Is emergency care near a crisis point?

On television, a badly injured patient is taken to the emergency room in an ambulance that's already communicating with the hospital, where emergency doctors and specialists are ready to rush him directly into examination and treatment. On television, few patients ever die.

Reality in America is a little different from that, according to three reports released in June by the Institute of Medicine. The reports address the state of emergency care in hospitals, rural areas and for children.

"Underneath the surface," one report says, "a national crisis in emergency care has been brewing and is now beginning to come into full view."

On Thursday at Primary Children's Medical Center, the institute held the first of four regional workshops on the crisis in emergency care and the solutions it believes would fix them. Similar workshops are scheduled later in the year in Chicago, New Orleans and Washington, D.C.

The current system is one that would have awed people 50 years ago, but time and treatment advances have shown there's "so much more we need to do," said Adm. John O. Agwunobi, a pediatrician who is America's highest-ranking physician in government. Agwunobi is assistant secretary for health in the U.S. Department of Health and Human Services and is admiral of the U.S. Public Health Service Commissioned Corps, and the boss of the U.S. surgeon general.

As proof of the crisis, the institute cites problems such as overcrowding, ambulances being diverted from the closest hospital at a rate of one per minute nationally because that hospital is understaffed and overused, and patients "boarded" in hallways for hours or days as they wait for an inpatient bed to become available.

Dr. A. Brent Eastman of ScrippsHealth said that between 1993 and 2003, there was a 26 percent increase in emergency-room admissions, while more than 700 hospitals closed nationally and another 400 emergency departments closed. Only 6 percent of those that are open have the supplies, resources and expertise to treat children, although that population is a huge consumer of emergency services.

Worse still, "disaster plans largely overlook the needs of children," said Dr. Marianne Gausche-Hill, director of Emergency Medical Services at Harbor-UCLA Medical Center.