California ER Waits Tying up Ambulances

Long waits at Inland hospital emergency rooms are nothing new to ailing patients.

But now ambulance crews are waiting, too.

Ambulance crews have waited for as long as 5 1/2 hours to transfer patients to the care of Inland emergency-room staffs. Some patients, unable to secure an emergency-room bed, were treated on the ambulance gurney tucked in a hospital hallway, Inland health officials said.

The delays are the result of the region's booming population growth, the slow pace of hospital expansions, and policy changes limiting how often ambulances are sent from hospital to hospital in search of an available emergency-room bed.

Delays became acute in December, when the region was hit hard with influenza and other respiratory ailments.

In Riverside County, ambulances waited a total of about 1,000 hours at hospital emergency rooms, said Michael Osur, who oversees Riverside County's emergency medical services system. That was more than twice as much delay time as in any other month last year. Delays of an hour are not uncommon, said Bruce Barton, Riverside County ambulance operations chief for American Medical Response.

In the San Bernardino Valley region, AMR officials said, crews waited about 1,500 hours to hand off their patients. That's like leaving two ambulances parked outside an emergency room for the entire month of December.

"It is taxing the system," said Renee Colarossi, director of operations for AMR's San Bernardino County office. "It does cause some delays, not only for us but for our first-responder fire agencies."

Such delays can snag several ambulance crews at a time at a given hospital, preventing them from responding promptly to new emergency calls, officials say. So many ambulances were stranded recently at Victorville-area hospitals that San Bernardino County's High Desert area was without a single available ambulance. AMR had to send backups from the San Bernardino Valley.

DISASTER AVOIDED SO FAR

Officials say they are not aware of any deaths resulting from the delays.

But, "the risk is there," said Virginia Hastings, executive director of the Inland Counties Emergency Medical Services Agency, which oversees the emergency medical system in San Bernardino, Inyo and Mono counties.

Josh Lee, an AMR emergency medical technician, once had to stay with a patient for 4 1/2 hours. The emergency room at Arrowhead Regional Medical Center in Colton was jammed and his patient wasn't as ill as others coming in for care.

A delay that long is rare, he said. More common are waits of 20 minutes or so before a patient is handed to hospital staff.

However long the wait, Lee continues monitoring his patient on a gurney in the hallway. Many hospitals will draw blood and begin other diagnostic tests while the patient waits for an emergency-room bed to open.

"It's not like we just stand there on the wall and wait there. Patient care continues. It's just not in the back of the ambulance," he said.

REROUTING DIDN'T WORK

In the past, crowding led emergency rooms to divert incoming ambulances to other hospitals. Surrounding hospitals often got jammed, too. Several years ago, Inland emergency medical officials limited how often hospitals could divert ambulances.

One result: Fewer ambulances were diverted, but they were stuck longer at hospital emergency departments as they added to the congestion. Ambulance crews call the delays "wall time."

"What we've done now is created another monster," said Hastings, the emergency agency executive director.

Critically ill ambulance patients - such as people suffering heart attacks or with life-threatening injuries from an automobile collision - are quickly handed off to hospital staff, Osur said. The ambulance crew will provide the medical and other information they've gleaned to the nurse and sometimes to a physician and help move the patient onto an emergency room bed. Then the crew will write its report, clean the gurney and head back out to be ready for the next call, Osur said. Normally, such a hand-off should be completed within about 20 minutes, he said.