Homelessness and the practice of emergency medicine: Challenges, gaps in care, and moral obligations

"During my research fellowship at Bellevue and New York University, I piloted a program to address the needs of frequent health system users. I found a surprising share of them were either homeless or unstably housed, in deplorable living situations incompatible with their disease states.I met these individuals frequently in the ED, yet recognized I was not using these repeated interactions to address the issues that led to their health system use. I recall one man in his late 20s who was brought into the ED more days than he was not. He always came in by ambulance, intoxicated, and was almost always discharged. One particularly cold day, he arrived hypothermic and lethargic. He was quickly transferred to the ICU, where he died from sepsis. He had been in our ED 2 days before his death and also 3 days before that. I wondered what we as emergency providers might have done to prevent it."

This article is part of a special supplement: Inventing Social Emergency Medicine: A Consensus Conference to Establish the Intellectual Underpinnings of Social Emergency Medicine.