title: The current crisis in emergency care and the impact on disaster preparedness.
abstract: BACKGROUND
  The Homeland Security Act (HSA) of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined.
  
  
  CONCLUSIONS
  After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.
  
  
  CONCLUSIONS
  Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.
authors.affiliation: Department of Surgery, Section of Trauma and Surgical Critical Care, Penn State College of Medicine, Hershey, Pennsylvania, USA. rcherry@psu.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cherry
authors.forename: Marcia
authors.initials: M
authors.lastname: Trainer
mesh_terms: D004189:Disaster Planning / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000191:economics* / Q000331:legislation & jurisprudence; D005380:Financing, Government; D006292:Health Priorities; D006801:Humans; D014193:Trauma Centers / Q000191:economics* / Q000600:supply & distribution; D017664:Uncompensated Care; D014481:United States; D054543:United States Department of Homeland Security / Q000191:economics / Q000331:legislation & jurisprudence; D000078329:Workforce