The public notice can be found in the October 22, 1998, issue of the Federal Register (Vol. Not surprisingly, EMTALA is one of the factors contributing to the erosion of doctors' and hospitals' ability to provide timely access to emergency care to both paying and non-paying patients. The ED visit rate for the uninsured is signifi­cantly higher than the rate for those with private insurance, and public programs place even more of a burden on emergency rooms.
More than 95 percent of emergency department physicians and more than 30 percent of physi­cians overall provide care covered by EMTALA in a typical week of practice.
EMTALA provisions have also been cited as a major reason for the lack of availability of medical specialists to provide on-call emergency services. Increased liability exposure is one of the most burdensome problems facing emergency physicians and one of the most common reasons why special­ists are increasingly unwilling to provide on-call ED coverage. These bills would amend the Public Health Ser­vice Act so that hospitals, emergency rooms, physi­cians, and physician groups that provide emergency care to uninsured individuals would be considered employees of the Public Health Service for purposes of any civil action that may arise due to items and services furnished to those patients.
While the Medicare physician payment system is profoundly flawed and in desperate need of a thor­ough overhaul, there is an urgent need to adjust the physician payment system for doctors who provide emergency medical services. These bills would increase Medicare payments for physician services provided to a Medicare recipient in the emergency department or critical access hospital to offset the costs of EMTALA-mandated uncompen­sated care.
Turning away bleeding patients and women in labor from hospital emergency rooms is not toler­ated in a civilized society.
This may put several Republican governors who maintain the earth isn’t warming due to human activities, or prefer to do nothing about it, into a political bind. If an emergency condition is found, the patient must be treated or stabilized before being transferred to another institution. EMTALA is a federal statute that attempts to deal with a complex problem that varies greatly in magnitude among states and commu­nities.
A lack of easy access to primary care, especially among the uninsured and underinsured, contributes significantly to the crisis in emergency medicine, specifically in terms of overcrowding and inappropriate and inefficient use of resources. In addition, EMTALA compli­cates the growing need of the emergency medical system to prepare for a medical disaster, whether natural or manmade, such as a terrorist attack.
Appropriately, the public does not endorse denying emergency care to patients because of their financial incapacity to pay for it. However, as a federal mandate, EMTALA has become the govern­ment instrument that guarantees uninsured patients the same care in the ED that patients who are fully insured receive, thereby making the provision of emergency medical care in emergency departments a de facto public service. Emergency room overcrowding is com­pounded by the substandard performance of government health care programs. Assuming that EMTALA remains on the books for the foreseeable future, Congress could make changes in emergency care—by grant­ing limited relief from medical liability and increas­ing the reimbursement for physicians who perform these services—that would ease the burden on doc­tors and hospitals that serve patients seeking urgent care under often difficult circumstances.
Specifically, beginning in March 2016, states seeking preparedness money will have to assess how climate change threatens their communities.
They might be the normal climate and local conditions (existing development) that pose threats to them and they are forced to label it climate change so the federal government can repackage that for political gain and throw it back them- you can close down your power stations because you said climate change affects you. This innovative approach, originally developed by analysts at the National Cen­ter for Policy Analysis, could significantly reduce the reliance of so many Americans on the nation's already overcrowded emergency rooms for primary care. Predictably, this gave hospitals greater incentive to avoid non-paying patients and resulted in a sudden and dramatic increase in reports of inappropriate transfers.[4] Growing public awareness of these cases led to increased pressure to address the problem, and Congress responded with EMTALA, an amend­ment to the Consolidated Omnibus Budget Recon­ciliation Act (COBRA) of 1985. The federal EMTALA mandate was never meant to supersede state laws and regulations focused on eliminating or reducing the provision of substan­dard medical care. Congress has a responsibility to act quickly to prevent further erosion of the services that EMTALA promises. Emergency departments face growing economic pressure because of a relative decline in overall reim­bursement. Eligibility for the Massachusetts premium assistance program broadly tracks the income eligibility for federal individual health care tax credits originally proposed by President George W.
Populations affected by disaster increase the demand on emergency response and public health systems and on acute care hospitals, often causing disruptions of services (1). Greater effort is needed to stress the importance of disaster and emergency preparedness, especially the need for a written evacuation plan.
DeBastiani MPH, Tara W Strine, PhD, Office of Public Health Preparedness and Response, CDC. Both campaigns encourage the general population to prepare for disasters by being informed, assembling an emergency kit, and having a plan (Box). Factors predicting individual emergency preparedness: a multi-state analysis of the 2006 BRFSS data.
