Military Emergency Medicine Is a Model in Many Areas to the
Civilian Health Care System
 

Major Barrier to Emergency Care Access Is the Deployment of
Military Emergency Physicians

Washington, DC─ Emergency physicians are among the most deployed physicians in the Military Health Service, which is the main barrier to access to emergency care in military hospitals, although access is improving, according to the National Report Card on the State of Emergency Medicine, released today by the American College of Emergency Physicians (ACEP).

The Report Card assesses support for emergency care in the nation’s Military Health System, which maintains 63 military hospitals and 413 medical clinics, plus the Veterans Health Administration (VHA).  Unlike the other report cards in the document, military emergency medicine, or government services, does not receive a grade, because the data and context for providing services are different from the 50 states and the District of Columbia, and this assessment uses a different methodology.   The Government Services Report Card is based on available data and interviews with experts, including representatives of the Army, Navy, and Air Force medical systems and the VHA.

“The Military Health Service and VHA have the advantage of universal health insurance, which greatly enhances their access to primary care and emergency care, but there are gaps, especially when medical specialists, including emergency physicians, are frequently deployed,” said Col. David Della-Giustina, MD, FACEP, chairman of emergency medicine at Madigan Army Medical Center in Fort Lewis, Washington, and former president of ACEP’s Government Services Chapter.  “As with many states, access to on-call physicians in certain specialties, such as neurosurgery, invasive cardiology and gastroenterology, is limited.”

In contrast to civilian emergency medicine, acute care beds are more available to emergency patients, and the “boarding” of patients in emergency departments is uncommon.  Ambulance diversion also is uncommon, except in cases where specialists are not available, which results in transfers of patients to the civilian network of hospitals. The Air Force and Navy Hospitals do not generally accept patients diverted from the civilian system, but Army hospitals do and are more likely to be the recipients of diverted patients, rather to be on diversion. 

According to the Report Card, the military services go to great lengths to promote safety and prevent injuries among their personnel and their families.  Injury prevention efforts include suicide awareness training, motorcycle helmet laws, strictly enforced seat belt and child safety seat requirements and random breathalyzer checks to prevent driving while intoxicated. In addition, within the MHS and VHA, there are smoking cessation programs, access to gyms and mental health screening and treatment.  Active duty personnel also are required to meet standards for physical fitness.

In the area of quality and patient safety, MHS and VHA are required to report on quality and patient safety issues, including waiting times, medical errors, patient satisfaction and hospital-acquired infections.   According to a 2008 report to Congress by the VHA, quality scores in the VHA are superior to those of the commercial, Medicare and Medicaid sectors for every measure for which scores are comparable.

Recommendations from the Government Services Report Card include:

• Develop standard emergency care measures that are centrally reported, tracked and compared with civilian systems that serve similar populations.
• Integrate military disaster preparedness efforts with the efforts in their local communities and states.
• Include emergency departments and improve the efficiency of the MHS’s electronic medical records system. 

The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

The Government Services Chapter of ACEP is a state chapter of the American College of Emergency Physicians, a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

# # #