title: A Profile of Indian Health Service Emergency Departments.
abstract: OBJECTIVE
  The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs).
  
  
  METHODS
  All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/).
  
  
  RESULTS
  Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity.
  
  
  CONCLUSIONS
  Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities.
authors.affiliation: Department of Emergency Medicine, Tuba City Regional Health Care Corp, Tuba City, AZ. Electronic address: kenneth.bernard@tchealth.org.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bernard
authors.affiliation: Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Sullivan
authors.affiliation: Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Camargo
mesh_terms: D000072957:Alaska Natives; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D019538:Health Care Surveys; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration / Q000592:standards* / Q000639:trends