inquiry did not issue an answer; there is little tracking of how emergency patients fare after a frantic 911 call or a race to the hospital. But there are troubling clues. For example, in some cities, emergency workers save half of the victims of cardiac arrest, but in other places, they save merely 5 percent.

This crisis report involves just day-to-day emergencies. Emergency rooms are far from ready to handle the mass casualties that a bird-flu epidemic or a terrorist strike would bring, the institute said yesterday in a three-volume report.

``If you can barely get through the night's 911 calls, how on earth can you handle a disaster?" asked a coauthor of the report, Dr. Arthur Kellerman, Emory University's emergency medicine chief.

Even a school bus crash would qualify as a disaster, but though children make up more than one-quarter of all emergency-room visits, only 6 percent of emergency departments have all the supplies needed, such as child-sized equipment to treat pediatric emergencies, and few have doctors trained in children's care, the Institute of Medicine panel found.

The inquiry by the independent scientific group provides a rare look at the problem's scope, and recommends urgent steps for health organizations and local and federal officials to start fixing it.

At the root of the crisis: Demand for emergency care is surging, even as the capacity for hospitals, ambulance services, and other emergency workers to provide it is dropping.

There were almost 114 million emergency-room visits in 2003, up from 90 million a decade earlier. Only about half were true medical emergencies. When the poor and uninsured cannot get healthcare anywhere else, they go to emergency rooms, which must treat them regardless of ability to pay.

``It is the only medical care to which Americans have a legal right," said Kellerman, adding that what constitutes an emergency is different to a doctor than to a desperate patient. Last week, he treated a woman who arrived in an emergency room after running out of some crucial medication and being turned away by four clinics.