The Future of Emergency Care in the United States Health System: an Institute of Medicine report.

The Institute of Medicine (IOM), established in 1970, is a member of the National Academies of Sciences and provides independent, unbiased, evidence-based advice to policy makers, health professionals, industry, and the American public. In 2006, the IOM produced a report on the Future of Emergency Care in the US Health System5 that addressed the critical status of emergency care in this country today. The report strives to define the problems and makes specific recommendations for solutions. Central to this crisis in emergency care is the uncertain availability of surgical specialists, including neurosurgeons, in our Emergency Departments (EDs) and Trauma Centers. This presentation to the Congress of Neurological Surgeons, General Scientific Session IV, on October 12, 2006, described the IOM report and discussed the provision of emergency neurosurgical care in this country. The motivation for the IOM study was a culmination of factors including: 1) Crowded EDs. 2) Ambulance diversions. 3) The increasing burden of uncompensated care. 4) Decreasing physician reimbursement. 5) The fragmentation of our emergency care systems. 6) Inadequate surge capacity. 7) Personnel shortages, which include the shortage of surgical specialists such as neurosurgeons. 8) Rising malpractice costs. 9) Limited data on quality outcome measures. 10) Inadequate research funding and infrastructure. 11) Limited preparedness for pediatric patients. As the IOM study was conducted, it became apparent that the crisis in Emergency Medical Services (EMS) is “under the surface” and that much of the American public believes that the status and availability of emergency and trauma care is what they see on popular television programs. For example, a recent Harris Poll4 showed that approximately one in three Americans believe that the hospital nearest to them is a trauma center, when, in fact, less than 8% of hospitals actually have a trauma center. It was also revealing in this same poll that 8 in 10 Americans indicate that having a trauma center nearby is equally or more important than having a fire or police department. EMS in the United States, currently, are overwhelmed, underfunded, and fragmented.