A few months back there were several news reports about ambulances in Osaka having so much trouble finding an ER to take their patients that the patients died before seeing a doctor. This week a survey by the Fire and Disaster Management Agency reported that nationwide in 2007, 24,089 ambulance patients were rejected by hospitals more than three times before being admitted somewhere. In 2006, a different agency reported only 667 such cases.
That is not good. But why is this happening and how can it be resolved?
Partly because hospitals are facing budget and staff crises and closing or cutting back their ER facilities. That seems to be a perennial, or perhaps cyclical, problem with hospitals.
Partly because hospitals rotate ER days. Not all ERs are open 24/7/365. The ambulances know the schedule and call ahead to confirm that there is a bed for the patient. If one ER is busy, or doesn’t have the right kind of doctor on staff, they reject the request.
Partly because many ambulance crews are not trained in medicine. Some have training beyond basic first aid, but it is not a requirement.
So how can this problem be fixed? From my armchair vantage point, I see a few obvious things that would improve the situation right away:
- Staff paramedics and other medically trained people in the ambulances. This would give the patient timely triage and accurate reporting of the situation to the hospital.
- More hospitals on rotation in the ER schedule. This is a challenge due to budgets and staffing, but it is certainly the most immediate fix. No more ER holidays.
- Establish local “urgent care” centers for non-traumatic emergencies, like earaches and food poisoning. Right now, you have to find an off-hours clinic or go to the ER (in an ambulance). This would free up the hospitals to handle trauma and more complicated issues.
I am sure that people in power are thinking along these lines, and in Osaka earlier this year, this issue was at the heart of the gubernatorial campaign.. I just hope it gets fixed before I need to go to the hospital in a rush.
