Report: Hospital ERs Not Prepared for a Major Incident

Published: May 5, 2008

WASHINGTON – A report on hospital surge capacity released May 5 by the House of Representative Oversight and Government Reform Committee says 34 U.S. hospitals are overwhelmed and not prepared to handle the influx of patients from a terrorist attack or disaster. The conclusions were the result of a one-day study conducted in March.

At the request of Chairman Henry A. Waxman, a California Democrat, the majority staff of the Committee conducted a survey of Level I trauma centers in seven major U.S. cities to assess whether they have the capacity to respond to the level of casualties experienced in the 2004 Madrid attack. The survey included five of the cities considered at highest risk of a terrorist strike: New York City, Los Angeles, Washington, D.C., Chicago and Houston. It also included Denver and Minneapolis, where the 2008 Democratic and Republican conventions will be held.

According to the report, the Level I trauma centers surveyed are not the only providers of emergency care in the seven cities, but they are the hospitals that can provide the highest levels of injury care and would be the preferred destinations for casualties in the event of a terrorist attack involving conventional explosives. Severely injured patients treated at Level I trauma centers have a significantly lower risk of death than patients treated at hospitals that are not trauma centers.

The survey was conducted on Tuesday, March 25 at 4:30 p.m. local time in each of the seven cities. The survey was designed to determine the real-time capacity of the emergency rooms at the Level I trauma centers to absorb a sudden influx from a mass casualty event. Thirty-four of the 41 Level I trauma centers in these cities participated in the survey.

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The results of the survey show that none of the hospitals surveyed in the seven cities had sufficient emergency care capacity to respond to an attack generating the number of casualties that occurred in Madrid. The Level I trauma centers surveyed had no room in their emergency rooms to treat a sudden influx of victims. They had virtually no free intensive care unit beds within their hospital complex. And they did not have enough regular inpatient beds to handle the less severely injured victims. The shortage of capacity was particularly acute in Los Angeles and Washington, D.C.

The survey found that on March 25, 2008, at 4:30 p.m. local time, emergency room crowding was severe in the hospitals surveyed:

  • More than half of the emergency rooms in the Level I trauma centers surveyed were operating above capacity.
  • The total number of available emergency room treatment spaces in each of the seven cities was less than the number treated at a single Madrid hospital.
  • In Los Angeles, three of the five hospitals surveyed were on diversion.
  • In Washington, D.C., there were no available spaces in the emergency rooms of the two Level I trauma centers surveyed.
  • None of the Level I trauma centers surveyed had enough critical care capacity available for seriously injured casualties from a Madrid event.
  • None of the Level I trauma centers surveyed had a sufficient number of regular inpatient beds available to absorb the casualties from a Madrid event.


Portions of this article are excerpts from “Hospital Emergency Surge Capacity: Not Ready for the ‘Predictable Surprise’

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