Ambulances Wait Over 4 Hours to Offload Patients in L.A.

As the first doses of Pfizer’s COVID-19 vaccine arrived in Los Angeles, local hospitals are being inundated with patients testing positive for the illness. Dr. Christina Ghaly, director of L.A. County Health and Human Services, says there were only 370 available hospital beds in county-run hospitals, with just 56 adult ICU beds remaining. 

According to the latest figures released by the state, southern California had just 2.7% of its ICU bed capacity remaining as of Monday. This is only the second time in history that the number of available ICU beds has dipped below 100.

Public health officials and local facilities have since started rationing care and canceling elective procedures to keep up with demand. But these changes come with deadly consequences.

Running Dangerously Low on Resources

Los Angeles County continues to be one of the worst hotspots in the nation. It reported a total of 7,344 new cases on Monday alone, but Public Health Director Barbara Ferrer says these numbers are statistically low due to a lag in reporting from one of the busiest testing centers in the city, which means the county will likely see thousands more cases over the next few days.

Things have changed dramatically over the last few weeks. The state went from being partially open to full lockdown as the number of new cases continues to rise. Between November 1st and December 7th, cases in Los Angeles County increased by 625%.

Hospitals in the area have increased their ICU capacity since the summer peak, but taking on more patients is pushing some facilities to limit. As Dr. Ghaly states, “That durability is not infinite. We cannot maintain this rate of increase. We will physically exhaust ourselves.”

Some ambulances have had to wait over four hours to offload patients at local facilities.

Public Health Director Ferrer says she is aware of the situation and the risks of delaying care. “We are aware that there are certain hospitals in the county where offload time can exceed four hours,” said Ferrer. “That’s why we need the diversion system.”

The Diversion System

Health officials and ambulance companies have started diverting patients away from the busiest hospitals in the country, but that means adding several hours to their commutes.

This past Sunday, on a day of the week when the ER tends to be less busy, 81% of the 911-receiving hospitals in L.A. asked to have advanced-life-support ambulance traffic diverted to other medical facilities due to overcrowded ERs. During a normal year, the average number of calls that get diverted would be between 10-15%, according to Dr. Ghaly.

As the situation grows increasingly dire, nurses and providers across the county have been sharing their experiences online using the website Reddit.

A critical care nurse in L.A. said:

“I’m currently working at a hospital in L.A. County. Our ICU was at capacity over the weekend, so I was holding (taking care of) two patients waiting for ICU beds in the Emergency Department. They both waited over 24 hours. They have shut down PACU and any non-emergent surgery to turn that unit into an overflow ICU.”

She went on to share a devastating story regarding one of her patients:

“We are not a Comprehensive Stroke Center, and do not have a neurosurgeon at our hospital. On Saturday night, I received a woman who had stroke symptoms, imaging of the head showed she was having a hemorrhagic stroke (brain bleed). Our hospital would typically immediately transfer this woman to a comprehensive center that had a neurosurgeon, but all the hospitals from L.A. to Las Vegas who could take her are full.

Took until Monday evening to get her to a hospital that could actually help her. By that time her neurological exam had worsened and she had a midline shift of 6mm (her brain was being compressed and damaged by the pocket of blood stuck in her skull). Her care was delayed because of COVID.”

A paramedic joined the discussion as well, adding:

“Where I live, in the northernmost part of the county, we have 2 hospitals that service about 750,000 people. The offload times off our gurneys are awful. Sunday when I worked, we had crews waiting for 7+ hours. We’ve been trying to transport patients from our small hospitals to other hospitals to make room for patients waiting but supply definitely doesn’t meet demand. There’s talk of opening up the buildings at our fairgrounds that just have cots and some medical staff to help with the overflow. It’s subpar care, but it’s better than nothing I suppose.”

It’s an awful situation that should be avoided at all costs, but until we get the virus under control, public health officials and providers are doing their absolute best. For that, we applaud each and every one of them.