Puerto Rico Suffers From Serious Access to Emergency Care Problems and
Lack of Disaster Preparedness in National Report Card on the
State of Emergency Medicine
 

Gurabo, Puerto Rico—Although it did not receive a grade or ranking in the American College of Emergency Physicians’ (ACEP) National Report Card on the State of Emergency Medicine, Puerto Rico’s performance in the categories of Access to Emergency Care and Disaster Preparedness falls well behind the nation in many key indicators, which bodes ill at a time when the national picture looks bleak.  Job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.

“The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP.  “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform.  We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are the health care safety net for us all.”

In the category of Access to Emergency Care, Puerto Rico fell behind the nation in the numbers of board-certified emergency physicians, registered nurses, staffed inpatient and psychiatric beds, and emergency departments, although it does not have the acute shortages of primary care physicians, experienced by the rest of the nation.  Only three hospitals in Puerto Rico have 24-hour coverage by trained emergency physicians and the Commonwealth’s only trauma center is not able to provide 24-hour coverage.

“Access to emergency care in Puerto Rico is at a critical junction,” said Manuel Colon, MD, president of the Puerto Rico Chapter of ACEP.  “We have severe health care workforce shortages that affect all aspects of access to medical care by patients.” 

In the Disaster Preparedness category, Puerto’s Rico’s disaster planning efforts include input from emergency physicians, but the island lacks a real-time notification system to notify identified health care providers of an event, real-time syndromic surveillance and patient or victim tracking systems. 

Puerto Rico lacks funding for quality improvement within the EMS system and has an extraordinarily low proportion (17 percent) of patients with acute myocardial infarction (heart attack) who are given angioplasty within 90 minutes of hospital arrival.  These and other factors contributed to a worrisome showing in the Quality & Patient Safety category.

The Commonwealth’s overall record in the Public Health & Injury Prevention category is mixed.  Puerto Rico has a lower than average rate of traffic fatalities and a higher than average rate of seat belt use.  Rates of smoking and binge drinking are lower in the Commonwealth than the average across the nation.  However, the records for adult immunization for influenza and pneumonia and on infant mortality are very poor. 

Very little data are available to assess Puerto Rico’s Medical Liability Environment, but it has a higher rate of medical liability award payments than the average across the states (5.6 per 100,000 people vs. the national average of 2.4).  Puerto Rico’s high rate of emergency medicine residents combined with the low rate of emergency physicians reflect the Commonwealth’s difficulty in retaining emergency physicians.  Providing a more favorable medical liability environment might help retain more physicians, draw a broader health care workforce and encourage more specialists to take call in the emergency department.

The Report Card recommends that Puerto Rico’s policymakers invest in data collection efforts that can be used to assess the factors related to public health, access to care, and quality and patient safety.  Failing to do so likely will result in funding allocations and interventions that are not scientifically based or do not address the roots of problems.

The nation’s failure to support emergency patients resulted in a C- for the country overall.  Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-.  The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.

The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than  twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card. 

The five Report Card categories (and weightings) are:  Access to Emergency Care (30 percent), Quality and Patient Safety Environment (20 percent), Medical Liability Environment (20 percent), Public Health and Injury Prevention (15 percent) and Disaster Preparedness (15 percent).

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 Puerto Rico 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.

# # #