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WASHINGTON - The emergency room at Mount Sinai Medical Center on Miami Beach was so crowded recently that physician Lisa DeWitt found herself treating patients in the halls, worrying how she would cope if terrorists or a natural disaster struck right then.

"All I could do was go out in the parking lot to treat patients," said DeWitt, a disaster response specialist with worldwide experience.

Lots of other disaster planners are worrying about the same problem: how to treat a sudden influx of hundreds or thousands of casualties due to terrorism or a natural disaster. Belt-tightening pressures over the past 20 years have made the pressure more acute by forcing many hospitals to shrink or close.

Today, Homeland Security Director Tom Ridge is expected to step in and urge members of the American Hospital Association to come up quickly with contingency plans for treating mass emergencies.

If state and local authorities fail to enhance their "surge capacity," the Bush administration threatens to withhold their share of $1.6 billion in upcoming federal bioterrorism grants.

Also today, the Chicago-based AHA, a powerful trade group, plans to release a report showing how bad emergency room overcrowding has become.

According to industry figures, the number of U.S. hospitals dropped 14 percent between 1985 and 2000 while the number of patients admitted remained the same.

Massachusetts, a hard-hit state, lost half the hospital beds it had in 1980. In California, the number of emergency departments dropped 12 percent in the 1990s while the number of ER visits rose 27 percent.

"There is very little excess capacity in hospitals today, and surge capacity is one of the core issues that we're dealing with," said Jerry Hauer, a former New York City disaster chief who now is national security adviser to Health and Human Services Secretary Tommy Thompson.

"Overwhelming a hospital these days is a piece of cake," said David Ozonoff, a Boston University School of Public Health professor.

"The reason New York made it (without flooding hospitals Sept. 11) is because everybody was dead," he continued. "They didn't need any hospital beds. If there had been 1,000 (life-threatening) burns, it would probably have overwhelmed the burn treatment capacity in this country."

For now, communities are improvising solutions to treat emergency surges. New York City plans to use armories and convention centers as makeshift hospitals. Syracuse, N.Y., has talked about making the state fairgrounds into a hospital if needed, officials said.

Hotels and motels could be turned into instant hospitals, said Boston University's Ozonoff, leading proponent of the idea.

Hotels have individual rooms that are helpful in containing infectious diseases, Ozonoff said. "You don't want (victims) next to each other in a huge open area," he said.

The District of Columbia and the U.S. Department of Defense are picking up on the idea. They plan to spend up to $8 million to prepare and convert a major hotel into an emergency hospital if needed, said District Health Director Dr. Ivan C.A. Walks.

"Hotels are ideal facilities because they come equipped with their own beds," said HHS adviser Hauer.

Kevin Maher, vice president for governmental affairs at the American Hotel and Lodging Association in Washington D.C., said the idea will take some study, but might work.

"We've helped the government house people who lost their homes in floods and hurricanes," Maher said. "There is precedent for this."

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