Arthur L Kellermann is a role-model to many of us who have earned or aspire to MD-MPH degrees. Having met him, he speaks with uncommon insight and wisdom. He has written a valuable editorial in the New England Journal of Medicine this week regarding the rising problem of crowding in the Emergency Department, particularly regarding disaster capacity. The Journal has been good enough to offer the editorial for free on their website.
When crowding reaches dangerous levels, hospitals often divert inbound ambulances to other facilities. In 2003, diversions occurred more than half a million times — an average of once per minute.3 Diversion may provide a brief respite for a beleaguered staff, but it prolongs ambulance transport times and disrupts established patterns of care. It also creates ripple effects that can compromise access to care throughout a city. Because crowding is rarely limited to a single hospital, one facility’s decision to divert ambulances can prompt others to follow suit. When that happens, a city may experience the health care equivalent of a “rolling blackout.” Everyone’s access to care is affected — the insured and uninsured alike.4
The complete article can be found here.