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                  E.R. Errors Cost Lives

Many US emergency rooms are staffed by doctors who were never taught how
to treat a heart attack, resuscitate a child, or treat bleeding, and
patients may be dying as a result.

"It would be fair to say that lives could be saved...if all emergency
departments were staffed with appropriately trained individuals," said
Dr. L. Thompson Bowles, president of the National Board of Medical
Examiners and the chairman of a group of 38 health care authorities who
studied the issue.

The panel, which convened in April, included a number of experts who
were not emergency medicine specialists. Their report is to be released
Monday.

The report strongly condemns a practice in which medical residents
supplement their modest incomes by working part time at night in
emergency rooms.

"Many 'moonlighters' lack training and adequate experience in any aspect
of primary health care," the report said.

Only about half the nation's 25,000 jobs in emergency medicine are
filled by doctors certified to provide emergency care. In many US
hospitals, doctors do not need such certification to work in the
emergency room.

"When people ask if there's a doctor in the house, they have reason to
suspect that every physician can do the minimum to save a person's life
in an emergency. This is not the case today," Dr. Lewis Goldfrank, one
of the report's contributors, said in a statement.

He said a better question might be: 'Is there a paramedic in the house?'

'When a young person finishes medical school, they might not know how to
treat these things as well as a paramedic," Goldfrank, director of
emergency medicine at Bellvue Hospital in New York City, said in a
telephone interview.

Hospitals often hire part-time emergency room doctors to save money,
said Dr. David Sklar, an emergency medicine specialist at the University
of New Mexico and the president of the Society for Academic Emergency
Medicine.

'If you get someone who's just done an internship, they're willing to
work for whatever you pay them, and you get what you pay for," Sklar
said.

William Erwin, a spokesman for the American Hospital Association, said,
"Hospitals would of course prefer to have their emergency departments
staffed by physicians who specialize in emergency care, but that's not
always possible.

"Particularly, in rural areas, hospitals are fortunate to attract enough
physicians of any specialty to provide emergency care," he said.

Part of the problem, the report said, is the lack of adequately trained
individuals. Fewer than 20% of American medical schools require courses
in emergency medicine, the report said.

"There aren't that many people to go around now. That has to be
understood," Bowles said. "One of our tasks was to implore the society
and its political structure not to cut back" on training emergency
medicine specialists.

The report called for a classification system that would give the public
some idea what an emergency room is equipped to handle.

[Many E.R. Doctors Have No Emergency Training, Study Says, Martinsburg
Journal, September 8, 1994]

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