Emergency Departments in Crisis: Implications for Accessibility, Quality, and Safety

Following the September 11th attacks and Hurricane Katrina, Americans have a renewed awareness of our dependence on emergency medical care during a mass casualty event. Yet, there is reason to question the capacity of our emergency care resources to meet this need, primarily because of the challenges they confront in meeting current demand. “If you can barely get through the night’s 911 calls, how on earth can you handle a disaster?” asks Arthur L. Kellerman, MD, a prominent emergency physician from Emory University. In recent reports, the Robert Wood Johnson Foundation has described hospital emergency departments (EDs) as “bursting at the seams,” while the Institute of Medicine (IOM) entitled one of its recent reports Hospital-Based Emergency Care: At the Breaking Point. This first installment of a 2-part commentary will examine the role of EDs, current challenges, and efforts to ensure continued quality and safety of care. In the spring, a second installment will discuss the critical role of EDs in responding to catastrophic events.