The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

Abstract

The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life-and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.

Integrating a Community Paramedicine Program with Local Health, Aged Care and Social Services: An Observational Ethnographic Study

“…Community paramedicine (CP) is an emerging model of health care where paramedics apply their training and skills in 'nontraditional' community-based environments (1)(2)(3). The genesis of the CP model is generally credited to the long established and well evaluated Long and Brier Island project in Nova Scotia, Canada (4,5) where inspiration was drawn from the 1996 EMS Agenda for the Future from the United States (6).…”

Impact of disasters on routine emergency service response performance

“…This framework links dynamic resource capabilities and performance. Previous studies discussed impact in terms of resource pressures but did not address performance measures (Dooley et al., 2015; Hsu et al., 2002; Lurie et al., 2013).…”

“…In a different context, Lurie et al. (2013) discuss the impact of the Boston Marathon bombings in April 2013 on the emergency care system in Boston. Similar to the change in the mix of complaints in the emergency medical literature, Dooley et al.…”

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

“…More recent events, including the Boston Marathon bombing and concerns over the nation's capacity to care for serious infectious diseases, maintain the nation's attention on this issue. 1 To emergently respond to disasters and public health emergencies, hospitals must mobilize physical and human resources as they "surge" to meet a heightened patient demand. Hospital surge capacity-or the maximum potential delivery of required resources through augmentation or modification of resource management and allocation-depends upon daily operational efficiency in both the emergency department (ED) and the hospital.…”

“…In the wake of the September 11, 2001, attacks and the response to Hurricane Katrina, significant investment was made into emergency preparedness. More recent events, including the Boston Marathon bombing and concerns over the nation’s capacity to care for serious infectious diseases, maintain the nation’s attention on this issue 1 . To emergently respond to disasters and public health emergencies, hospitals must mobilize physical and human resources as they “surge” to meet a heightened patient demand.…”