Crowding forces rescuers to ‘shop’ for hospitals. "This is a nationwide U.S. problem," says Robert Bass, emergency medical services chief in Maryland.By Julie Appleby; USA TODAY; February 4, 2000 (Exerpted)

Fire Capt. Joe Gulotta found himself in the middle of a Tucson intersection recently, on the radio, demanding that one of the city's two swamped trauma centres take five seriously injured car wreck patients.

"I said, 'I don't care where we take these pa_ tients, but someone's got to take them,'" Gulotta says. His demands led one hospital to take all five. "It's becoming disastrous. We're travelling across town, shopping for hospitals."

From California to Massachusetts, emergency officials are reporting similar problems: Crowded hospitals leading to long waits for emergency care.

Patients kept in the ER for days because no beds are available in the hospital. Ambulances forced to drive farther and farther for help.

Is it just the flu?

No, according to doctors, nurses and other experts. They fear that emergency room and hospital overcrowding are proof that a decade of cost cutting has created a crisis in emergency care.

' For nearly ten days in December, 60 of Los Angeles' 81 ERs were so full that hospital adminis- trators asked to send ambulances elsewhere.

' In nearby Riverside, hospitals were so busy this month that ambulances had to wait up to 30 minutes outside the ER with their patients.

'The amount of time Maryland hospitals spent on near capacity "yellow alerts" has doubled in each of the past three years.

"Emergency rooms are the safety net for health care in this country, and the system's rapidly crumbling," says Peter Boss of Hemet Valley Medical Center in Riverside County, California.

ER visits increased from 90.4 million in 1994 to 94.7 million in 1998. At the same time, patients are often sicker, requiring more complex care. Uninsured patients tend to wait longer before they seek medical aid. The problem could worsen, experts fear, as hospital finances remain uncertain, a nursing shortage grows and more Americans find themselves without health insurance – 44 million and growing numbers. Some hospitals have shut down their emergency departments, which often draw patients who can’t afford to pay.

In the past decade, about 500 hospitals nationwide have closed, federal data show. From 1993 to 1996, the number of hospital beds per 1,000 residents in the USA fell by 9%, the Dartmouth Atlas of Health Care says. And; from 1988 to 1998, the nation lost 1,128 ERs, the American Hospital Association says. "It’s only a matter of time before patients are sitting in ER wards for upwards of two or three days waiting for admission — and getting less-than-ideal care," says Bruce Auerbach, of Sturdy Memorial Hospital.

With fewer nurses, hospitals can make fewer beds available. Without beds in the intensive care unit and other wards, some patients must remain in the ER, adding to backups.

New drugs and technology allow patients who once might have been admitted to the hospital to be treated in the ER. For example, asthma patients are given treatment, then observed for 6 to 8 hours, but this ties up an ER bed.

Not a new problem, but a growing one. Uninsured patients, for example, often have nowhere else to turn. Some insured patients also find their doctors are busier than ever under managed care and pressure for profits, making it difficult to get timely appointments. So they turn to ERs.

"Unless the problem is solved, the general public may no longer be able to rely on emergency departments for quality and timely emergency care, placing the people of this country at risk," a report in January’s Annals of Emergence Medicine warns.