Public health and emergency services agencies should increase the accessibility of household preparedness materials and information to the Hispanic population and persons with resource and language barriers. To estimate current levels of self-reported household preparedness by state and sociodemographic characteristics, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data collected in 14 states during 2006–2010. The primary method to access preparedness materials and information through these organizations is via predominantly English language websites, creating a possible barrier for non-English speaking adults, persons of low socioeconomic status, and those without Internet access.
In general, as the age of respondents increased, reported household preparedness increased. With the exceptions of having a 3-day supply of water and a written evacuation plan, persons with a high school diploma were more likely to indicate preparedness than those with less than a high school diploma. This Special Report by The Heritage Foundation Emergency Preparedness Working Group focuses on the lessons learned from Hurricane Sandy in 2012. Where FEMA failed in its response efforts and overall preparedness, the National Guard and Coast Guard excelled. In addition to the Red Cross and Salvation Army, local faith-based and community organizations played vital roles in the emergency response to Sandy.[4] Sandy was certainly a severe storm that will not soon be forgotten.
In the aftermath of Hurricane Sandy, the federal government responded by doling out more than $60 billion in total emergency spending, an appropriation process driven strongly by politics.
When the influence of 24-hour news channels carrying images of suffering citizens is married with politicians eager to squeeze as much out of the federal government as possible, the ability of fiscally responsible politicians to stem the tide of more spending is washed away like the houses built too near the unpredictable ocean. Modify the Stafford Act to establish clear requirements that limit the situations in which FEMA can issue declarations.
Nothing typifies the extent to which states rely on the federal government for disaster spending like New Jersey Governor Chris Christie’s (R) demand that the federal government essentially give him a blank check to deal with Hurricane Sandy.[8] With his charge that Congress’s refusal to give him that blank check was a “dereliction of duty,” Governor Christie fails to appreciate that Congress has an obligation to ensure that precious taxpayers funds are appropriated responsibly. In some ways, it is hard to criticize Governor Christie too much for his expectation that the federal government should pick up the tab for Hurricane Sandy. Governor Christie’s position reveals, however, just how dependent states have become on federal funding. Yet, with the federal government’s increasing fiscal crisis, including the $17 trillion national debt, the ability of FEMA to continue to pay for routine disasters across the United States will become harder to justify. Without a return of responsibility to the states, the federalization of routine disasters will continue to require FEMA to become involved with a new disaster somewhere in the United States at the current pace of every 2.5 days. Congress should reduce the federal share for all FEMA declarations to a maximum of 25 percent of the costs. FEMA’s operational tempo and lack of preparedness can be contrasted with that of the National Guard and Coast Guard before and after Sandy made landfall. Having learned in recent catastrophes, such as Hurricane Katrina, the value of “dual-status commanders”—generals that can have both state and federal authority—they were appointed by the governors of Maryland, New Hampshire, New York, and New Jersey prior to Sandy’s landfall. The initiative for dual-status commanders emerged after insufficient direction and coordination between state and federal forces during Hurricane Katrina hampered response efforts.
In Massachusetts, for example, a National Guard Civil Support Team (CST), a unit for emergency preparedness support, was activated to respond to a possible hazardous material threat, but local response forces determined that they had control of the situation.[27] CSTs do not solely respond to hazardous material threats, however.

Overall, the National Guard has proven to be a robust amplifier of local response efforts by virtue of its consistently trained force and federal funding stream.
Americans must, however, take a more realistic and pragmatic view on which actions community members should take based on the likelihood of various risks they may face. While many people rely on the Internet for information, the best method for conveying information to individuals is through a trusted community actor, such as a popular news personality or community leader. With individuals taking action to prepare themselves and their families, and engaging in community-based efforts so that the ‘‘do no harm’’ principle is followed, a community’s resiliency will be high.
While not authorized to deploy outside their home states except under special circumstances, SDFs in some of the hardest-hit states, such as Maryland, New York, Virginia, and Connecticut, were activated to assist in the Sandy recovery efforts. The Maryland Defense Force (MDDF) deployed one Disaster Assessment Team (DAT) in Salisbury ahead of the storm, and had two more DATs and four medical teams on standby that were never required to activate.
State and federal policymakers should integrate SDF units into state and federal emergency management planning.
Incorporate NGOs, faith-based organizations, and businesses into federal and local disaster plans before disaster strikes.
