I came across this AP article today, about emergency rooms being swamped in Florida post-hurricane - not for the obvious hurricane-related injuries, but simply because doctor's offices in the region are closed due to damage or lack of power:
AP article at CNN.com
PLANTATION, Florida (AP) -- A week after Hurricane Wilma, more than 1 million Florida homes are still without power and many doctors' offices remain closed, leaving hospitals swamped as the only source of medical care in some communities.
"You can't get any regular doctors on the phone. You can't get anything filled," said Tim Swett, 41. He waited five hours at one emergency room and finally left without help for a back problem he had aggravated while cleaning up his mother's yard.
Think about all the diabetics and other people in the middle of an ongoing health issue. Pregnant women. Anyone who's sick. If you've ever had a major illness you know that even a weekend where you cannot see or reach your doctor for all practical purposes is an eternity.
Think about the warning bells this raises for our health care infrastructure.
In Los Angeles County, the area I'm most familiar with, it's already common for emergency rooms to be overcrowded and even shut down to new patients under relatively ordinary circumstances. Now imagine adding a disaster on top of that - your choice of fire, flu, earthquake, physical or biological terrorist attack - and you can see the problem.
In addition to the obvious problems we have already with our health care infrastructure, hospitals are designed to run at maybe (this is a guess) 80% of capacity. After all, excess capacity is expensive, and most hospitals are for-profit enterprises. Plus, they have obligations to treat everyone, including people who cannot pay or who may not be able to pay - and a trauma center, a great innovation that saves lives of poor and rich alike - can be a big cost center under those circumstances. Because of that, many trauma centers were closed in the Los Angeles area - the hospitals simply couldn't afford to keep them open and staffed.
But what is largely sustainable for your everyday load is totally inadequate for a Homeland Security emergency. I think it would be better for the nation if we redirect the focus of a lot of the HS funding and planning away from the rare events that might kill a couple of thousand people once in a while to the everyday events that DO kill thousands of people every year, that have the dual purpose of also better equipping us for the ordinary disasters (big and small, natural and manmade) that we know will happen.
And a universal healthcare solution would help too - making sure that people who end up in emergency rooms will be paid for whether they've suffered from ordinary bad luck, a major hurricane, or a malicious act of terrorism. It also makes it more likely that a serious transmissable infection would be seen by a medical professional early on. It's good for the hospitals, the doctors, and the patients.
Edited to add some more links and cites about trauma care in LA County:
October 7, 2005 article from California HealthLine about the importance of trauma centers:
Patients with severe traumatic injuries are 20% more likely to die if they are taken to a Level II trauma center than if they are taken to a Level I trauma center, according to a study by researchers at the University of Southern California's Keck School of Medicine, the Los Angeles Times reports.
New York Times, August 2004
Since 1990, 70 hospital emergency rooms and trauma centers have closed in California, a state whose emergency and trauma system is overwhelmed and underfinanced, health officials say.
"We are in real tough times here," Meyer (director of the Los Angeles County Emergency Medical Services Agency ) said, adding, "It's not going to change until somebody in a high position has a family member die because they couldn't get treatment in an emergency room." Meyer said that because of higher medical malpractice insurance premiums and the lack of reimbursement for treating the uninsured, "fewer and fewer" doctors are willing to be on call in EDs. The state's 500 hospitals are "on the verge of a whole series of unraveling events," Dr. Jack Lewin, executive director of CMA, said, adding, "No place is safe when you have large volumes of people who need care, but there's no one to pay for it" (Madigan, New York Times, 8/21).
link
Every new shutdown creates another hole in a system that has been stretched to the breaking point.
“It becomes a domino effect,” said Carol Meyer, the county’s head of emergency services. “What happens is those patients seeking emergency care go to the next hospital, which increases their load and potentially delays care.”
Emergency rooms are generally a greater drain on hospital finances than other departments
because more of their patients don't have insurance.
A study by the California Medical Assn. released this week found that Los Angeles County
emergency rooms lost $143 million in the 2001-02 fiscal year, the latest data available.
As the remaining emergency rooms fill up, paramedics then have to drive farther to find
available care, Meyer said.
If a new 911 call comes from an area where the paramedics are busy looking for a hospital
where they can drop off a patient, it may take longer for an ambulance to arrive as
dispatchers look for a paramedic who is free, she said.
Story from 2002 about County Measure B and the dire situation for the trauma network (Measure B passed)
California HealthLine
Plans from last year to open a new trauma center at California hospital, which includes fun facts like:
Under the agreement with California Hospital, the county will provide $21,000 per week for the treatment of uninsured trauma patients, a figure equivalent to what other private hospitals receive. The county estimates that about 50% of California Hospital's trauma patients will be uninsured and that about 80% of those patients will qualify for county reimbursement.