Ambulance Wait Time

I think I've waited long enough to talk about this. The issue is long wait times in local Rochester, NY hospitals...some as long as 4-5 hours...to get patients delivered to ED via ambulance to see a triage nurse or get into an emergency department bed. There has been spotty coverage in the local media since March 10, 2008 and the problems persists to various degrees.

On March 10, 2008, a day described as "a perfect storm", numerous hospitals were in a code-red status (extremely busy conditions and limited bed space in the hospital). Ambulances were stacked up in hospital parking lots and lines of patient-laden gurneys stretched out the door of some emergency departments. On this day of "a perfect storm" there were no mass casualty incidents, no terror attacks, no multiple shootings, even the call volume in the region was not overwhelming. Just for some reason hospitals were code red...and people kept calling 9-1-1 and ambulances kept coming.

I got thinking about this topic again after reading a follow-up story in our local D and C that looked back on the issue and the pending report on the matter and reminded us that "People take this seriously, not only because it's important to get patients into the ER swiftly for the care they need, but also because, if wait times are too long and something catastrophic occurs, lives could be in danger."

...no kidding

A lot of (cheap) talk, nothing changes. Am I sarcastic? You bet! Here's why:

The Code-Red situation in Rochester is nothing new - I have meeting minutes going back to 1984 talking about this same issue. Little or nothing could be done then, same applies today. Also, before we jump on the "we used lights and siren so it must be an emergency" bandwagon, let me remind everyone that few if any patients suffered poor outcomes because of delays. That is, no dead bodies stacked up in the halls and people weren't crapping out in the streets because there were no ambulances. It just didn't happen. That brings me to the idea that many people we take to the hospital (with or without lights and siren to the scene or to the hospital) are not severe and maybe don't need an emergency department at all!

The story notes that there is a "countywide investigation" looking at the problem. Big deal. The "county" has nothing to do with EMS in our area; not the ambulances, not the hospitals, not the insurance providers...nothing. That means we can have a big countywide investigation cake-walk down the middle of Main Street and it will be meaningless (like it has been since 1984).

Another problem is the term "a perfect storm". What storm? There was no big events going on the generated large numbers of patients, no flu, no nothing...and the term implies that this issue only happens once in a while...a storm. No so. Hospital overcrowding and ambulance/hospital delays have become the norm. In fact, most now agree that a wait time to see a triage nurse of 30 minutes to an hour is acceptable. Interestingly, the story notes that this time is seen as reasonable "when you consider paperwork involved int he handoff from EMTs to ER staff." What paperwork? We make a verbal report at triage, repeat it at the bedside, and generate an electronic document after the fact.

I'd hate to bring a problem without a solution - so here it is, Ricks solution that will never happen and that nobody wants to hear:

• First - lets keep in mind that if you arrive by ambulance at the local ER and can wait 30 minutes to an hour (or 3-5 hours sometimes), you don't need an ambulance...maybe even a hospital at all...
• Second - meetings, investigations, and building bigger ED's don't solve the issue...haven't for 25 years and won't in another 25. If I'm wrong about it, look me up in the nursing home and let me know.
• Solution - Not every person who calls 9-1-1 needs to go to the hospital. Changes in NY PHL need to be made to allow EMS to transport patients to appropriate alternate destinations...clinics, offices and the like.
• Solution - Patients being sent to the hospital (for direct admits to a floor) don't need to stop in the ED...bypass the ED and go to the floor.
  
• Solution - Use existing technology to backup EMS decision making. My cell phone can record and email about 20 hours of video. Why can't we do the same for medical control? Take a video and email it to medical control for review. My MacBook Pro (and most other laptops) have built in cameras...we use wireless technology to connect to the internet for documentation...put 'em together! Let the ED doctor see the patient as well as talk to them...live.
• Solution - Hospital staffing needs to increase to meet demands on the floors and in the emergency departments.
  
• Solution - This one will never happen...Improve programs to serve the needs of drug abusers, those with mental health issues, those with alcohol and other additions, and homeless people.

I await comment.
Rick