Krista S. Kano
Akron Beacon Journal
AKRON, Ohio — Fire departments across the county are reporting higher-than-normal wait times at local hospitals due to staffing shortages in emergency departments.
These delays are affecting the ability of emergency medical crews to respond to subsequent calls and increasing their response times when people call 911.
The Summit County Fire Chiefs’ Association is trying to collaborate with County Executive Ilene Shapiro and area hospitals to find a solution to what some are calling a crisis.
“Essentially, we’re finding that it’s not that the hospitals are full, it’s that the beds that they’re able to staff are full,” said association President and Twinsburg Fire Chief Tim Morgan. “That bottlenecks everything in the emergency rooms ... and all of this throws the burden back on the local fire and EMS systems because when they’re waiting in the hospitals to transfer patients, they aren’t in their neighborhoods prepared to answer the next call for service.”
Hospitals officials have stated they were already experiencing staffing issues, particularly with nurses, prior to COVID-19, but the pandemic exacerbated the situation, resulting in fewer staff members available to care for patients. More recently, that has trickled into emergency departments, as EMS calls are also on the rise.
“In the past, we used to claim that hospitals just didn’t want to hire additional staff and were trying to control costs, but we know that’s not the case anymore,” Munroe Falls Fire Chief Lee Chafin said. “The problem is that there’s no staff, and that’s happening at all hospitals in Summit. Same with Stark, Portage and Cuyahoga counties.
“We’re in a crisis,” he continued. “We don’t have anywhere to take patients right now. And so when we do, it’s taking us much too long.”
Increased wait times
Once an EMS crew picks up a patient, they are responsible for that patient until they transfer care to hospital personnel.
Typically, the goal is to complete the transfer in about 20 minutes, but the time fluctuates based on how busy the hospital is and the severity of the patient’s illness or injury, Green Fire Chief Jeffrey Funai said.
Limited hospital staff means that EMS units are generally waiting longer for the transfers. In recent months, several departments have experienced wait times of an hour or longer with more frequency.
Tallmadge Fire Chief Michael Passarelli said there have been issues on and off for the past two months, but that it has been “real bad” in the last 30 days.
Tallmadge crews have been stuck at hospitals with patients for over two hours, and during that time, hospital staff had initiated treatments before the patient was transferred, Passarelli said.
“The hospital staff has actually done procedures, EKGs, drawn blood, on our cots in the hallways. That’s where I drew the line,” he said.
The Stow Fire Department has waited more than an hour at area hospital ERs 76 times this year, representing 4.2% of all patients transported, compared to 2.9% in 2018. In eight cases this year, Stow has waited over two hours, compared to two cases in 2018, two in 2019, and only one in 2020.
Stow’s average EMS wait times are still closer to the 20-minute goal. The 2021 average is about 26 minutes, compared to high of nearly 28 minutes in 2018 and a low of 24 minutes in 2020.
“We have to remember that during that time, the patient is laying on an uncomfortable cot,” Stow Fire Chief Mark Stone said. “That’s not a good situation, and at the end of the day, our end goal is to help patients.”
‘It’s killing operations’
Cuyahoga Falls Chief Chris Martin said it’s not uncommon for the department to have multiple units tied up for 1 to 2½ hours waiting to transfer care of a patient.
“It’s killing operations,” he said.
Dr. Sonny Bare, emergency medical director of Western Reserve Hospital in Cuyahoga Falls, confirmed that a squad waited 55 minutes last week.
“While traditionally we have zero to minimal EMS wait times, we are facing similar challenges as our peers, finding recent wait times increasing to 20 minutes,” he said.
About three weeks ago, at least one hospital, Summa Akron City, stopped providing EMS units estimated wait times without explanation, Martin said.
“We always call in and give them a picture of our patient and in normal times they’d tell us how long we can expect to wait or at least how many are ahead of us,” Martin said. “A patient may say take me somewhere else if it’s too long, but now we’re not getting that information. It may be because of the acuity of a patient there could be no wait time. There may be a valid reason, but we don’t get that information the way we used to.”
