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Fire and EMS departments grapple with long ambulance waits at hospitals amid latest covid surge

Paramedic Captain Tom Potter is the hospital disposition officer for Montgomery County Fire and Rescue where part of his job is to direct ambulances to hospitals. (Marvin Joseph/The Washington Post)
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The latest surge in coronavirus cases throughout the Washington region has fire and emergency medical service departments wrestling with a tangle of challenges including delays in returning ambulances back to service after hospital drop-offs and shifting staff needs as employees call in sick with covid-19.

Many are experiencing longer hospital drop times, the time it takes from when an ambulance arrives at a hospital to when a unit goes back onto the street, with some backed up for hours at a time before they’re available again to answer other calls. Hospitals say they are facing staffing challenges and a high demand in emergency departments, which are keeping patients in ambulances waiting longer before they can be transferred into a hospital’s care. Though many departments say the latest influx of issues brought on by the rapidly spreading omicron variant has not reduced service or lengthened response times, an increased volume of calls, coronavirus infections among staff and the extended hospital drop-offs have forced many departments to make adjustments.

“These are extraordinary times. We’re in a 20-month response to an event, with the pandemic, that’s stressed our workforce, it’s stressed our health-care system and it’s stressed our community,” D.C. Fire Chief John A. Donnelly Sr. said.

Nearly 17 percent of the department’s employees, or 345 fire and emergency personnel, were out as of Thursday morning because they had tested positive for the coronavirus or were quarantining because of exposure, according to data from D.C. Fire and EMS.

With the current surge of cases, Donnelly said, there have been cases in which staff members have tested positive or become sick during a shift and the department has had to place a unit “out of service.” The chief said there have been no staffing shortages, as others from the department of over 2,000 have been able to fill in, but it does stress the system that has been working in mandatory overtime mode.

They were so careful, for so long. They got covid anyway.

“We are designed to be able to expand and cover for people that are out, that have absences. That’s sort of a byproduct of the four shifts that we work. We always have people in reserve,” Donnelly said.

The department has also had to grapple with an increase in hospital drop times. According to data provided by D.C. fire and EMS, the average transport unit drop time from Dec. 21 to Tuesday was about 75 minutes.

In the nine days, 12 percent of all patient transports were more than two hours, compared with nearly 7 percent of drop times that were greater than or equal to two hours earlier in fiscal year 2021.

The department’s medical director has been working with area hospitals to help units get back on the streets faster, Jennifer Donelan, director of communications at D.C. Fire and EMS, said, adding that while ambulances are used, firetrucks are also fully staffed with EMTs and paramedics when they respond to emergencies. The department also uses an emergency liaison officer to help distribute patients across the city and balance the loads with the conditions of the hospitals, Donnelly said.

Jen Hirt, spokeswoman for the District of Columbia Hospital Association, said it is working with the fire and EMS departments to speed up transfers.

“This includes quickly assessing and moving low acuity ambulatory patients to the waiting room to speed up drop times. Our goal is to work with DC Fire & EMS to reduce [drop times] to 30 minutes,” Hirt said in a statement to The Washington Post. “This will not happen overnight and hospitals and FEMS are committed to collaborating to address this issue.”

In Virginia, the Alexandria Fire Department is also seeing a spike in drop times.

“Typical hospital drop-off time is 30-45 minutes, and it has recently exceeded 2 hours at times. It is still early in our data review to provide statistically significant information. The combination of challenges of our regional hospitals and our staffing impact availability and response times,” Kelly Gilfillen, acting director of communications for the city of Alexandria, said in a statement.

The department is having to make temporary staffing adjustments, including temporarily suspending the approval of new annual leave requests, in response to “steadily increasing” numbers of staff members out because of covid-19, Gilfillen. Currently, 37 employees tested positive and are on leave, she said.

In Montgomery County, the fire and rescue departments released a statement Tuesday announcing service adjustments to address a reduction in staff of about 10 percent, including “adding recently graduated recruits to full shifts, reassigning firefighters and paramedics currently in training to their community service responsibilities, requesting volunteer partners to staff additional peak time transport units and prioritizing Advanced Life Support care delivery and firefighting water delivery across the County.”

“COVID and the Omicron variant is expanding the staffing challenges for the department,” Montgomery County Fire and Rescue Service (MCFRS) Fire Chief Scott E. Goldstein said in an email to staff members Tuesday afternoon.

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MCFRS also reimplemented an EMS disposition officer “to ensure load balancing at the local emergency departments,” the statement said.

Goldstein said in an interview that the department has recently experienced drop times of up to “two to three hours,” compared with what would normally be “30 to 40 minutes.” In some cases, he said, they transport patients to hospitals that are farther away but have more availability, which could contribute to longer drop times but faster care for patients.

Goldstein said there are compounding factors contributing to the stressed system, brought on by the omicron variant.

“The workforce availability, sick members, is spiking. It’s going up as it is throughout all elements of the business community and the work community. The hospitals, because of their staffing problems and covid impacts, are having less ER capacity than they had in the past. Add to that our call volume now in 2021 is far exceeding our call volume that we had at the same time in 2020; daily demand for 911 services is exceeding the 2020 demand,” Goldstein said, “And a group of dedicated folks who are fatigued and need to be doing all things possible to make additional staffing available.”

There has been about a 50 percent decrease in covid-related calls compared with this time last year, but there have been increased calls for incidents such as crashes, Goldstein said.

Prince George’s County fire and EMS department had 9.9 percent of its personnel out as of Thursday, with 105 in quarantine — a number that includes 74 who tested positive for the coronavirus, according to data from the department.

Like the District and Montgomery, Prince George’s departments are also seeing higher drop times, including one unit waiting for eight-and-a-half hours Monday and another unit had a drop time of 8 hours 9 minutes Tuesday night, PGFD Fire Chief Tiffany Green said in a statement Wednesday. The average drop time to transfer patients for PGFD was about 60 minutes on Wednesday. From Oct. 1 to Nov. 30, the average was about 1 hour 10 minutes, according to data from the department.

Patient safety top concern as emergency rooms fill up

“The longer drop times are not due to staffing issues on our end, however, these delays do keep our ambulances from returning to circulation in a timely manner. So far, these longer-than-average drop times have not impacted our service to the community, but PGFD leadership plans to work with our emergency department partners to come up with strategies to prevent more drop times like these from occurring,” Green said.

Reginald Brown, director of the Emergency Department at Luminis Health Doctors Community Medical Center in Prince George’s, said drop times have increased across the region, including at his facility.

“We certainly understand and share the frustration with our EMS partners,” Brown said in an interview Thursday. “We are working hard to mitigate those wait times.”

The hospital instituted a rapid assessment room, where people with relatively mild or low-priority complaints can get treatment quickly and decongest the waiting room, while people who need more intensive care, such as intravenous fluids or blood pressure medication, await care.

The problem is exacerbated by the current covid surge, an increase in people seeking treatment generally and staff out of work because they tested positive and must quarantine, Brown said.

“Those are some of the factors that are at play with these increased drop times,” he said, “It’s widespread not just through our emergency department but D.C., Maryland and Virginia, and I would hazard to guess it’s throughout the nation at this point.”

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