The Gulf Coast's Emergency Care Crisis
To understand the genesis of Save Our ERs, you must understand the rapidly intensifying crisis that exists in the Greater Houston area's trauma and emergency care system. There is a severe shortage of intensive care beds and fixed emergency room capacity at the region's three primary trauma hospitals and two children's hospitals, and the deficiency is becoming more serious every day.

The Gulf Coast region has three Level I trauma centers-Ben Taub, Memorial Hermann and The University of Texas Medical Branch. Level I facilities have the highest trauma care capabilities and provide round-the-clock care. The region has no Level II hospitals (hospitals that can provide the same level of care as Level I facilities, but have no research capabilities). The remaining trauma hospitals in the region are Level III and Level IV-facilities capable of caring for patients with illnesses or injuries of lower severity or stabilizing a patient until they are transferred.

In the 13-county Gulf Coast region today, it is common for trauma hospitals to reach maximum capacity for emergency care patients. Quite simply, the area's hospitals are hard-pressed to handle the current exigency for trauma care, much less rise to the call of any greater burden.

Increasing Diversions, Increasing Risks of Death
The defining hour of the region's trauma care crisis is the "Golden Hour"-the first hour or two after an injury, the time when the best chance of saving a life exists. The Gulf Coast region is losing far too many patients because its emergency centers are ill equipped to deliver critical services to patients for whom the Golden Hour means the difference between life and death.

In 1998, both Ben Taub and Memorial Hermann hospitals began to experience periods of insufficient capacity for Level I-care patients with increasing regularity. When one of the trauma centers reached maximum capacity, the hospital issued a "divert" signal to the City of Houston's Emergency Medical Services (EMS), directing that emergency patients be transported to an alternate facility. In such instances, patients had to be transferred to a Level I hospital hundreds of miles away if they required care that smaller hospitals could not provide.

Hospitals in counties surrounding Houston also are forced to go on diversion routinely; in fact, 78% of hospitals in Southeast Texas reported having a difficult time transferring patients requiring a higher level of care than they could provide. Only 30% of hospitals can transfer patients requiring a higher level of care within the life-saving two-hour time frame, and almost 10% report that it takes more than six hours to transfer these patients. Moreover, on "significant" diversion days-days when both of Houston's Level I trauma facilities were on diversion-the mortality rate for all trauma patients doubled.

Studies Confirm the Crisis
Studies recently commissioned by Save Our ERs quantify the deterioration of the Gulf Coast's emergency and trauma system. A survey of hospital emergency departments across the region conducted by The Abaris Group indicated that hospital diversion hours increased by 77% from 2000 to 2001. Furthermore, 69% of emergency departments reported that it takes three hours or more to transfer seriously injured patients to facilities that provide a higher level of care.

The results of a study conducted by Bishop+Associates are even more sobering. The Bishop study notes that while trauma systems nationally are experiencing economic pressure, the Houston-Galveston regional trauma system, in particular, is in serious jeopardy because the proportion of uninsured trauma patients is double the national norm. Hospitals providing the highest level of care to seriously injured patients indicated that they could not accept all transfers due to high trauma caseloads and high ICU occupancy levels. Very high trauma patient volumes in relation to hospital capacity have impacted other programs at these hospitals negatively, as well. The Bishop+Associates report urges that corrective action be taken in the near term to avert trauma system collapse.

Texas' Uninsured Population Drains Emergency Resources
A major cause of trauma centers' financial distress is the fact that they care for so many uninsured patients. In fact, approximately one-third of patients cared for by the Houston-Galveston-area trauma system are uninsured. The Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) mandates that any patient who comes to an emergency center, regardless of citizenship or insurance status, must receive a medical screening examination, regardless of his insurance status or ability to pay. If the examination reveals an emergency condition that the hospital is capable of treating, it is obligated to provide the treatment

The high percentage of uninsured in the region, combined with the limited availability of after-hours routine medical care, has resulted in gross over-use of Level I, II and III hospital emergency resources for non-emergency needs. This abuse makes it financially impossible for trauma centers to expand their bed capacities to meet the needs of their communities.

What Is Save Our ERs?
Save Our ERs was established by a coalition of Houston-Galveston-area medical professionals, community leaders and business leaders to find solutions for the growing trauma and emergency services crisis in the Texas Gulf Coast region. The organization’s goals are to educate the public and implement regional solutions to help ensure that the Gulf Coast's emergency care system can meet the area's growing needs.