Unique Tweak To San Bernardino EMS
Hospitals in San Bernardino County are encountering such capacity issues that ambulance crews are now able to hand off patients to the care of other paramedics waiting at hospital loading bays prior to their admission.
The change in policy, implemented Jan. 13, makes San Bernardino County the only California county that allows paramedics to hand off patients before they're wheeled into the hospital, according to Tom Lynch, emergency medical services administrator for the Inland Counties Emergency Medical Agency.
According to data compiled by ICEMA, the number of hours patients waited to be handed off to hospital care increased by 50% last year, to more than 15,000. That works out to an average delay of about 25 minutes.
Lynch and other ICEMA officials said a recent increase in the number of patients with flu-like symptoms and other factors have been putting stress on the county's emergency rooms. Countywide, about 25% of all 911 calls are not answered by paramedic teams within 10 minutes. County regulations prohibit hospitals from diverting ambulances to other ERs when theirs reaches capacity.
Although Lynch said that paramedics have been trained to monitor multiple patients at once, they rarely do so unless there has been a disaster or other incident that creates multiple injuries.
It was also stressed that the policy change is not permanent. It is in place until Feb. 28, at which point ICEMA may rescind the new policy or keep it in place for another fixed period of time.
“This is an interim fix to address the dramatic increase in patient volume currently being experienced in the local emergency rooms. It is not intended as a solution to the overall problem of holdovers,” said Jason Sorrick, a spokesperson for American Medical Response. The Colorado-based AMR operates about 70 ambulances in San Bernardino County under a contract with the county's public health agency.
There are also caveats for the new policy: Ambulance crews may only monitor multiple patients if they're stable and require no new medications or treatments. The crews also have the option of not monitoring multiple patients if they feel it will be a threat to their safety.
Nevertheless, the change has left the provider community unhappy, claiming that it is being done for the benefit of ambulance companies, which get paid for each patient they transport. Freeing up more vehicles in theory would provide them more patient volume.
“I foresee problems with this,” said Jennifer Bayer, spokesperson for the Hospital Association of California. Bayer noted that this could create new liability issues for providers.
"This policy puts profits for ambulance companies ahead of risk to patients,” said Jim Lott, executive vice president of external affairs for Cope Health Solutions, a Los Angeles firm that focuses on clinical integration for hospitals.
Sorrick suggested that the issue could be addressed by expanding ER capacity at hospitals in the county, a solution hospital officials say is complex and extremely expensive.
“It's definitely a band-aid cure,” Bayer said.
