Navigating Medical Deserts

A zip code has become a life or death matter. Families that live more than an hour from a hospital may face a death sentence based on their address. A long ambulance ride increases the risk of death. Patients with respiratory emergencies, like the ones caused by coronavirus, are particularly vulnerable.

According to an American Hospital Association Annual Survey, more than 1,000 hospitals in our country have closed since 1975. As a result, communities from coast to coast have populations in which residents must drive more than 60 minutes to reach an acute care hospital. These places are called medical deserts. They exist in every state.

Now is the time to strengthen known weaknesses in our health-care safety net. We desperately need new investment in our health-care infrastructure. A recent study by the U.K. Imperial College COVID-19 Response Team anticipates the “capacity limits of the U.K. and U.S. health system being exceeded many times over.” It warns that “even if all patients are able to be treated, we predict there would still be in the order of 250,000 deaths in Great Britain and 1.1-1.2 million deaths in the U.S.”

As an emergency medicine physician and co-chair of the Health Committee of Black Women for Positive Change, I call on the nation’s leaders to immediately implement three recommendations to improve access to medical care and thereby save lives before it is too late:

1. The U.S. Congress should pass legislation to create free standing emergency departments. FSEDs are 24-hour, seven-days-a-week, emergency departments established in communities that lack immediate health-care services. Stand-alone emergency departments are physically separate from hospitals. They can be independently owned, hospital owned or government owned, and are staffed by emergency medicine physicians. FSEDs are available for walk-in patients and accept patients arriving by ambulance. These facilities treat and discharge patients, while also transporting admitted cases to full-service hospitals by ambulance or helicopter. FSEDs can be quickly built and maintained at a fraction of the cost of large hospitals. FSEDs are just as effective at providing time-sensitive critical medical care services as hospital associated emergency departments. FSEDS can be a vital safety net for people who live in medical deserts.
2. Convert unused spaces into temporary COVID hospitals. Health-care facilities and providers can quickly become accelerating vectors for the transmission of COVID-19. It is important for that reason not only to increase the number of critical beds with ventilator capability, but also to separate COVID and non-COVID patients. We need immediately to convert unused spaces into dedicated temporary COVID hospitals. If that is not done immediately, patients that are ill from non-COVID medical diseases can be infected by providers and other patients, increasing their morbidity and mortality. Since every State in the U.S. now has empty conference centers, cruise ships, coliseums, concert halls and other large venues, those unused spaces can be converted into temporary COVID-only hospitals. Physically separating patients is a critical step to decreasing mortality and morbidity rates.
3. Expand medical flight and ground transportation capacity. To strengthen our emergency and intensive care capacity, we need to rapidly put an increased number of ambulances and medical flight helicopters into service. Expanding transportation capacity must include enhanced staffing with medical personnel. The physical location of patients in medical deserts, and their health-care resources, should not factor into their access to transportation. Since the coronavirus pandemic is straining transportation systems, there is a need to establish Uber-like emergency transportation models that can facilitate transportation to hospitals and emergency medical facilities.

—Valda Crowder, M.D.