Superfreakonomics_ global cooling, patri - Steven D. Levitt [31]
All things considered, WHC performed well. But for Craig Feied (pronounced FEE-ed), an emergency-medicine specialist there, the incident confirmed his greatest fears. If the hospital nearly went haywire with just a few extra burn patients, what would happen during a major disaster, when the ER was most needed?
Even before September 11, Feied had spent thousands of hours thinking such grim thoughts. He was the chief architect of a federally funded pilot program called ER One, which was meant to drag the emergency room into the modern era.
Until the 1960s, hospitals simply weren’t designed to treat emergencies. “If you brought someone to a hospital at night,” Feied says, “the doors would be locked. You’d ring the bell, a nurse would come down to see what you wanted. She might let you in, then she’d call the doctor at home, and he might or might not come in.” Ambulances were often run by the local mortuary. It is hard to think of a better example of misaligned incentives: a funeral director who is put in charge of helping a patient not die!
Today, emergency medicine ranks as the seventh-largest physician specialty (out of thirty-eight), with a fivefold increase in practitioners since 1980. It is a master-of-all-trades endeavor, performed at lightning speed, and the emergency room has become the linchpin of public health. In a given year, there are roughly 115 million ER visits in the United States. Excluding pregnancies, 56 percent of all people admitted to U.S. hospitals come through the ER, up from 46 percent in 1993. And yet, Feied says, “you could drive a truck through the gaps in our protocols.”
September 11 brought home the point that emergency rooms are painfully limited in their surge capacity. If there had been a thousand victims at WHC, would they even have gotten inside?
Such a prospect makes Feied grimace. Most ERs have an ambulance bay that can fit only a few vehicles at a time. The docks are also built too high—“because the people who designed them were used to building loading docks,” Feied says. Rooftop helipads are similarly problematic because of the time and space constraints of a single elevator. Feied’s idea for getting rid of such bottlenecks is to design an ER more like an airport, with a large convex intake area that could accommodate a multitude of ambulances, buses, or even helicopters.
But these intake issues aren’t what worry Feied the most. A hospital that gets hit with something serious and communicable—SARS or anthrax or Ebola or a new strain of lethal influenza—would soon cripple itself. Like most buildings, hospitals recirculate their air, which means that one sick patient could infect hundreds. “You don’t want to go to the hospital for a broken ankle and get SARS,” Feied says.
The answer is to build hospitals, and especially ERs, with rooms designed for isolation and zero air recirculation. But most hospitals, Feied notes, don’t want to spend money on such unsexy, non-revenue-generating features. “There were some nice emergency departments built in 2001, state-of-the-art, and they’re completely obsolete today. They were built with open bays, divided by curtains, but if you have a SARS patient in Bed 4, there’s not a patient or doctor in the world who will want to go into Bed 5.”
And don’t even get Feied started on all the hospital patients who die from a cause other than what brought them to the hospital: wrong diagnoses (the result of carelessness, hubris, or cognitive bias); medication errors (based, far too often, on sloppy handwriting); technical complications (reading an X-ray backward, for instance); and bacterial infections (the deadliest and most pervasive problem).
“The state of current medical practice is so bad right now that there’s not very much worth protecting about the old ways of doing things,” Feied says. “Nobody in medicine wants to admit this but it’s the truth.”
Feied grew up in Berkeley, California, during the very raucous 1960s, and he fit right in. He skateboarded everywhere; he occasionally jammed on drums with a local band called the