Many ERs ill-prepared for major disaster

ATLANTA — At this city's main trauma hospital, lines of waiting patients clog the hallways, even on slow days. Doctors say they probably couldn't handle a major plane crash or any other incident with more than 20 or 30 severe injuries.

"It's a struggle to meet the nightly demand of 911 calls," said Dr. Arthur Kellermann, an emergency-room physician at the hospital, Grady Memorial. "But somehow we're supposed to deal with a ... terrorist bombing? Or a new strain of influenza?"

Trauma centers and emergency departments in many U.S. cities are similarly strained, experts say.

"Trauma systems are never more than a couple of minor incidents from being overwhelmed," said Larry Gage, president of the National Association of Public Hospitals and Health Systems.

Hurricane Katrina destroyed New Orleans' only trauma center. A few years ago, funding problems nearly closed primary trauma centers in Detroit and Los Angeles, and more than a dozen other U.S. hospitals have scaled down or closed their trauma units since.

The story is different elsewhere, including Seattle.

Harborview Medical Center, the only Level 1 trauma center in Washington, provided $93 million of free medical care in 2004 — up from $55 million in 2003, said Chief Operating Officer Johnese Spisso.

Despite that growing demand and an overcrowding problem, Spisso said Harborview is better off than most hospitals because of a statewide plan designed to take the pressure off of Harborview.

Lower-level trauma centers across the state handle lesser emergencies, freeing Harborview to take on the most-intensive cases. And Spisso said Washington is one of just a few states with a trauma trust fund to help pay for care of patients who qualify for Medicaid.

"One of the positives we have in this state is we have a very good state plan. ... Our state is actually looked to as a model."

Harborview is urging other health centers to take on some charity care to share the load of uninsured patients. The hospital is also adding 50 trauma-center beds in 2008.

The trend of U.S. hospitals scaling down or closing trauma units, along with a growing U.S. population, is making it harder for many hospitals to handle severe emergencies.

"Across the country, the level of crowding at emergency departments has reached levels that are unprecedented in America's history," said Dr. Kathleen Clem, chief of emergency medicine at Duke University Medical Center.

Many hospitals have gotten out of money-losing trauma care, increasing the load on those that have stayed in that business, industry experts say.

Grady Memorial is Atlanta's primary emergency-care center, with about 200,000 visits a year, and it's been getting busier. Grady's 100 intensive-care-unit beds are often full, meaning dozens of patients at a time have to wait on gurneys in the ER. That, along with a heavy flow of new cases, doesn't allow much room for dealing with a multitrauma incident.

In New Orleans, the situation is unusual in that hurricane flooding, not scarce funding, closed the main trauma center. But some ER doctors say that even before the floods, they expected problems getting the center reaccredited this fall.

Charity Hospital, New Orleans' only top-level trauma center and once one of the nation's largest hospitals, was irreparably damaged by floodwaters after Hurricane Katrina. Most of the city's trauma and emergency cases have been handled on U.S. Navy ships, in temporary combat-hospital tents, and in four civilian hospitals that have managed to restore some services.

"We are a bus crash away from complete and total disaster," said Donald Smithburg, chief executive of the Charity's parent organization, the Louisiana State University Health Care Services Division.

However, officials at Detroit Receiving Hospital, that city's chief trauma center, said their center is on solid footing right now and has been able to handle multiple-trauma incidents pretty well.

But that's a turnaround, they say, from the situation two years ago, when budget shortfalls spurred rumors that the trauma center would have to close. An infusion of state money saved the day.

In September, emergency physicians from across the country gathered in Washington, D.C., to rally for additional government support, including a measure that would increase Medicare payments to emergency doctors and hospitals by 10 percent.

But the bill so far has only two sponsors. Emergency physicians say they are amazed that the Bush administration is willing to spend billions to stockpile Tamiflu for a possible flu pandemic — even though it's not clear that the medicine would be effective — while showing disinterest in aiding emergency hospitals that would have to handle flu cases.

Information on Harborview was provided by Seattle Times staff reporter Emily Heffter.