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COVID Shows How Outdated EMS System Needs to Evolve

With the usual suspects calling 911 for nonemergency needs combined with the omicron variant, the system is backed up to the point where some patients are waiting an hour or more to be admitted to the hospital.

The California Assembly Emergency Management Committee held a statewide meeting this week on ambulance patient offload delays, a problem exacerbated by the pandemic that has caused costly and unnecessary delays in transporting patients and getting them into a hospital.

When the EMS system was developed, it was meant to help get severely injured or sick people to the hospital as quickly as possible so they can get the treatment they need to survive. In recent years, the system has been misused by people calling 911 for nonemergency reasons, sometimes several times a month. During the pandemic, that misuse has accelerated to critical levels as people call 911 for symptoms or even to get a COVID-19 test.

Now, with the usual suspects calling 911 for nonemergency needs and the added callers calling for nonemergency COVID-related issues, the system is backed up to the point where some truly sick or injured people are waiting an hour or more to get moved from the EMS gurney to a hospital gurney and into a bed.

When you add in staff shortages at hospitals because of COVID-19 and that beds are being taken by those suffering from the virus, you have an unsustainable, catastrophic scenario.

“I don’t think people really realize what it does to the system in general,” said Assemblymember Freddie Rodriguez (D-Pomona), who led the discussion among a diverse group of constituents this week. “Now, instead of that ambulance spending 20 minutes getting back out on the road or to the station to handle another medical emergency, it’s going to be delayed and you’re going to have to pull resources from other areas to get other 911 calls.”

And it’s not just California that’s experiencing the problem.

“It is [happening] in many communities across the country, not all but many,” said Matt Zavadsky, chief strategic integration officer for MedStar Mobile Healthcare in Fort Worth, Texas, and immediate past president of the National Association of Emergency Medical Technicians. “We’re hearing that more communities are experiencing it than not.”

Zavadsky added that the problem has been getting worse since the onset of the omicron COVID-19 variant. “When you are stressing a health-care system like we’re seeing, it’s creating this domino effect,” he said. “You can’t get patients out of the hospital, you don’t have enough staff to care for the patients that are there and you end up with boarders.”

Boarders are patients who are taking a bed in the ER waiting for admission to a bed in the hospital. There is simply no place to put them except in the ER. They are technically doing their inpatient stay in the emergency room, which then limits the availability of beds for other patients, some of whom may need more intense care.

The system is outdated and never counted on people calling 911 to get a test or for minor ailments, not to mention the factors of a pandemic.

There are solutions, albeit not easy ones, and some hospitals have already begun to implement those. For instance the John Peter Smith Hospital (JPS) in Fort Worth has kept drop times — the time to transport and get a patient into a hospital — the same during the pandemic as before.

That is because not all of the patients taken to JPS are being given a bed. “They might have an assessment or some treatment, and a fair percentage of patients that we bring to that facility we deliver to the waiting room,” Zavadsky said.

Those patients will be seated comfortably in the waiting room and may even be treated in the waiting room by a physician’s assistant or other personnel, but they are not taking a bed. “Any hospital could do this,” Zavadsky said. “Now it’s more battlefield medicine where we’re going to stitch you up and give you medication, do whatever you need to keep you from having to take up a bed.”

Zavadsky said EMS can play a role in helping decompress the emergency room by doing follow-up care on patients, making sure they’re taking meds, getting enough to eat, taking care of doctor appointments and so forth.

Some communities have special units called community paramedicine teams that keep track of certain patients who have been discharged so they don’t end up calling 911 repeatedly. “We do that often, and now those patients no longer have to hang out in the ER; they’re in the community and we’re doing follow-ups,” Zavadsky said. “Those types of partnerships are things health-care systems and EMS agencies need to be doing more of to manage this patient flow.”

Another solution is to flatly tell the patient that their situation isn’t life threatening and that they will not be transported to the hospital. “Especially if you’ve got COVID-related symptoms,” Zavadsky said. “We have a protocol where we tell the patient, ‘We’re not taking you to the hospital’ even though the patient wants to go.”

Assemblymember Rodriguez said having EMS partner with alternative destinations, such as mental health facilities or drug rehabilitation facilities, is another way to lesson the load on emergency rooms, where often people with mental health issues or drug problems end up and can’t get the care there that they need.

Another solution is to allow fire departments to transport patients to the hospital as they often arrive on the scene first.

“In some cases this is deadly because you have some folks out there who have a lot of medical conditions that would require prompt medical attention in a hospital setting, and we know our first responders can only do so much,” Rodriguez said. “I’m sorry, this is 2022 and we’re having this issue in California?”