During a large-scale health emergency, emergency care must be available to seriously ill or injured patients. Without substantial changes in policies and procedures, overcrowded emergency departments and inefficient hospitals will struggle to handle a surge of patients who are acutely ill, as well as those who are worried but only mildly ill. The emergency departments in New York City experienced overcrowding in the spring of 2009 because of H1N1 influenza. Yet studies repeatedly suggest that one half to two thirds of emergency department visits are potentially avoidable if there is timely access to high-quality primary care.4 In some cities, the lack of communication between emergency transportation systems and hospitals means that patients are taken to emergency departments that are too busy or too poorly equipped to care for them. Implementing the recommendations of the Institute of Medicine for revamping the emergency medical services system as part of health care reform will be critical to alleviating overcrowding in emergency departments, improving turnover time, and enhancing the capacity of emergency departments to handle a surge of acutely ill or injured patients.
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