Congress should enact legislation that restricts the items for which the federal government can provide emergency funds post-disaster. Rather than simply throwing money at the issue, a better and more honest federal approach to global warming right now is to encourage economic health—precisely what global warming energy subsidies do not accomplish. Beyond plant design, federal law also requires nuclear plants to have preparedness and emergency response plans with local, state, and federal groups approved by FEMA and the Nuclear Regulatory Commission (NRC) before an operating license is granted. One plant, Oyster Creek Generating Station, issued an “unusual event” declaration and then an “alert”—the two lowest of four emergency alert levels—during the course of the storm. Emergency Management Agency, recommended important changes to the National Flood Insurance Program.
According to surveys on the subject, the Ameri­can people are becoming aware of the crisis in the nation's emergency medical system. Medical malpractice reform is fundamentally a state issue, not a federal issue, and states can imple­ment a variety of innovative measures to relieve phy­sicians from the burden of unreasonable liability.[32] EMTALA was never meant as a substitute for state medical malpractice laws, and reform attempts should in no way supersede state legislation or a more comprehensive reform of the tort system. The Emergency Medical Treatment and Active Labor Act makes thehospitals and doctors that provide emergency care to the uninsuredless able and increasingly less willing to provide such care. The policy doesn’t affect federal money for relief after a hurricane, flood or other disaster. New federal rules and regulations were crafted in an attempt to make EMTALA better understood among medical professionals and easier to imple­ment for hospital officials.
Because it is an unfunded federal mandate, the provisions gov­erning EMTALA-related care have been predicated on the ability of providers to cross-subsidize care for the uninsured through revenues from other payers and revenue sources. Part of specialists' growing reluctance to take emergency calls is a genuine concern that ED patients will sue. However, they promise only limited relief and may actually conflict with existing state medical malpractice legislation. Starting next year, the agency will approve disaster preparedness funds only for states whose governors approve hazard mitigation plans that address climate change. 2729), sponsored by Representative John Shadegg (R–AZ); and the Access to Emer­gency Medical Services Act of 2006 (S. 2750 suggest funding these payments from the Federal Supplementary Insurance Trust Fund through an amendment to the Medicare legislation (Title XVIII of the Social Security Act).
Household disaster preparedness measures, as defined by the BRFSS questionnaire, included the following items: having 3-day supplies of food, prescription medications, and water, a written evacuation plan, a working battery-powered radio, and a working battery-powered flashlight. Knowing about the local emergency plans for shelter and evacuation and local emergency contacts will help you develop your household plan and also will aid you during a crisis. CDC uses preparedness metrics to assess systems, with the findings disseminated to states and used to inform Healthy People 2020 objectives.
The General Preparedness module was included in BRFSS surveys conducted by 14 states during 2006–2010.
To help improve household disaster preparedness in the general population and to inform national and state preparedness planning and policy, systematically measured, generalizable state-based household preparedness data are needed (9).
An increased effort to make household preparedness materials and information more accessible, particularly by those with resource and language barriers, is needed. Part of the problem driving the need for emergency spending is the increasing volume of disaster declarations issued by the Federal Emergency Management Agency (FEMA) over the past two decades. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Stafford Act), the controlling federal statute for disasters. As the litmus test for federal disaster dollars, the Stafford Act fails to clearly establish which disasters meet the federal requirements and which do not. That means that states must begin planning for disasters as they once did from 1787 to 1992, before federal disaster declarations skyrocketed. This high operational tempo is affecting FEMA’s overall preparedness because it keeps FEMA perpetually in a response mode, leaving little time and few resources for catastrophic preparedness. This increases the likelihood that the federal response to catastrophic events will be insufficient, as once again demonstrated by the response to Hurricane Sandy. In Katrina, active duty and National Guard operations, even those that were seemingly identical in practice, were directed by two separate chains of command. However, due to the nature of the incident, and the evidently robust state force responses from New York and New Jersey, only 12,000 of the 60,000 guard personnel were activated for Hurricane Sandy. Continuing to understand how the National Guard transitions between state and federal duty is vital to maintaining the guard’s success as a response force in the future. As with the National Guard, many more militia troops were prepared and ready to serve their communities than were actually needed, but this is exactly the problem a state would want to have during a crisis. States, the Department of Defense, and the Department of Homeland Security should integrate SDFs into existing and future emergency management plans to ensure that all players in state emergency response are aware of the resources provided by each state’s SDF.
