NC county plans to have EMS crews transport some patients to urgent care, not ED

Haywood County emergency management officials are working with area hospitals to get patients the right level of care amidst an influx of COVID-19 case


Vicki Hyatt
The Mountaineer, Waynesville, N.C.

HAYWOOD COUNTY, N.C. — A plan has been hatched to ease the pressure at Haywood Regional Medical Center and other hospitals in the region as COVID cases mount and the hospital staffing is stretched thin.

Greg Shuping, director of Haywood County's emergency management operations, and his staff have been working with hospital officials to transport patients to the most appropriate center for care — and that's not always the Emergency Department.

EMS crews in Haywood County will soon test a plan to transport some patients to urgent care instead of hospital emergency departments. The plan comes as local hospitals are overwhelmed with mounting COVID-19 cases.
EMS crews in Haywood County will soon test a plan to transport some patients to urgent care instead of hospital emergency departments. The plan comes as local hospitals are overwhelmed with mounting COVID-19 cases. (Photo/Haywood County Emergency Services)

For example, if an elderly woman with a sprained ankle calls for an ambulance because her neighbors are working and her family lives elsewhere, the county EMS crew would routinely take her to the hospital ED.

Lately, nonemergency ambulance patients have to wait for an hour or more just to get inside the doors. The number of COVID patients had reached 25 — almost double the previous high several weeks back — and hospital numbers typically rise during winter months.

Emergency situations always take precedence at the hospital, Shuping explained. If a person is having a heart attack, respiratory issues or experiencing life-threatening symptoms, for instance, emergency doctors will see the patient immediately.

It is the nonemergency calls that are up for discussion — ones that tie up not only a patient but an entire ambulance crew that might be needed elsewhere.

Ambulance crews have the authority to transport patients to an appropriate care facility, either in the county or to a hospital in a neighboring county, Shuping said. One option that has never been used before — or even considered — is taking patients to an Urgent Care center. Haywood has two — one on either side of the county.

When making calls around the region to see how such a plan might work, it was hard to find anyplace it had happened, Shuping said, but all asked to be kept in the loop if it worked.

"Here in Haywood County, as usual, we think outside the box and find ways to get things done," Shuping said.

A team effort

The county has been in close communication with officials at Haywood Regional on how to make sure patients are dropped off at the place where they will get the most appropriate level of care.

The paramedics picking up a patient will make a thorough assessment, confer with physicians and personnel at the Urgent Care to make sure where the patient will get the care needed.

"To help us help the citizens, we're talking about low-acuity decisions when thinking about going to Urgent Care as opposed to the Emergency Department," Shuping explained. "[...] major cases are not part of the transport decision discussion. But if we see general illness symptoms that might not need a high level of care, we'll call, text or radio the ED physicians, let them know the situation, and they will help us make a good transport decision."

The plan was to test the process late this week, but the adverse weather forecast prompted a delay.

Stretched thin

The Emergency Departments at Haywood Regional, as well as hospitals across the region, has been inundated, largely due to the post-holiday spike in COVID-19 hospitalizations.

Shuping said getting an ambulance patient with minor issues dropped of at the ED has been time-consuming lately, especially in the afternoons.

"We can't just leave someone on the sidewalk," Shuping said. "We have to hand them off."

The wait not only prevents the ambulance crew from responding to other calls, but is frustrating for the person waiting for care.

The situation is more about hospital and EMS staffing than anything else, Shuping said, saying he totally understands because his department is experiencing the same thing. A number of personnel have had COVID, which leads to quarantines and reduced staff, and that's on top of the usual reasons employees can't make it to work — family emergencies, childcare issues or illness.

The EMS department works closely not only with Haywood Regional, but other hospitals in the region. There are times certain facilities are on diversion, meaning ambulance patients are not to be dropped off there.

A mid-week review of hospital capacity in the region tells the story.

On Wednesday there were 159 lab-confirmed positive COVID-19 cases in Mission Health system; 129 at Mission Hospital; six at Angel Medical Center, seven at Blue Ridge Regional, one at Highlands-Cashiers Hospital, seven at Mission Hospital McDowell and nine at Transylvania Regional Hospital.

Haywood Regional had 25 COVID-19 patients alone, double the high number recorded several weeks back. This doesn't include patients hospitalized for other reasons.

Mission Hospital is the regional transfer center for Western North Carolina and processes about 800-1,000 transfers each month, said spokesperson Nancy Lindell. While Mission still has the capacity to accept and care for patients, it takes a good bit of coordination.

"We rely on staff at our transfer center to coordinate these transfers between hospitals in the region and out of state. Less than 1% of the time is a transfer to Mission not completed and reasons vary," Lindell said.

The Mission Hospital system is asking the community to be diligent in wearing a mask, waiting six or more feet apart, washing hands and to go out only when necessary.

"At Mission Hospital, our number of COVID patients has more than tripled since the beginning of November, and we ask the community to help stop the spread," Lindell said.

At Haywood Regional there are delays in transfers to other facilities when required, according to a prepared statement.

"Our staff is doing a great job of managing day-to-day under difficult circumstances and will continue to work closely with other hospitals and EMS in the area, keeping lines of communication open to best manage patient needs regionally," the statement reads.

"We are here for you," said Greg Caples, HRMC CEO. "We do, however, want to encourage our community to stay home as much as possible, wash hands, social distance, and wear masks. We're only now seeing the effects of the Christmas holiday and the results of New Year's gatherings are still to come."

A warning

While patients are still being served at hospitals in the region, Haywood County Medical Director Mark Jaben warns that the situation could change.

He is in communication with all the hospitals and said every facility is stretched thin.

"What's happening is staffing, not space," he said. "I would say they are at their limit. Listening to the scanner, you see diversions taking place and there are periods of time they are not taking patients, and that's true for hospitals across the region. I would say all hospitals in Western North Carolina are at their limit right now."

That makes it all the more crucial for individuals to stay diligent in following COVID guidelines. The hospitalization levels being experienced now don't include any cases that could have stemmed from New Year's gatherings, which are expected to keep the surge going.

On a positive note, flu cases are down dramatically this year. Out of 5,000 flu specimens processed in the state, only one was positive for flu, he said. Whether it is good luck, prevention measures that contain germs or the less virulent strain being noticed globally this year is anyone's guess, Jaben said.

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(c)2021 The Mountaineer (Waynesville, N.C.)

McClatchy-Tribune News Service

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