Calif. county health officials say ambulances, patients 'waiting hours' for ER beds
Orange County's director of EMS said that an "overwhelming increase" in COVID-19 patients has created a crisis for the county's healthcare system
Ian Wheeler and Roxana Kopetman
The Orange County Register
ORANGE COUNTY, Calif. — The rising flood of coronavirus patients has prompted Orange County's Health Care Agency to warn that emergency room backups have had some ambulances waiting "hours" to offload patients and the county's critical care network "may collapse unless emergency directives are implemented now."
The grim assessment was sent to Orange County's 26 emergency receiving centers, as well as ambulance companies and 911 paramedic providers, late Wednesday, Dec. 9, by Dr. Carl Schultz, director of the agency's Emergency Medical Services.
"The health care system in Orange County is now in a crisis resulting from an overwhelming increase in the number of COVID-infected patients," Schultz wrote.
In some cases, ambulances are being diverted from full emergency rooms, forcing them to transport their patients elsewhere, with paramedics waiting at least an hour one day this week to get their patients from their vehicles into the ER, county health officials said.
In the memo, Schultz urged hospitals that haven't yet done so to activate their pandemic surge plans while there is still time, expand their patient capacities by setting up alternate treatment areas and cancel all elective surgeries, as was done earlier in the pandemic to keep beds open. He applauded those that already have.
During a news conference Thursday, Dr. Clayton Chau, Orange County Health Care Agency director and county health officer, tempered Schultz's words.
"We do have capacity in terms of regular hospital beds as well as ICU beds," he said. "The letter that was sent out from EMS was just to caution and make sure we have a plan with all our hospitals, and not wait till the last minute."
Hospital systems that serve Orange County form their own surge plans in cooperation with public health officials and other health care networks.
Ambulances now are allowed to travel more than 20 minutes from their standard destination in order to avoid emergency room bottlenecks and can move on to another hospital if a patient has waited more than an hour to get into an ER.
This week, representatives of various health care networks that run some of the county's largest hospitals — Kaiser Permanente, Providence, UC Irvine — said they were carefully tracking the ebb and flow of patients each day to staff the right number of beds to handle the surge.
About three-quarters of beds were full at Orange County's hospitals by Thursday.
For months, even during the pandemic's summer surge, medical centers held bed occupancy steady between 60% and 70% as patients came and went and staff shifted beds around depending on need. But since Dec. 1, the share of full beds has not dropped below 71%.
Coronavirus patients are making up a rising share of more than 4,000 hospital patients in Orange County, now accounting for one of every four people in a bed, up from one for every 20 in early November.
The tally of COVID-19 patients in hospitals has never been higher this pandemic, breaking 1,000 patients for the first time Thursday, well above the previous peak of 722 in July. About a quarter of those patients were in intensive care, which state health officials have thrust into the spotlight as a vital determiner of how a county is weathering the end-of-year coronavirus storm.
By Thursday, just 3.5% of Orange County's adult ICU beds were open, according to the Health Care Agency, lower than the Southern California region as a whole at 7.7% availability. These figures exclude incubator beds for newborns and others reserved for children.
However, officials from various health care networks this week have said it is unlikely Orange County would actually run out of intensive care beds, even amid a worsening surge, given the ability for staff to quickly convert other types of hospital beds and equip them with now more abundant ventilators and other lifesaving equipment.
Moving patients between hospitals, including hospitals in other counties, is not out of the ordinary. But with backed-up ERs and beds filling up across the region, some ambulance patients are having to travel farther and wait longer for in-hospital care.
The average patient offload time for ambulances operating in Orange County, starting the clock when its wheels stop outside a hospital to when the crew places their patient on an emergency room gurney, rose above 20 minutes this week from around 13 minutes two weeks ago, according to county reports.
There has been an uptick in the number of calls for ambulance service recently, and it's taking a bit longer to drop off patients, said Bill Weston, director of operations for Care Ambulance, which serves large areas of Orange and Los Angeles counties.
"But it's not beyond anything the system can't manage," he said.
Weston praised Schultz on Thursday for taking a "proactive approach" in his recommendations.
"He's getting ahead of potential problems so we don't have problems like they did in New York last spring," Weston said.
Asking hospitals now to put their surge plans in overdrive is wise, Weston said. "He's asking them to prepare."
Schultz also is giving ambulance EMTs the extra option to take patients to other area hospitals. "One of Dr. Schultz's tools is they don't necessarily have to take the patient to the closest hospital if that one is already busy," Weston said.
Care Ambulance's crews have not recently been turned away from any Orange County hospital due to a lack of beds, he said.
On Thursday, Chau said the 180-bed Fairview Developmental Center in Costa Mesa will open Tuesday, Dec. 15, to take on non-critical overflow patients from around Southern California, opening up even more hospital beds.
Chau said private gatherings from Thanksgiving and, likely, from upcoming winter holidays will keep adding to coronavirus case counts into the new year.
"More important than ever, please do not mix households," he said. "If anything, this is the holiday that you don't want to go out and mix with folks."
Chau ended Thursday's news conference with a plea to the public: Wear a mask, social distance, avoid multi-household gatherings, practice good hygiene and the sick, especially, should get tested and avoid going out.
(c)2020 The Orange County Register (Santa Ana, Calif.)