It is quite clear from the emergency spending doled out after both Hurricane Katrina and Hurricane Sandy that the absolute worst time for Congress to appropriate funds is right after a disaster has occurred. It also lures states and localities into greater dependence on federal funds, further undermining the principle of federalism. With this restriction on the federal government’s appetite to engage in emergency spending, Americans should see a bit more responsible treatment of their tax dollars. Federal programs like cap and trade, efficiency mandates, and fuel economy standards will not significantly affect global temperature, especially considering the efforts of developing nations to provide electricity to millions of people currently without it.
Even in the case of serious damage caused by weather, nuclear plants are built with layered safety systems to mitigate and control emergency situations. Nuclear facilities participate in full emergency exercises with state and local first responders at least once every two years. Indeed, FEMA’s lack of preparedness will come as a surprise to no one, nor will the sometimes-tenuous nature of the U.S.
Agency (FEMA) via the California Governor's Office of Emergency Services, $5.5 million, 36 months.
For example, 62 percent of Americans favor legal protection for physicians who care for unin­sured patients in the emergency room, similar to the legal protections given to physicians who treat patients in community health centers. Several legislative proposals attempt to address this issue, including the Access to Emergency Medical Services Act of 2005 (H.R. The Federal Emergency Management Agency is making it tougher for governors to deny man-made climate change. This type of action greatly undermines the Warmists argument when they say Deniers are conspiracy theory nuts…As it would be impossible to get 97% of scientists to agree in AGW unless it were true.

In a 2004 survey of ED directors conducted by the Amer­ican College of Emergency Physicians, 65.9 percent reported a problem with inadequate on-call specialist coverage. In addition, the American College of Emergency Phy­sicians noted in a recent report that EMTALA may actually encourage uninsured patients to seek ED care in increasing numbers because they are aware of the federal mandate to provide screening and sta­bilizing care.
With waivers from HHS, Massachu­setts officials are transforming an esti­mated $1.3 billion in federal and state uncompensated care funds into a pre­mium assistance program for unin­sured persons to help them buy health insurance. Similar to previous studies, the findings in this report generally indicate increased levels of disaster and emergency preparedness among men, English-speaking persons, and adults with more education (3,4). A disaster supplies kit is simply a collection of basic items your household might need in the event of an emergency. is an Internet-based disaster preparedness initiative, and the Citizen Corps encourages government and community leaders to involve the general population in all-hazards emergency preparedness activities (5,6). Non-English speaking and minority respondents, particularly Hispanics, were less likely to report household preparedness for an emergency or disaster, suggesting that more outreach activities should be directed toward these populations. Each declaration issued by FEMA drains the Disaster Relief Fund (DRF), a fund intended for emergencies that overwhelm state resources.[5] The more declarations issued, the faster the DRF needs replenishing. Under this act, the federal government pays 75 percent to 100 percent of disaster response bills as long as FEMA has issued a disaster declaration. Through the use of relatively new command structures, streamlining direction and information gathering, and use of specialized units, the National Guard, in conjunction with other state forces as well as active duty military personnel, was poised to respond to Hurricane Sandy well in advance. The dual-status structure of the National Guard during Hurricane Sandy, however, enabled state and federal military responders to receive the instructions from the same personnel and operate in a more streamlined fashion. Many members, therefore, have high levels of training and professionalism stemming from past experience that makes them invaluable for high-risk states, acting as force multipliers for response efforts in the aftermath of natural disasters or domestic attacks.
Other MDDF personnel served in support roles at the State Emergency Operations Center and the Joint Operations Center at Camp Fretterd.
There was no system for keeping track of all of this state-owned and leased equipment used for the response effort before activation of the NYG. Further, emergency management plans and exercises will provide the SDF with greater guidance on its role in state response in the event of a disaster. After a disaster, the government should make it easier for homes, businesses, and infrastructure to be rebuilt by temporarily suspending requirements like those in the Davis–Bacon statute, which effectively mandates wage premiums for those hired to work on federal construction projects. Some, however, have incorrectly blamed global warming for an increase in disasters like Sandy, as well as the resulting increase in emergency declarations.
Utilities can, however, undertake cost-effective actions to reduce potential outages and speed up power restoration in the event of catastrophic disasters, such as performing rigorous testing and analysis of aging transmission and distribution system assets to determine when various assets should be repaired or replaced, and the lowest-cost approaches for doing so. Moreover, the main federal law that governs the provision of emergency medicine is outdated and counterproductive. Nonetheless, federal and state policymakers can mitigate the law's defi­ciencies and transcend the problems that it was originally designed to resolve.