‘It’s a big scary mess’
The longer an EMS squad is waiting at the hospital, the longer they are unable to handle the next call.
Twice in September, Munroe Falls’ units were all tied up at the hospitals, and the communities they rely on for mutual aid were waiting at the same hospital.
“Response times, therefore, are up. People think if no one’s available, we can just call up Stow, but their main station may be out,” so a crew may be coming from farther away, Chafin said.
A few weeks ago, only one crew was available to respond to a fire in Stow because all others were with patients, Stone said. That crew was on the opposite side of town.
Along with calling neighboring communities for mutual aid, departments can also try to recall some off-duty personnel. But that can be unsuccessful as many in the industry work part time at several other departments and are likely either on duty elsewhere, sleeping or spending time with their families. Many personnel do not live in the city they serve and may not be able to arrive for 45 minutes.
“That also incurs overtime, and my costs are going through the roof,” Passarelli said of Tallmadge.
Morgan called the current system unsustainable and expressed fear about what could potentially happen if the county experienced a large-scale disaster resulting in multiple severe injuries.
“It’s a big scary mess, and we honestly don’t know if the help is there beyond waiting out the current circumstance and hoping more people come in to the medical field to help address the shortage in the hospital,” Morgan said.
Solutions
Bare, the head of Western Reserve Hospital’s emergency department, said regional fire chiefs and emergency medical directors have been collaborating on pre-hospital and hospital strategies.
Tallmadge, for example, has recently enacted a policy that if an entire three-person crew is stuck at a hospital, someone else in the department will retrieve all but one of the crew members.
Passarelli also has instructed crews, with patient permission, to go to hospitals that are farther away but may be quicker to transfer, so the crew can return to their station faster.
In Stow, Stone is examining how many people are needed to transport patients for non-life-threatening issues, but noted that may have to be OK’d by the unions. Stone also is taking trained administrators off the desk to respond to calls.
Akron’s EMS bureau is trying to avoid heading in to the emergency department in non-emergency situations with a telehealth pilot program that has been used about 1,100 times since starting in January.
Akron is one of only a few that won a spot in the five-year trial, and other departments have said they would be interested in implementing the program if it become more widely available.
Morgan noted, however, that there still needs to be a health care professional at the other end of the call, which may still take time given the staffing shortage.
“That still ties up an ambulance for some period of time, waiting for the doctor to answer and deal with the patient,” he said.
There has been mention of mobilizing the National Guard, Morgan said, but “you find that a lot of the people in the National Guard medical units are already nurses and doctors somewhere else.”
From the hospital end, Summa announced a reduction of beds by 22% on Monday, and has said it will begin placing specialists, primary care physicians and/or hospitalists in the emergency department on the Akron and Barberton campuses to initiate care more efficiently.
“After learning of this change, both Fire Chief Clarence Tucker and District Chief of EMS Joe Natko feel that this change will positively impact emergency services in the Akron community,” the Akron department said in an emailed statement. "... We appreciate that Summa is making tough decisions for the health and safety of Akron residents.”
Summa also is in the process of hiring a team of paramedics to work in the Akron City Hospital emergency department during the busiest times when beds are not always available and to take over for the EMS crew, said Dr. David Custodio, president of Summa Health System’s Akron City and St. Thomas campuses.
Cleveland Clinic Akron General Emergency Department Chair Dr. Steven Brooks said the hospital has asked EMS crews to move appropriate patients to the triage rooms for initial evaluation and to start the patient workup.
“We have instructed any squad that has waited 30 minutes to alert our resource nurse and attending ED physician to help find a place for the patient. We are constantly evaluating our capacity and staffing, and adjusting as needed to accommodate and best serve all of our patients,” Brooks said.
Morgan said many solutions offered right now are just “moving the furniture around the proverbial deck of a sinking ship ... We’ve got to get some discussions going to find solutions because the current situation just isn’t ideal for patient health and welfare.”
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