Emergency in the Emergency Room

LISA ROTH

Illinois Central College

The following speech by college student Lisa Roth investigates the crisis in emergency room care and advocates a claim of policy—that our emergency room system should be overhauled. Note that the speech is organized in a problem-cause-solution pattern. Lisa offers a variety of types of claims, evidence, and reasoning to build her argument.

This dramatic incident serves as an effective attention getter.

Last year, forty-nine-year-old Beatrice Vance began experiencing some alarming symptoms—nausea, shortness of breath, and chest pain. She called her daughter, Monique, and asked to be driven to the emergency room at Vista Medical Center in Lake County, Illinois. Upon arrival, a nurse briefly met with her. She asked Ms. Vance to wait until she could be seen by a doctor, as patients are treated in order of severity.

Lisa’s vivid description appeals to listeners’ emotions (pathos) and indicates that a problem exists.

Fully two hours later, when her name was finally called, Beatrice didn’t respond. In fact, hospital officials found her slumped over in her chair, ten feet or so from the admitting station, unconscious and without a pulse. According to an ABC Nightly News report on September 17, 2007, Beatrice had already died from a massive heart attack while waiting to be seen by a doctor.

Lisa states her thesis and backs it up with an expert’s opinion; to ensure her source’s credibility, she names his title and affiliation.

Sadly, Beatrice is not the only one who suffers at the hands of an overwhelmed, sometimes inconsistent, and sometimes incompetent emergency room staff. Hospitals across the country are wrought with discord. According to experts on the frontline, such as Dr. Brent Eastman, Chief Medical Advisor at Scripps Health Hospital in San Diego, America’s emergency rooms are in a crisis that could jeopardize everyone in this room and all their loved ones.

Lisa’s preview statement indicates a problem-cause-solution pattern.

Today, we’ll uncover the catastrophic conditions existing in America’s emergency rooms, discover what is causing these conditions, and look at how to restore our faith in a system that has—to quote from an editorial in the June 21, 2006, edition of the New York Times—“reached a breaking point.”

Lisa introduces the first problem plaguing the ER system.

Lisa cites recent statistics from a credible source about the ER system, emphasizing the gravity of the situation.

To begin, emergency rooms are desperately overcrowded. According to a landmark series of three reports on the breakdown of our emergency room system conducted by the Institute of Medicine, the need for emergency rooms has increased by 26 percent since 1993; during the same period, 425 emergency departments closed their doors. The average emergency room wait is now almost four hours, according to a report broadcast on Good Morning America on September 18, 2006, but patients could be asked to wait up to forty-eight hours before they are allowed into an inpatient bed.

Lisa introduces the second problem—understaffing.

The United States emergency care system is also seriously understaffed, especially with regard to specialists. As reported in the New York Times editorial, emergency rooms find it very difficult to get specialists to take emergency room and trauma center calls. Furthermore, specialists such as neurosurgeons shy away from emergency room procedures because of the lack of compensation associated with treating so many uninsured patients, as well as the risk of seeing their malpractice premiums rise.

Not only are emergency rooms understaffed; existing staff often are unprepared for disasters. An investigation in the July 6, 2006, edition of the Columbus Dispatch found that EMTs received only one hour of training for major disaster preparation. What’s even scarier, says a team of reporters at the Fort Worth Star Telegram of June 15, 2006, is that with one major disaster our emergency care service could fall apart completely.

Lisa introduces the third problem plaguing the ER system.

The third problem with our current system is not surprising. There is simply not enough money to adequately fund our emergency rooms.

The New York Times reports that emergency rooms are notorious money losers. While most emergency rooms have operating budgets well in the millions, they receive only a fraction of that amount even while being asked to operate securely and safely. Additionally, as reported in the June 15, 2006, edition of the Pittsburgh Tribune Review, because of the lack of money, there are now 200,000 fewer hospital beds in the United States than there were in 1993, even as the need for them has increased tremendously.

Lisa makes effective use of transitions here and throughout; here, she briefly summarizes the nature of the problem.

So, our emergency rooms are broke, overcrowded, and understaffed. Don’t you feel secure?

Lisa now turns to the causes of the crisis.

We can pinpoint three specific causes for the emergency room crisis. These include the highly fragmented emergency medical care system, the uninsured patients, and the lack of money.

Fragmentation occurs on all levels because there are no standardized procedures and no clear chain of command. On the regional level, emergency vehicles fail to communicate effectively with ER and trauma care centers, causing poorly managed patient flow. On the national level, there are no standardized procedures for the training and certification of emergency room personnel.

To complicate matters even more, there is no lead agency to control emergency room and trauma care centers.