Its also bureaucratically burdensome- they are forced to actually put in activists into the structures to produce this necessary but false document. Since the 2001 terrorist attacks, the federal government has increased its emphasis on emergency preparedness, including the response and recovery capabilities of emergency management agencies, hospitals, and public health systems (7). Emergency planning should address the care of pets, aiding family members with access and functional needs and safely shutting off utilities. Second, responses were dependent on the participant's understanding of preparedness measures taken in the household; for example, some respondents might not have known that the household had a 3-day supply of food, water, and medications. Comparison of data collected by these two states showed no significant increases or decreases in preparedness measures over time.
If FEMA reserved the DRF and its resources for nationally catastrophic disasters, the need for emergency spending would drop significantly. After two decades of an increasingly active and generous FEMA, governors have slashed preparedness budgets and drained any disaster rainy day funds over the past 13 years. In the case of the New Jersey 21st CST, the guard implemented a Joint Incident Site Communications Capability (JISCC).[29] The JISCC essentially creates a command and control center by which federal, state, and local forces can all communicate with each other regardless of which devices they employ to do so. Community members can use this actuarial data to develop a better understanding of the natural disasters likely to occur in their area and, therefore, make better decisions about how to prepare. George Gibson, Deputy Incident Commander of the Division of Homeland Security and Emergency Services for Citi Field operations, stated: “I can’t begin to come up with a number of what our possible losses could have been without this system. There are, as outlined in this Special Report, a number of vibrant SDFs that can serve as models for new ones throughout the states, and whose command and staff elements could act as valuable advisers in the start-up process. Instead of diverting federal dollars to these programs, Congress should pursue greater reform within the energy sector, where much of this spending takes place. NRC resident inspectors always staff each reactor facility in America, and independent groups like the Institution of Nuclear Power Operators and the World Association of Nuclear Reactors train, evaluate, and circulate best practices.[59] Because of these preparations and routine refreshing of emergency plans, America’s nuclear reactors are among the world’s safest. The problems confronting the nation's emergency medical system are likely to get worse, especially con­sidering the gravity of the challenges, most notably the threat of a pandemic or a major terrorist attack using biological or nuclear weapons.
Congress could also target a portion of Medicare funds to emergency departments to ease the pressures confronting emergency personnel. However, the federal law and its subsequent regulations added yet another layer of complexity to the problem without yielding a stronger benefit in terms of better enforcement or deterrence of undesirable behavior by doctors and hospitals. Household preparedness measures, such as having a 3-day supply of food, water, and medications and a written household evacuation plan, can improve a population's ability to cope with disasters and emergencies, decreasing the number of persons who might otherwise strain emergency and health-care services.
Alternate Text: The figure above shows the percentage of participants reporting household disaster or emergency preparedness, by preparedness measure and language (English or Spanish) used in the interview, in 14 states during 2006-2010. Outcomes associated with individual household preparedness activities, however, are not similarly assessed or shared (3,8). Unfortunately, politicians often feel that they and the federal government must be seen in control after a disaster, even if government control is ultimately detrimental to true relief. The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is another example of federal legislation that hurts the very people that it was meant to protect: low-income patients in need of emergency medical services. The law required hospitals, as a condition of receiving gov­ernment funds for construction or modernization, to provide emergency services to all patients, regardless of their ability to pay.
Household preparedness measures, such as having a 3-day supply of food, water, and medication and a written household evacuation plan, can improve a population's ability to cope with service disruption, decreasing the number of persons who might otherwise overwhelm emergency services and health-care systems (2).
Policymakers need to undertake urgent reform of the emergency medical system, especially in the face of an increasing need for disaster preparedness. Doubling the per capita threshold to a minimum of $5 million (and a maximum threshold of $50 million) would significantly reduce the number of events that would warrant a federal disaster declaration. For example, Congress can diminish the adverse effects on doctors and other medical professionals by providing relief from medical malpractice lawsuits for those who deliver medical care in hospital emergency departments. Policymakers can stop the continued erosion of quality care in the nation's emergency departments (EDs) and reverse the adverse effects of two decades of ineffective law and misguided regulation on the provision of emergency medical services. The Hill–Burton Hospital Survey and Construc­tion Act of 1946 was an early but largely ineffective attempt to prevent patient dumping.
In 1998, federal officials added interpretive guidelines to detail the administrative require­ments for compliance with the law and to address the dilemma that hospitals face when treating managed care patients in the emergency room. The Institute of Medicine (IOM) recently issued a major report that details the deficiencies of America's emergency medical system, not only on a day-to-day basis, but also in the ability to meet specialized demands for medical care under critical conditions.

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