“This has to be one of the most difficult times in the history of emergency medicine,” said one Tacoma emergency physician.
The COVID-19 pandemic has been a truly unprecedented moment for our hospitals, with a combination of crises such as homelessness, substance use disorders (particularly fentanyl), and mental health issues leading to an increase in our hospitals’ emergency A new epicenter of crisis has emerged: the sector.
Each of these crises has been steadily escalating for years, and COVID-19 has partially masked these growing problems in the ED. With the rise in chronic homelessness, ED use by unhoused people has increased by 80% over the past decade. Mental health conditions affect more than 1.2 million Washingtonians in our state, and no U.S. state saw a greater increase in drug overdose deaths than Washington in 2022. It increased by 38.5% from 2023 to 2023. Fentanyl is currently the most important drug. It is the leading cause of death for people under 45, and the fentanyl crisis disproportionately affects homeless people.
In the event of a health emergency, such as a heart attack or an accident, we all rely on hospital emergency departments to provide immediate care for ourselves and our loved ones. But acute care hospitals are now filled with patients who don’t necessarily require emergency medical care. Emergency departments are often the only source of medical care for unhoused individuals, and while some visits are for true medical emergencies, law enforcement and emergency personnel are Patients are increasingly being taken to emergency departments. Our acute care hospital is designed to care for acutely ill and injured patients, and provides shelter, regular, and It does not provide medical visits or long-term care. New data from the Washington State Hospital Association shows that one in 10 emergency department visits in our state is by unhoused individuals.
Washington hospitals are committed to making sure every patient who walks through our doors gets the care they need. Emergency rooms are designed to provide the most intensive and cost-effective treatment for emergencies 24 hours a day, 365 days a year. Emergency departments are already under great stress, overcrowded, and facing safety challenges as doctors, nurses, and staff deal with these complex issues right now. One doctor in Tacoma emphasized the impact on people needing emergency care, saying, “We don’t have capacity in our emergency hospitals, so we’re starting to treat heart attack and stroke patients and pregnant women in waiting room chairs.” Dealing with difficult situations and complex patient needs naturally leads to burnout among doctors, nurses, and emergency department staff.
We need urgent responses to these crises while building longer-term treatment and housing solutions. Time is of the essence. Challenge Seattle, in collaboration with the Washington State Hospital Association, has developed 10 recommendations you can implement now. We look at successful solutions from around the country and share three cost-effective ideas you can get started in weeks or months instead of years.
∙ Establish a street medical team. People are in danger on the streets, in storefronts, under bridges, and in encampments. Communities across the country created new programs that sent doctors, nurses, counselors, and colleagues to provide medical care to unsheltered populations. Given the high comorbidity and complexity of mental health and substance use disorders and medical needs, street medicine programs provide needed care directly on-site, averting crises and eliminating unnecessary visits to the emergency department. It has the potential to prevent In the first year of the Los Angeles street medicine program, the program reduced ED return visits by high-risk patients by 32%. Communities including Seattle, Spokane, Tacoma and Everett are poised to install additional street medical teams in the coming weeks and months with new pilot funding from Congress.
∙ Establish emergency stabilization facilities. Local and tribal governments, hospitals, and health care providers are recognizing the need for additional alternatives to emergency departments to address mental health and substance use disorders. Although major investments have been made, including $1 billion in King County Emergency Management Center levies and hundreds of millions of dollars by the state Legislature, many of these facilities are new construction projects and will not be operational for years. be.
We propose a new approach. It could create new spaces to transform underutilized hospital wings, vacant medical facilities, or new spaces in current shelters to address behavioral health with a particular focus on the fentanyl crisis. It is a low barrier stabilization site with capital funding.
We need more treatment and intervention options like the proposed Opioid Recovery and Care Access Center led by Seattle’s Downtown Emergency Services Center, and we cannot afford to wait. Congress could create an Emergency Stabilization Facility Fund to help communities across the state quickly create replacement facilities for emergency hospitals opening this year. Within two months, Boston opened a 24/7 stabilization clinic in a hotel. In the first year, he saw 1,722 patients, had 7,468 office visits, and average length of stay was 11.5 hours.
∙ Authorizes paramedics and paramedics to administer opioid treatment. Treatment should be basic and more accessible than a $3 fentanyl pill. If a patient is at risk of overdosing or has taken an overdose, the first person to contact is often an EMT or EMT. Across the country, including in Camden, Pittsburgh and Minneapolis, EMTs and EMTs responding to overdoses are urging patients to begin treatment immediately by administering Suboxone. This reduces the severity of early withdrawal symptoms and increases the likelihood that patients will seek further treatment. Patients seen by paramedics equipped with Suboxone were at least six times more likely to visit treatment clinics. Through a partnership with the Department of Health, Seattle paramedics are expected to be the first in the state to roll out the treatment, but the training and program should be expanded to paramedics and departments across the state. Congress could make this type of progress possible by giving the Secretary of Health the authority to issue a statewide standing order authorizing this treatment.
By working together, we can implement these proven solutions across the state in a timely manner. We can reduce the burden on our emergency systems and provide better care for everyone. Every day we fail to act, more lives are at risk. The time for action is now.
