Editor's Note: Four years ago the premier issue of HSToday featured a ground-breaking report on the crisis in America's trauma and emergency care that was featured in the book, "Journalism that Matters: How B2B Editors Change the Industries They Cover."

Published by the American Association of Business Publication Editors, the book showcased hard-hitting, results-oriented journalism that had an impact on the industries they cover. The cover of the book featured the photograph above of then Rep. Curt Weldon holding up the inaugural issue of HSToday open to the report at a press conference on the trauma care crisis.

Beginning with this Kimery Report, HSToday.us re-examines the ability of emergency health care to cope with mass casualty terrorist attacks or natural disasters. Part I of this exclusive series examines the deterioration of trauma and other emergency care in the US.

Correction: In the original posting of Part I, House Committee on Oversight and Government Reform ranking Republican member Tom Davis of Virginia was incorrectly identified as a Representative of Oklahoma. We apologize for the error. 

"The Department of Homeland Security (DHS) is not focused on trauma care," announced then Rep. Curt Weldon (R-Pa.) at a Capitol Hill press conference in May 2004.

Holding up a copy of the premier edition of HSToday open to its report on the state of trauma care, Weldon read a loud the story’s headline, "The Trauma in America’s Trauma Care."

"There could not be a truer statement" about the dire state of American emergency care, he stated.

Weldon and executives of the National Foundation for Trauma Care (NFTC) called on the federal government to pay greater attention to a trauma care network starved of funds and facing widespread meltdown.

"Trauma care," Weldon said, "is not on the Department of Homeland Security's agenda, let alone a priority."  He vowed: "We are going to focus on this. We are going to focus on this until all American media covers this crisis."

It was a noble promise, but it languished for lack of attention. Weldon lost his re-election bid and only a handful of lawmakers have expressed much of an interest in championing a solution to the deepening crisis the US trauma care system finds itself in. The shortage of defenders likely has more to do with the fact that the crisis is integrally tied to the politically-charged problem of uninsured and uncompensated care, which in turn is bound to the problem of illegal immigration.

Exact figures are hard to come by, but by many accounts, the financial drain from providing unreimbursed care to illegals is significant for many hospitals’ trauma and ER departments. This issue will be examined in Part II of this report on America’s emergency care crisis.

Meanwhile, the evidence is overwhelming: Hospitals are being forced to shut down or scale back emergency services; trauma units and EDs are strained to bursting; more and more hospitals – especially in urban areas - are having to divert more and more patients to other facilities; and patients are being stacked up to wait for treatment in crowded or overflowing emergency rooms.

“We are on the brink of collapse,” exclaimed NFTC Executive Director, Connie Potter, a seasoned veteran of the frontlines of trauma care. “Trauma care today is worse than it was four years ago” when NFTC issued its first report on the condition of America’s trauma care system.

Dr. Ramon Johnson, an emergency physician from southern California where he has practiced for the last 24 years, told the House Committee on Oversight and Government Reform a year ago that "we find ourselves on the brink of collapse."

Indeed. An HSToday.us investigation found that increasing numbers of hospitals are shuttering their doors or scaling back emergency services; trauma units and EDs are operating routinely at or above capacity; more and more hospitals – especially in urban areas - are having to divert more and more patients to other facilities; and patients are being stacked up to wait for treatment in crowded or overflowing emergency rooms.

Since 2002, 19 trauma centers have closed; five since 2006. Thirteen trauma centers have reduced their emergency services by downgrading their level of care; six have downgraded since 2006.

Sixty-one regional trauma centers closed between 1988 and 1991.

According to a 1991 Government Accountability Office (GAO) study for the Senate Subcommittee on Health for Families and the Uninsured, of the 36 trauma centers GAO reviewed at that time, 15 had closed ...”

In California alone, 75 EDs have been closed in recent years. And according to a study in Health Affairs, several hundred EDs nationwide have been closed.

“This is the reality of the situation,” said Potter.

In June 2006, the Institute of Medicine of the National Academies (IOM) released a voluminous three volume report on the future of emergency care in the United States that was based on a review of more than 4,300 published studies, 11 commissioned reports, and testimony from 62 experts. The conclusion was grim, and for those who practice emergency medicine, not at all surprising - or reassuring.

Echoing NFTC’s Potter, IOM concluded trauma and emergency care in the US is at the “breaking point.”

Four years after HSToday first exposed the crisis in trauma care and Weldon’s call to action, the Democratic staff of the House oversight committee concluded in the new report, "Hospital Emergency Surge Capacity: Not Ready for the ‘Predictable Surprise," that trauma centers in major cities at risk to catastrophic terrorist attacks do not have the capacity to handle the numbers of casualties that can be expected to seek emergency care.

Notable findings of the committee majority staff survey were:

* 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.

* 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.

Post 9/11, the nation’s emergency care system remains unprepared for mass casualty terrorist attacks, least of all another regional 9/11-scale attack.

The 9/11 assault injured more than 7,000 persons, some gravely. As HSToday originally reported in May 2004, there were so many wounded that treating them stretched the resources of the region’s trauma care capabilities.

Because New York City was unable to care for so many injured, 108 attack victims had to be transported to hospitals throughout New York, New Jersey, and Connecticut.

Above photo: Former US Rep. Curt Weldon with a copy of the inaugural issue of HSToday at a Capital Hill press conference at which he and members of the trauma care community called for increased funding for trauma centers.

Photo: Tom Williams