WhiteCoat

The Wait of Death

intensive care unit monitorWhile searching for more information about the alleged death in the University of Chicago emergency department waiting room, I came across this article at the Huffington Post regarding an emergency patient in Japan who died after sustaining head and back injuries in a motorcycle accident.

When paramedics on the scene called hospitals to accept transport, 14 hospitals refused to accept the patient because they did not have the proper specialists. By the time the paramedics found a hospital to accept the patient, the patient had gone into shock from blood loss and later died.

The article notes that it is common for hospitals in Japan to be on the equivalent of “bypass” in the US, with more than 14,000 emergency patients being rejected by at least three Japanese hospitals in 2007 before getting treatment. In one case, a woman in her 70s with a breathing problem was rejected 49 times by Tokyo hospitals.

For all of you that think a situation like this could never happen in the US, consider this: In the US, under EMTALA laws, every patient is guaranteed a screening exam and stabilizing treatment to the best of an emergency department’s ability (unless coming by ambulance and the closest emergency department is on bypass – in which case you generally get diverted to another facility). If you are in a smaller ED and need specialty care that the hospital does not provide, you’re at the mercy of the specialty hospitals and the transport services.

I’ve had psychiatric patients in need of transfer rejected by seven different psychiatric hospitals. The time that I’ve spent trying to transfer those patients could have been used to treat other patients. I’ve seen many patients whose medical condition has gotten worse while waiting for transport from the rural hospital where I moonlight. I’ve watched patients die in front of me from heart attacks that didn’t respond to thrombolytics while waiting for transport to the tertiary care facility to arrive.

As more and more hospitals close and the services available at community hospitals shrink, I don’t expect things in this country to get better.

I foresee more and more essential services being centralized to large academic centers that will have finite resources. When those resources are overwhelmed by all of the patients being transferred to them, well …

When everything’s an emergency, nothing’s an emergency.

6 Responses to “The Wait of Death”

  1. BlackSails says:

    I dont see your email anywhere, but I thought you might find this interesting: http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece

    The autism-MMR link wasnt just the result of bad statistics – the data was made up.

  2. Dahc says:

    I wouldn’t be surprised to find out if the UChicago Hospital story is true; they’re currently going through some MAJOR problems. I know, I was just laid off today.

  3. k says:

    This article has a good explanation of the differences between the US and Japanese systems of ambulance transport and ED admissions/refusals:
    Western Journal of Emergency
    Medicine, Vol 9, Issue 3, 2008, Article 10 – Issues and Solutions in Introducing Western Systems to the Prehospital Care System in
    Japan by Tetsuji Suzuki
    .

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