Chester Gap chief: “It’s bad. People don’t realize how bad. We’re fighting it tooth and nail right now.”
In December, a crew from the Sperryville Volunteer Rescue Squad responded to a call. They picked up a patient and headed for Fauquier Hospital.
There, they waited to transfer care of the woman, but the Emergency Department’s staff was clearly overwhelmed. After 40 minutes, the EMTs, knowing that their patient was not an emergency, made a call to Culpeper Medical Center. There wouldn’t be a wait, they were told, so they drove the 28 miles there instead.
On Jan. 4, the day after the snowstorm that shut down I-95, most of the hospitals in the region made “divert” requests to rescue companies, meaning that EMTs should consider taking patients to one of the very few emergency departments not stretched beyond capacity at the time.
In fact, Wayne Perry, regional director of the Rappahannock Emergency Medical Services (REMS) Council in Fredericksburg, sent a notice to Emergency Management Services (EMS) agencies, alerting them to the gravity of the situation and recommended having “frank conversations” with patients and their families.
“If, after a comprehensive patient assessment, the lead clinician at the scene determines that the patient does not have an acute life-threatening condition, then transport to the closest emergency department should not be the primary disposition,” he wrote.
“A patient with a two-week history of constipation,” Perry added, “would not need to be seen in the emergency department in the middle of the night and could likely follow up with their primary care physician in the morning.”
COVID’s impact
The nasty weather and resulting power outages elevated demand for emergency care, but the biggest factor was the surge in COVID-19 cases, both in terms of rapidly-rising Emergency Department caseloads and shrinking numbers of available staff.
“We’re doing a whole lot more transporting to the hospital lately. Probably every other call has been COVID,” said Todd Brown, chief of the Chester Gap Volunteer Fire and Rescue Department. “We’ve taken cases to the hospital and had to wait 45 minutes to get the person off the cot. That’s at Warren Memorial, at Fauquier Hospital. They’re that busy.”
“It’s bad. People don’t realize how bad. We’re fighting it tooth and nail right now.”
That’s become a common experience. Lt. Serena Imel, of Culpeper Emergency Services, noted that on the day after the storm, her company made a record 45 calls in 24 hours. Ordinarily, she said, a “very busy” day has 25 calls.
“It was crazy,” she said. “We had to call in additional staff.”
But even before the big snow, Imel said area emergency departments were already jammed. Some days as many as half the runs her company made involved known or suspected COVID-19 cases. The storm just exacerbated strains, a troubling ripple effect that could reoccur in the remaining two months of winter.
“You had people who were in their home, and they were sick and felt awful, and they didn’t have power,” she said. “So they called for help.” Imel said she’s also heard people say they were going to emergency rooms simply to get tested for COVID-19 because they didn’t want to pay the out-of-pocket costs for a test. That adds to the ER crowds, which stretches delays for rescue crews and their patients.
A ‘crapshoot’
One rescue company chief described trips to emergency departments as something of a “crapshoot” these days. EMTs are not really sure how quickly they’ll be able to sign over a patient to the hospital staff. Sometimes there’s not much of a wait. Chief Bobby Smoot, of Washington Volunteer Fire and Rescue, said crews from his station have experienced few delays, although on Jan. 4, one had to transport a patient to Page Memorial Hospital in Luray because the closer hospitals had requested diverts.
Other EMTs haven’t been as lucky. Chief Todd Summers, of the Sperryville Volunteer Rescue Squad, said a crew had to wait with their non-emergency patient in the vestibule outside an ER for 40 minutes.
“We’re trying to come to grips with something we’ve never faced before,” he said, “which is showing up at a hospital and having a long wait. That’s obviously not good for the patient. But it also means our team could be out of pocket for as long as two hours.”
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Chief J.D. Carter, of Amissville Volunteer Fire and Rescue, had a similar experience last week. “It was 20 minutes to get into the room,” he said. “Then another 25 minutes before a nurse showed up. Until they take charge of the patient, we can’t leave.”
While true emergencies are prioritized, less acute cases brought in by EMTs have to wait with everyone else. “I tell people that just because you came in an ambulance doesn’t mean you’re going to get in a bed right away,” said Carter.
Emergencies only
Part of the challenge facing hospitals is not just a spike in actual COVID-19 cases, but also an uptick in visits from people who worry they might have the virus.
“The emergency department is for emergencies,” said Jennifer Coello, administrator of Warren Memorial Hospital in Front Royal. “If you have virus symptoms, especially with complicating medical conditions, it is best to err on the side of caution and not wait to be seen. But if you have mild symptoms or just want a test, please don’t come to the ED.”
With 18 beds available, the Warren Memorial emergency department has been averaging 72 patients a day since the beginning of the year. Some days the total gets as high as 90.
Fauquier Hospital has been dealing with a big jump in COVID-19 cases in the surrounding county since Christmas. More than 100 cases are being reported most days, with the number spiking to 238 on Jan. 8. Hospitalizations have also climbed, with five or more occurring on four days since Dec. 31. On the last day of 2021 alone, 11 county residents were hospitalized with COVID-19, according to the Virginia Department of Health. . Nine more were hospitalized on January 19.
It’s a similar story in Culpeper County. Since the beginning of the year, ED visits at Culpeper Memorial have been running 50 to 80 percent above average. On eight days since December 29, more than 100 new cases have been reported, with a bounce up to 242 cases on January 8. Since the beginning of the year, there have been 10 COVID hospitalizations in Culpeper.
But the statistics tell only part of the story. “I feel bad for all my nursing and doctor and tech friends in the hospital,” Imel said. “We’ve never seen them this overwhelmed. We’ve never seen them this distressed. They’re doing their best and trying to keep a smile on their faces.”
“And we know that us bringing all these patients in is just making their situation worse,” she added. “But we don’t have a choice.”
Imel, who is fully vaccinated, now has tested positive for COVID-19.
By Randy Rieland — For Foothills Forum
