America's Emergency Rooms in Crisis

Our ERs in Trouble

It doesn't take a lot of imagination to get good and scared: Someone could release plague bacteria into the ventilators of the concert hall downtown or SARS could break out at the airport. Maybe there's another huge earthquake. Crowds of injured pour into the ER of your local hospital and stack up like traffic in rush hour.

Even a multiple-car highway crash can create havoc in an emergency department, according to a June 2006 Institute of Medicine report, which concluded that "the nation's emergency care system is very poorly prepared to handle" megadisasters.

What's also piling up is the scientific evidence pointing to the danger of overcrowded ERs. Delay in getting proper treatment and being dispatched speedily to the intensive-care unit means patients are less likely to survive, according to a 2006 Australian study that found a 50 percent higher mortality rate in crowded facilities. Researchers at New York's Albert Einstein College of Medicine came to similar conclusions in 2007: Longer ER waits translated into longer hospital stays and more deaths. And when the American College of Emergency Physicians polled 1,500 emergency-medicine doctors about overcrowding in 2007, half said patients were harmed and 200 reported that patients had died.

A chronic shortfall of funds is one key reason for the crush, but the other shortfall -- until recently -- has been in finding strategies that truly target the crises that Americans must now expect to face. We finally have the know-how to address each of the challenges: A blueprint of the emergency room of the future is on the drawing board.

Called "Project ER One," it's a model for the next-generation ER, based on 10 years of planning with input from top national and international experts from more than 90 institutions, including nurses, hospital administrators, ex-military doctors from the U.S. armed services, and an Israeli trauma surgeon. The goal is to make ER One a national model for the emergency departments of the 21st century.

ER One is planned for the Washington Hospital Center, where victims of the 9/11 attack on the Pentagon and the anthrax scare were treated. At present the project awaits federal funding (it's expected to cost $100 million, which is less than the $137.5 million that the New York Mets just spent on pitcher Johan Santana's contract). However, some of its cutting-edge features have already been adopted by a handful of hospitals, including seven of the hospitals in the MedStar Health network, to which Washington Hospital Center belongs. In the meantime, the hospital has revamped its current emergency department space, including pilot testing some of the innovative ER One technologies for the first time.

"ER One is going to be a demonstration facility for the whole nation on how emergency departments should be designed and built going forward," says Mark S. Smith, MD, director and chairman of emergency medicine at Washington Hospital Center.

Here, how the world's smartest ER doctors are planning to remake emergency medicine for the 21st century.