So, as you can see, this lack of organization, from poorly managed patient flow to the absences of standardized training and certifying personnel, causes chaos and confusion in what should be a streamlined and secure service industry.

Lisa transitions into the second cause.

Consider the second cause of the crisis.

Uninsured patients cause about as much chaos in the emergency room as does fragmentation. According to the July 6, 2006, Columbus Dispatch, through no fault of their own, there are now 46 million uninsured in the United States. This of course leads to more unpaid ER bills, which leads to more financial problems for the emergency rooms.

But please understand, I am not blaming the patients who simply cannot afford or are not offered health insurance. They are merely the effect of a larger cause: a society that doesn’t place a premium on affordable health care. A lack of affordable health care only perpetuates the cycle in which no affordable health care means no insurance, which in turn leads to unpaid ER bills.

Lisa transitions from the second to the third cause of the crisis.

The vast numbers of uninsured lead us to the third and final cause of the emergency room breakdown. Emergency rooms are plagued by insufficient reimbursements from insurers and insufficient funding by the government.

Lack of money is a major cause of the shortage of capacity and staffing stability in the emergency rooms. The June 15, 2006, Fort Worth Star Telegram tells us that emergency rooms received only 4 percent of the $3.38 billion that was allotted to them by the Homeland Security Department in 2002 and 2003 for emergency medical preparation. As government budgets continue to be slashed, the quality of our health care will continue to deteriorate.

Lisa turns to solutions to the problem.

So, how can we renovate a cycle that seems beyond control? Well, we can look to solutions on a national level and then on a personal level.

The first step to defeating the chaos in the emergency rooms is to create a coordinated, regionalized system with national standards and a lead agency. Everyone—from 911, to ambulances, to emergency care services—needs to coordinate their operations effectively and efficiently in order to ensure each patient a safe and secure emergency room visit. Additionally, the Institute of Medicine suggests that a lead agency be started in the Department of Health and Human Services in order to control emergency room and trauma care centers.

Lisa offers listeners a concrete solution; this also serves as a call to action.

On a personal level, the National Association of Emergency Physicians asks us to be responsible before going to the emergency room. Before going to the emergency room, ask yourself, do I really need to go to the emergency room, or can my primary care physician take care of my needs? Take steps to lessen the impact of the uninsured on emergency rooms by following the lead of the people of Columbus, Ohio, who, according to the July 6, 2006, edition of the Columbus Dispatch, are building affordable primary care clinics in some of the poor neighborhoods.

Lisa’s summary of the main points signals a close to the speech.

Today we have uncovered some of the catastrophic conditions existing in America’s emergency rooms. Armed with a greater understanding of what is causing these issues—overcrowding, lack of specialization and training, and funding—we can now look to the future and focus our energy on solving this national crisis.

Lisa returns to her opening story to bring the speech full circle.

Unfortunately, while it is too late for Beatrice Vance, because she was not given an EKG within ten minutes of admission to the emergency room, authorities recently ruled that her death was a homicide. This paves the way for criminal prosecution of the Vista Medical Center and puts emergency rooms across the country on notice that they too could be found liable should they be found similarly negligent.

Perhaps this terrible tragedy will turn out to be the wake-up call that the United States has needed in order to restore safety and stability to our emergency care system.

Works Cited

Amen, Rob. “Emergency Rooms Turn Away More Patients.” Pittsburgh Tribune Review, June 16, 2006.

Campo-Flores, Arian. “How to Stop the Bleeding.” Newsweek, May 8, 2007. www.newsweek.com/id/34803.

“Code Blue.” Editorial. Columbus Dispatch, July 6, 2006, 18A. www.dispatch.com.

Committee on the Future of Emergency Care in the United States Health System. Emergency Medical Services: At the Crossroads. Bethesda, MD: National Academies Press, 2007.

“Emergency in the Emergency Rooms.” Opinion. New York Times, June 21, 2006. www.nytimes.com/2006/06/21/opinion/21Wed4.html?ex=1189137600&en=fdd466fef8f1534c&ei=5070.

“Illinois Woman’s ER Wait Death Ruled a Homicide.” Good Morning America. September 17, 2006. abcnews.go.com/GMA/Health/story?id=2454685&page=1.

“Inexcusable Death.” ABC Nightly News. September 18, 2006. abcnews.go.com/Video/playerIndex?id=2457808.

National Association of EMS Physicians. Summary of “Future of Emergency Care: Hospital-Based Emergency Care at the Breaking Point” Recommendations. www.naemsp.org.

Perotin, Maria M. “Serious Condition.” Fort Worth Star Telegram, June 15, 2006, C1.