As Kern’s hospitals get closer to reaching max capacity, local emergency medical services are forced to become the temporary emergency departments for many patients seeking ambulances during this COVID-19 surge.
The pandemic has greatly impacted ambulance off-load times — the time between an ambulance patient arrives at an emergency department and the time the patient is transferred into emergency department care — have increased due to hospitals reaching capacity. As of last Wednesday, the entire Kern County EMS system had experienced a 30 percent increase in off-load times at hospitals, according to Mark Corum, the Director of Media Services at Hall Ambulance Service.
“Hall Ambulance is faced with patient off-load delays much of the year and it greatly impacts our system, but nothing like we have currently been experiencing,” Corum said. “Each time an ambulance crew must wait for the ER to accept patient care means one less ambulance available to respond to a 911 call for medical aid.”
Last Monday alone, there were 37 instances where a Hall Ambulance crew waited more than one hour at a hospital to off-load a patient. During one of these instances, EMS personnel had to wait longer than four hours with a patient. And just before Christmas, a Hall Ambulance crew experienced a 22-hour delay to transfer a patient into care to the ER staff at a hospital in Palmdale. Prior to COVID-19, the standard off-load time is is about 20 minutes, according to Kern County EMS Ambulance Patient Offload Policy.
Corum also said the need to decontaminate ambulances following the transportation of a suspected or confirmed COVID-19 patient has increased, causing ambulances to be out for longer periods of time.
In response to this increase in off-load time, Kern County Public Health implemented an EMS System Surge Plan last week, which intends to keep ambulances available for the most serious requests for 911 medical emergencies.
According to the plan, ambulances will only respond to low acuity 911 calls when there are sufficient resources available. If an ambulance is not available to be dispatched, the caller will be informed of the situation and provided other options for obtaining care by the dispatch center, according to the plan.
“These alterations to the normal EMS system of care are designed to provide the best level of patient care by integrating additional resources and helping to prioritize our responses as the system becomes further impacted by the current pandemic,” a news release says.
As of Wednesday, Kern County remained in the second tier of the four-tier plan, according to Michelle Corson, the spokeswoman for the Kern County Public Health Department. Kern has moved into the level 2 tier because it has sustained a surge of 12 to 25 percent increase in 911 volume; and/or has experienced a significant increase of units out of service for decontamination; and/or has a 30 percent increase in patient offload times; or has significant staffing reduction.
Corson says it is unknown if the increase in demand for ambulances will continue for a long period of time; however, she said the plan the County has implemented has allowed EMS Department to prepare for the unknown.
The County has integrated an additional emergency response provider to respond to low acuity calls when ambulances are not available. They will not transport but assess and advise on patient care needs.
Hall Ambulance has experience a “sharp” increase in ambulance calls over the last few months, Corum said, largely due to COVID-19. While the final numbers are not yet in, Corum estimates in December 2020 the agency received nearly 1,000 more calls than it did in December 2019. Corum estimates the agency received 9,700 calls last month.
Kern County is not alone in experiencing ambulance shortages. In Los Angeles, ambulance services have been advised to cut back on their use of oxygen and to not bring patients who have no chance of survival to the hospitals because of the shortage of ambulances and hospitals beds, the LA Times reports. Kern County’s EMS Department has not implemented any new protocols of this nature, according to Corson.
As of Tuesday, there were 416 COVID-19 patients in Kern hospitals — 15 more than the day prior, according to the California Department of Public Health. Of these patients, 86 were in the Intensive Care Unit, leaving 14 ICU beds available.
Kern Public Health confirmed 1,014 new COVID-19 cases Wednesday, bringing the total to 73,892 cases, and three new COVID-19 deaths, bringing the total to 521.