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May 7th, 2008
04:24 PM ET

ER capacity and terrorism

By Miriam Falco
CNN Medical Managing Editor

How crowded is your neighborhood emergency room and could it handle the aftermath of a terrorist act? That's been the topic of two hearings on Capitol Hill this week. On Monday we learned that lawmakers had surveyed hospitals in seven cities (New York; Washington, D.C.; Los Angeles, California; Chicago, Illinois; Houston, Texas; Denver, Colorado; and Minneapolis, Minnesota) to see whether their emergency departments would be able to handle the flood of injures after a conventional terrorist attack, such as the subway bombing in Madrid, Spain, four years ago, which killed almost 200 people and injured more than 2,000.

Of the 34 hospitals surveyed on March 25 (a randomly chosen date, according to the House Committee), more than half of the hospitals said their ERs were already above capacity and only five had available beds in their intensive care units. Washington and LA hospitals were in particularly bad shape in terms of capacity.

The House Committee on Oversight and Government Reform, chaired by Democratic Rep. Henry Waxman, commissioned the survey and held these hearings because new Medicaid regulations are taking effect as early as May 26, which will cut tens of billions of federal dollars to public and teaching hospitals nationwide.

Today, Health and Human Services Secretary Michael Leavitt and Department of Homeland Security Secretary Michael Chertoff were grilled by the same committee.

Asked if they thought the nations' level 1 trauma hospitals had the capacity to deal with such a terrorist attack, Chertoff said he did, and Leavitt said repeatedly that even though some hospitals were not able to handle a terrorist threat, Medicaid dollars are not the solution. "The job of Medicaid is to take care of people who are poor, or indigent, or disabled," not institutions or hospitals, as Leavitt told the committee many times.

One ER physician I spoke with said he was "dumbfounded" when he listened to today’s testimony. Dr. Art Kellerman, a long-time emergency room physician at Grady Hospital in Atlanta and Dean for Health Policy at Emory University continued, "This is mind-boggling. It's deeply disturbing that the two cabinet secretaries most responsible simply are not going to take responsibility for the current crisis in our Emergency Departments."

For the American College of Emergency Physicians, overcrowded emergency rooms have been a concern for quite some time. "This is an EXTREME crisis, not just for surge capacity (in the event of a terrorist attack), but day-to-day capacity," the group's president, Dr. Linda Lawrence, told CNN following Monday's hearing.

A few years ago, my husband sliced his hand in the kitchen. Fortunately, I knew of a smaller hospital nearby. Its ER wasn't too crowded and he got in pretty quickly. I couldn't do that today. That hospital is closed. Today I would have to go to a different hospital with the potential of an overcrowded emergency room and a long wait.

Have you been to an emergency room recently? Did you have to wait a long time?  Are you concerned about emergency departments in hospitals in the city where you live being able to handle ordinary patient care, let alone coping with the disaster following a terrorist attack?

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