Fresno, Valley counties reimpose COVID limits on ambulance rides for non-emergency patients
Just three weeks after relaxing a policy calling for ambulance crews in Fresno, Kings, Madera and Tulare counties to deny rides to hospitals for patients who were experiencing life-threatening emergencies, local health officials reimposed those limitations again this week.
Dan Lynch, emergency medical services director for Fresno County, said the “assess-and-refer” policy took effect again on Wednesday, after hospitals across the Valley reported that their emergency rooms were flooded with patients, including a continuing influx of people coming in with COVID-19.
The measure calls for ambulance crews responding to a call to assess the patient and determine if their case is an actual medical emergency requiring immediate transport to a hospital. If not, the patient is referred to call their regular doctor, visit an urgent-care clinic, or use a “telehealth” service to connect by phone or videoconference with a doctor for a consultation, Lynch said.
This is the third time during the COVID-19 pandemic in the region that the assess-and-refer practice has been put into place because of the burden faced by hospitals from coronavirus patients and those with other illnesses or injuries.
The first occasion was in mid-December, when a winter surge in new coronavirus infections in Fresno County and the Valley created a flood of patients into emergency rooms and an upswing in hospital admissions, including into intensive-care units.
More recently, the policy was in place from Aug. 11 through Oct. 15, as emergency room visits and hospitalizations once again surged across the Valley.
When the policy was eased in mid-October, “we thought we were coming back down” on patient volumes in hospitals, Lynch said. At that time, Fresno County had about 240 COVID-19 patients being treated in hospitals – down from about 400 on some days in August and September when it was implemented.
“Things were coming down, we thought we were going to see some relief … and then we started increasing again,” he added. “We’re seeing the hospital emergency departments overwhelmed; we’re seeing a 26% increase in non-emergency calls or non-urgent requests.”
As of Thursday, hospitals in Fresno County reported 325 inpatient COVID-19 cases, including 62 who are sick enough to require treatment in intensive-care units. Valleywide, there were 606 confirmed coronavirus patients in hospitals, an increase of more than 15% from three weeks ago.
“So it’s time to slow that down,” Lynch said.
When hospital emergency departments are overflowing, they have few, if any, places to put new patients arriving by ambulance. The result is an increase in the time ambulance crews wait to get their patients into the hospital, tying them up longer and increasing the waiting time for people who call for an ambulance.
On Wednesday, Kaweah Health Medical Center in Visalia declared what executives there called a “code triage,” or internal disaster, because of the volume of patients who were backed up in the emergency room waiting for a bed into which they could be admitted. On Wednesday, the hospital reported that it was stuffed with 368 patients and was holding 51 additional patients in the emergency room waiting to be admitted.
“It was kind of the perfect storm,” Kaweah Health CEO Gary Herbst said Thursday. Between the influx of patients and staff who were out sick or in isolation because of COVID-19 exposure, the hospital was overwhelmed.
On Thursday, 109 of the patients filling the Visalia hospital to overflowing were there for COVID-19 infections – the largest number of COVID-19 patients of any hospital in California, Herbst said.
Lynch said the situation is similar at hospitals in Fresno County, even if they don’t use a formal term like “code triage” or “internal disaster.”
“The local hospitals have been working in this crisis mode; as we see the rest of the state calming down, we’re trending up,” Lynch said Friday. “All of them are basically operating in disaster mode because of the number of patients they have in their facilities. All of them are at full capacity or even over capacity.”
