The responses are from emergency physicians who work in the areas devastated by last year's storms, many of whom stayed to care for their patients until they were evacuated. More than half (52 percent) report little to no progress in the recovery of the emergency care system in their communities. Thirty-three percent said some parts of the medical care system have experienced significant progress, an acknowledgement of how hard many hospitals have worked to keep operating through the worst of the hurricanes.
"The survey gives a good indication of what emergency physicians here have been saying all along," said Dr. Jim Aiken, director of Emergency Preparedness at Charity Hospital in New Orleans. "You survive and work through the hurricanes and the damage and you expect it to get better at some point. We're still waiting."
The vast majority of emergency physicians (93 percent) said the shortage of beds is at least 25 percent below what is needed to care for patients, with 30 percent saying the shortage is 50 percent below what is needed. More than half (52 percent) said the need for medical specialists available for emergency care is greater than it was prior to the storms in "several" or "most" practice areas. Nearly all (96 percent) said their emergency departments were experiencing staffing shortages in areas such as nursing.
"We all knew when the storms hit that it would take a while for New Orleans to recover," said Dr. James Moises of Tulane Medical Center and president of the Louisiana chapter of ACEP. "But despite some miraculous work at some individual hospitals and clinics, emergency medicine doesn't look like it's among the highest priorities in the rebuilding process. It's frustrating for patients and doctors to see so little progress in 1 year."
Eighty-seven percent of emergency physicians reported increases in the number of uninsured patients seeking emergency care. Higher numbers of uninsured patients result in lower compensation for hospitals and physicians, which could make it difficult to attract new emergency physicians to the Gulf area
When asked what changes to the system might have saved more lives during the hurricanes, 54 percent said the most important change would be an increased ability to transport patients quickly out of the area to medical facilities. Twenty-five percent said that a quicker response from government and relief organizations would have been most important, and 15 percent said that increased surge capacity in nearby hospitals not devastated by the hurricane would be most important.
To speed recovery and address these concerns, ACEP made the following recommendations:
- Emergency department capacity: Authorities should take both immediate and long-term steps to increase the number of staffed emergency department beds and acute care beds.
- Attract physicians to the region: There is a dire need to attract new primary care and specialist physicians to the region. The affected Gulf region has suffered the greatest relocation of physicians in U.S. history. It will be a difficult and long-term task to attract all the physicians that are needed. The first step should be the re-establishment of physician teaching facilities in the region. Government authorities should also consider creating economic incentives for physicians to locate in the region.
- Psychiatric care: Throughout the region affected by Katrina, there is an immediate need for more emergency and long-term care for psychiatric patients. The benefits will include not only aiding the patients, but also helping to reduce crimes that might be committed by untreated patients and reducing emergency department crowding.
- Patient reimbursement: A disproportionate share hospital (DSH) of funding should be shared with the private sector medical providers who are caring for the uninsured.
- Electronic medical records: Electronic record keeping should be implemented for all medical records. During hurricanes Katrina and Rita, patients were separated from their medical records. Electronic records would make it much easier for medical records to "follow" patients moved during emergencies. Also, many medical records kept only on paper were lost forever during the storms.
More than one-third (36 percent) of emergency physicians said that if the post-hurricane recovery is not sufficiently improved in one more year, they would consider leaving to practice in another state.
"The one-year anniversary of Hurricane Katrina is a time to reflect on the lessons of last year's hurricanes and do whatever we can to prepare ourselves for what comes next," said Dr. Frederick Blum, president of ACEP. "Emergency preparedness doesn't come without cost and we have to make sure our elected representatives know what needs to be done so that when called upon, emergency physicians can continue to provide life-saving care."