State of Emergency

Sorry for the hiatus, I was a bit distracted yesterday.

Anyhow, in the past week we've seen the truly bizarre hypocrisy and perverted priorities at the heart of our current political system and culture ripped open for inspection like a swarthy man's luggage. For all the attention on who really has moral values and who really knows how to win a war, I'd still like to see a bit more attention paid to what us little people who pay taxes are getting for our money.

While they're spending $2 billion and a couple of dozen young Americans killed or maimed every week to establish permanent military bases in Iraq, along with an an embassy designed to put the palace at Versailles in the second tier of excess, they aren't taking care of business here at home, particularly when it comes to keeping us safe. I've talked about some of what makes us not safe before, but stuff like not getting poisoned by the air you breathe or the food you eat may seem like namby pamby nanny state liberalism to some people.

So how about no room at the Emergency Department when The Terrorists set off their Dirty Bomb? Arthur Kellerman discusses the recent IOM report on the overburdened emergency care system in the U.S. In 1986, Congress passed legislation affirming that everyone had a right to critical care in hospital emergency departments, putting an end, in theory (only), to the wallet biopsy which used to determine whether you got your compound fracture pinned. Unfortunately, it didn't occur to anybody to provide money for this purpose, so many hospitals responded by simply closing their EDs. Others didn't maintain sufficient capacity to meet demand so they keep people waiting for hours and divert ambulances to other hospitals. It is likely that this perpetual state of backlog contributed to the recent death of a woman who sat in an ED for hours unattended despite complaining of the symptoms of a heart attack.

As Kellerman discusses, Congress has appropriated all kinds of money for "terrorism" preparedness, but almost none to strengthen the emergency medical system. We are still muddling through the ordinary flow of seriously ill and injured people, though who knows how many may have died, suffered, or had their conditions worsen unnecessarily due to backlogs and diversions? No-one is keeping track. But if there is a mass casualty event -- whether its a terrorist bombing, or far more likely events such as a mass casualty fire or earthquake, emergency facilities in most parts of the country will be unable to respond adequately.

Is this the biggest problem we face? Certainly not. But one week's worth of spending on the war in Iraq would be more than enough to fix it. The next week, we can do addiction treatment on demand. Then you get your favorite thing.