Saturday, July 22, 2017

[San Bernardino County] Grand Jury focuses on improving ambulance availability in the High Desert

SAN BERNARDINO >> To improve ambulance availability in the High Desert, a public education plan, enhanced 911 screenings and better coordination between ambulance service providers were among the recommendations in a report by the San Bernardino County grand jury.
The report, called “High Desert Ambulance Availability and Bed Delay,” highlights a statewide, national and international issue which centers on the length of time it takes an ambulance crew to release its patient to hospital emergency room staff.
“The ability of a community to maintain a viable EMS (Emergency Medical System) is related to solving this problem,” said Dr. Howard Backer, director of the California Emergency Medical Services Authority, after reading the San Bernardino County grand jury report.
California is in the process of collecting the information to develop a statewide picture of how widespread the problem is, Backer said.
For 2016, the grand jury report said there were 11,695 hours of Ambulance Patient Off-load Delays at the three High Desert hospitals in San Bernardino County which operate emergency departments.
This total is in addition to a 25-minute grace period for each ambulance patient delivery — a wait time when ambulance vehicles and their crews are in a holding pattern with the clock not running.
The grand jury report found that contributing factors in the data were:
• An increase in the number of newly insured patients as a result of the Affordable Care Act, placing higher demands on an already strained, overcrowded emergency department.
• A disproportionately low number of local primary and specialty care physicians.
• An aging population with additional medical needs and the evolving role of EMS in health care systems.
B.J. Bartleson, vice president of nursing and clinical services for the California Hospital Association, said that a large number of High Desert residents received medical insurance under Obamacare, but they can’t get to see doctors on a timely basis, if at all.
So they show up at hospital emergency rooms, which by law must see them, she said.
In November 2015, the Inland Counties Emergency Medical Agency, which oversees ambulance services in Inyo, Mono and San Bernardino developed a plan, at the request of the Hospital Association of Southern California, said Tom Lynch, the agency’s EMS Director.
The grand jury report recommended implementation of that plan, called the Centralized Medical Control Proposal.
Among other proposals, the plan called for creation of enhanced 911 call screening, designed to identify patients who do not require EMS response or an emergency department to care for their medical complaint.
• Development and implementation of an ongoing public education strategies to address appropriate use of the EMS system.
Those two proposals were separately listed in the grand jury’s recommendations.
The ICEMA report also recommended development of protocols to guide transportation of patients with behavioral health conditions to appropriate health care settings.
Backer said the dangerous part of this problem is that because of hospital bed availability or staffing issues, emergency service equipment and crews are tied up and not available to accept other calls.
To help alleviate this problem, the San Bernardino County Fire Department created an ambulance operation staffed by paramedics and emergency medical technicians who were not also trained firefighters.
That way, firefighting equipment and their crews were not kept out of service waiting to deliver a patient to the hospital, said Tracey Martinez, a department spokeswoman.
The problem of long waits for patient deliveries at hospitals “has been going on for a long time and getting progressively worse,” Martinez said.
American Medical Response said its San Bernardino County operations experience the highest level of delays of its California operations.
“Due to the lack of a trauma center in the High Desert, patients suffering from traumatic injury must be transported outside the area, which places additional strains on our staffing in AMR’s High Desert operations,” said spokesman Jason Sorrick.
To address High Desert issues, including time delays for off-loading ambulances, “AMR is paying to put our own EMTs through paramedic school, flying in personnel from other parts of the state to run calls, offering $10,000 signing bonuses and increasing compensation,” Sorrick said.
The grand jury recommended the creation of a new San Bernardino County Hospital in the High Desert similar to Arrowhead Regional Medical Center in Colton, which includes a trauma center.
Asked for a response to the grand jury report, Lynch said that “the report is being evaluated and a recommendation on the response will be developed for review and approval by the board of supervisors.”
Jennifer Bayer, vice president for external affairs for the Hospital Association of Southern California, said her organization is “pleased the grand jury is illuminating this issue.”
July 7, 2017
San Bernardino County Sun
By Jim Steinberg

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