As hospitals become overcrowded, nursing staff spend more time transferring patients and reducing emergencies
Gunnison, Colorado-The night after Thanksgiving, a small ambulance covering a large area of ??southwestern Colorado received a call saying that a patient needed to be urgently transferred from Gunnison’s hospital to an intensive care unit 65 miles away. Of the larger hospital. Montrose.
The patient is a 78-year-old man with atrial fibrillation. Irregular heartbeat, usually not life-threateningBut for patients like this with chronic diseases, heart problems and a history of hypertension, this condition may lead to stroke or heart failure.
Workers come from Gunnison Valley Health Care Workers Roll the patient lying on the gurney out of the hospital and into the cold night air. Annie Grace Haddorff, an emergency medical technician on call, helped lift the patient into the ambulance and jump into the driver’s seat. The paramedic Alex Newby went to the back and hung the patient on the blood pressure cuff; a pulse oximeter, used to measure heart rate and blood oxygen saturation; and an electrocardiogram that records the electrical activity of the heart.
“Your heart is obviously angry,” Newby told the man when the electrocardiogram confirmed atrial fibrillation.
The ambulance drove onto U.S. Highway 50, a 1-hour and 15-minute drive, passing the rolling sagebrush hills, the vast Lantai Reservoir, and the wide Black Canyon of Gunnison and its rugged spires among the houses.
The patient is stable enough for long-distance driving, which covers only a small part of the 4,400 square mile service area of ??GVH caregivers. It is more than twice the area of ??Delaware and is the largest ambulance service response area in Colorado. The typical fire or emergency medical service response area ranges from 100 to 400 square miles.
In recent years, inter-facility transportation or transfers like this, also known as IFT, have become more common for GVH caregivers, forcing teams to stay away from already vast areas. Before the pandemic, as the Gunnison County population grew steadily, more and more tourists were attracted to places such as the popular Crest Butte ski resort, so the number of referrals increased, and GVH caregivers It has expanded its services to large urban hospitals outside of Gunnison County.
But now the team is required to move patients more frequently and farther distances because the hospital beds in the relatively close cities of Montrose and Grand Junction are crowded with COVID-19 patients. The team often needs to send patients to Denver, about 3 hours and 40 minutes from Gunnison.
Officials in the ambulance service department are concerned that they may find themselves unable to respond to an emergency because their resources (including six ambulances, but only enough staff to operate three of them) are occupied by long-term transfers.
The Montrose trip, which once took 2.5 or 3 hours, is now longer. “It requires the resources of this community,” said CJ Malcolm, director of emergency services. “We did this before COVID, but now the state is so affected, it’s like a daily part of our lives.”
Before the pandemic, all ambulances called 911 or IFT at the same time less than 10 times a year. Now, Malcolm says, it is happening at a higher frequency. In these cases, GVH caregivers will rely on the emergency response team in Crested Butte, about 28 miles from Gunnison, or the response to the patient will be delayed.
According to data collected by the team, in 2018, GVH paramedics performed 166 IFTs, requiring nearly 40,000 miles of travel and a total of 987 hours of ambulance operations. Last year, 260 IFTs, more than 70,000 miles of travel and 1,486 hours of ambulance operations were completed. This means that the time on the road has increased by 50%.
Malcolm said: “Whenever we have one or two ambulances on IFT, there will be a large piece of land left and only one ambulance can respond.” “When we can easily dial two or three 911 in a row. This is a moderately horrible location when calling.”
For example, in August, Gunnison Valley Health Hospital transferred more than 60 patients, 37 of whom were transported by GVH caregivers. Malcolm said this meant that at least once a day that month, the staff of the GVH nursing staff took a patient out of the city. If the crew does not arrange to return to Gunnison before 1 am, they must stay overnight in the hotel to avoid driving along the sinister mountain roads when they are exhausted.
The service area of ??GVH nursing staff covers almost all areas of Gunnison County, most of Saguatche County, and parts of Montrose County and Hinsdale County. It contains mountains, canyons and vast highland deserts. With approximately 6,600 full-time residents and a university, Gunnison is the largest town served by the team. The surrounding towns—including Tin Cup, Pitkin, and Ohio City—are villages or former mining towns with hundreds of people, and there are more artifacts than residents during the boom.
The 21 full-time staff of GVH paramedics and 10 to 20 on-demand staff have certifications in wasteland firefighting and field medicine skills, including rapid water, ice and avalanche rescue. In response to the increased demand from IFT, they have added a staff member to each shift and are calling out staff to help.
As the pandemic continues, the number of IFTs may continue to increase.By mid-November, the number of people infected with COVID-19 in Colorado hospitals was Amazingly high, Which is close to the peak of 1,847 in December 2020. By the end of the month, the number of inpatients remained above 1,500. As a result, as of November 30, 93% of emergency beds and 94% of intensive care beds in the state were in use. Colorado Department of Public Health and Environment.
“I don’t think we will see concerns about capacity anytime soon,” said Caravelci, senior director of communications for the Colorado Hospital Association.
Welch said that due to the pandemic and other respiratory viruses (such as respiratory syncytial virus) spreading in the state, the time people spend seeking care has increased.
Kelly Thompson, the director of operations at CareFlight of the Rockies, agreed with this assessment, an air ambulance service that operates in Colorado and other parts of the west. Thompson said: “We have transported a large number of children with RSV, and on top of all this there is COVID.” “This is a big problem. This is when we have a lot of patients.”
In early November, in response to escalating concerns about hospital capacity, Colorado hospitals and health system Activate layer 3 of the state patient transport system -The highest level. This means that COVID and non-COVID patients can move from hospitals with insufficient capacity to hospitals with more space without their consent. Hospitals can also send more severely ill patients to medical centers that provide more professional care.
On the recent holiday weekend, when the GVH paramedic staff approached Montrose with their patients, Newby called the hospital to let the staff know that they had arrived. They stopped at the door of the emergency room, and Newby and Hadolph pushed the patient into the ward. Staff at Montrose Hospital took over and transferred the patient from the gurney to the bed. Newby updated the patient’s medical record.
Soon, they got into the ambulance, ready to go home. “IFT can be stressful,” said Hadolph, driving on winding mountain roads bathed in moonlight.