Waiting for Bioterror
Atlanta's Health Emergency
On September 11, 2001, Dr. Arthur Kellerman was in Washington waiting to testify before Congress about the consequences of uninsurance when a plane struck the Pentagon, across the street from his hotel room. He immediately called back to Grady Memorial Hospital in Atlanta, where he oversees the emergency room residents, and got a disturbing report.
While Atlanta appeared to be safe from terrorism, the emergency room had twenty-five admitted patients waiting for hospital beds, the intensive-care area was packed and the staff had shut the emergency room to new patients. Worse, every emergency room in central Atlanta had declared saturation at the same time. None were taking new patients, and loaded ambulances were circling the block. If attacks had occurred in Atlanta that morning, "there was no way on God's earth we could have absorbed more patients," said Kellerman. Since then, all the Atlanta-area hospitals have gone on simultaneous diversion numerous times, leaving "nowhere to put casualties."
Despite all the effort to gear up for biological terror, the problem of overcrowded and understaffed emergency rooms--where terror's victims would be treated--has received only spotty attention. U.S. News & World Report featured the problem as a cover story, "Code Blue: Crisis in the E.R.," but it ran on September 10, 2001. A month after the attacks, Representative Henry Waxman prepared a report on ambulance diversions and their effect on disaster preparedness, finding a problem in thirty-two states. In at least nine states, every hospital in a local area had diverted ambulances simultaneously on a number of occasions, causing harm or even death to some patients. In Atlanta, one diverted patient was admitted only after he slipped into respiratory arrest while in the idling ambulance. The report quoted an editorial from the St. Louis Post-Dispatch last year:
A word to the wise: Try not to get sick between 5 p.m. and midnight, when hospitals are most likely to go on diversion. Try not to get sick or injured at all in St. Louis or Kansas City, where diversions are most frequent. And if you're unlucky enough to end up in the back of an ambulance diverted from one E.R. to another, use the extra time to pray.
In Washington, Hauer has directed each region to identify 500 extra beds that can be "surged" or put into use quickly, which has led a number of states to identify armories, school auditoriums, stadiums and hotels that can be used as MASH hospitals. But no bubble tent can replace a hospital bed, with a full complement of services readily available within the "golden hour" so crucial to treating trauma patients, said Kellerman. And no proposal exists to address the problem as a systemic one, in which a shortage of nurses and cutbacks in reimbursement have made it impossible for hospitals to staff enough beds.
Without a solution in sight, Grady Memorial uses a makeshift system, parking admitted patients on stretchers in the hallways beneath handwritten numbers that run from 1 to 30. With the crisis deepening, more numbers--1a, 1b, 1c, for example, seventeen additional spaces in all--have been squeezed between the initial numbers up and down the hall. The other night Kellerman had fifty patients lined up waiting for rooms. "These are not disaster scenarios," he said. "This is Friday night. Wednesday afternoon."