Preparing for Disasters by Strengthening Everyday Systems

ASPR partners with Health Affairs to Raise Awareness of Challenges and Opportunities in Emergency Medicine

Emergency responders rely on the same systems of care that they use every day to protect health and save lives during disasters and public health emergencies. When those systems are better able to cope with everyday needs, they are also better able to cope with the complex, urgent, and diverse threats to health that arise during a disaster. Developing an emergency care system that is patient- and community-centered, integrated into the broader health care system, and able to provide high quality care will be better equipped to meet the challenges faced every day and in times of crisis.

Raising awareness of the issues that impact the emergency care system is the first step in finding answers to those challenges and making those systems more reliable and effective when we need them most. In December 2013, ASPR partnered with Health Affairs to develop a special issue of the journal that focused on the challenges and opportunities that face emergency medicine. The series of articles in the December 2013 issue of Health Affairs presented a coherent set of information that helped explain this complex issue to the journal’s 11,000 domestic and international subscribers.

As part of this special edition, Assistant Secretary for Preparedness and Response, Dr. Nicole Lurie, Director of the Division of Health System Policy, Dr. Gregg Margolis, and ASPR fellow, Dr. Kristen Rising, co-authored The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters Exit Icon. In this article, the authors describe the importance of building an emergency care system that meets everyday acute care needs while being ready for disasters. One of the core concepts of building this kind of system is re-orienting the current system so that it is both patient- and community centered. A comprehensive emergency care system must meet the needs of patients and communities and envision a system of care that efficiently delivers a high quality product both day to day and in times of surge. While considerable federal resources are available in times of disaster, most emergency care is delivered in the private sector in the US, and the civilian system is thus the critical foundation upon which national response efforts must be built.

Dr. Carr, the newly appointed Director of the ECCC, and Dr. Ricardo Martinez, administrator of the National Highway Traffic and Safety Administration during the Clinton administration, co-authored Creating Integrated Networks Of Emergency Care: From Vision To Value Exit Icon. Their paper focused on developing a vision for the emergency care system of the future. Although there are many successes in the existing systems of care that have been developed over the last half century, challenges remain. Both the challenges and the path forward are framed around the domains of: people, quality and processes, technology, finances, and jurisdictional politics.

Both papers highlight the importance of the patient and community in the ongoing development of the emergency care system. In some ways the emergency care system is already patient-centered; emergency departments are mandated by law to provide a medical screening exam to any and all patients who seek care, no appointments are necessary, and services are offered 24 hours a day, every day of the year. But little has been done to develop a system of care that empowers patients to make informed decisions about their acute care needs or to incentivize hospitals to plan around the needs of the populations that depend upon them for unscheduled care.

A number of important factors have contributed to the growth of emergency medicine over the last half century. Americans live longer and with more chronic medical conditions than ever before. At the same time, complex conditions are increasingly managed as outpatients rather than inpatients, and many Americans are not able to rapidly access office-based care. Much of the need for unplanned acute care has been shifted from office-based care to the emergency department. Rather than an option of last resort, the ED has become an option of first resort for individuals with acute conditions or exacerbations of chronic conditions. Many Americans feel a close connection with their local hospital and depend upon the emergency care safety net to be in place.

Both papers also highlight that there is important work still to be done. Emergency departments are efficient and readily accessible for acute conditions, but much of the care delivered in the ED is focused on identifying and treating an acute problem and not on the long term diagnostic or management strategy. Less than a fifth (18%) of patients presenting to the ED require hospital admission – most are treated and released. And too often, the care that is received in one acute setting is not accessible to providers in other settings. This results in fragmented care.

A community centered emergency care system would decrease the amount of fragmented episodic care that is delivered by blending the needs of patients (timely access to high quality care for acute conditions) with what providers know about the importance of care continuity. Innovative solutions include regional health information exchanges, population based planning approaches, and mobile integrated healthcare. Developing a community-centered emergency care system requires the seamless integration of emergency care into the healthcare system and into the community.

Although many challenges remain, emergency care systems can become stronger by implementing a patient- and community-centered approach and by working through their healthcare coalitions on innovative approaches. These approaches can help the emergency care system provide lifesaving care and promote health and well-being during a disaster and every day. To learn more, check out the December 2013 issue of Health Affairs, which focuses on the future of emergency care.

Health Affairs Issue on Emergency Care

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Dr. Gregg Margolis, director of ASPR's Division of Health System Policy, speaks at the press event for the unveiling of the special Health Affairs issue on Emergency Care.