Overcrowding and fiscal pressures in emergency medicine.

Emergency departments in America are disappearing at an alarming rate. Those that remain face a daily ordeal of overcrowding and budgetary shortfalls. The reasons for this phenomenon include changes in reimbursement rates by managed care organizations, the nationwide reduction of hospital beds, the nursing shortage, a more acute patient mix, and a general deterioration of the healthcare safety net. Another reason--more vital today than ever before--is the uncompensated integration of EDs into governmental disaster planning and response. Despite their importance to society, the emergency department is the first to be cut. Emergency departments are much more than the nation's last line of defense for the medically indigent; they are the frontline caregivers to all of us, providing care during our most vulnerable times: emergencies and disasters.