As hospitals fill up, paramedics spend more time moving patients, less for emergencies.

GUNNISON, Colo. – On the night after Thanksgiving, a small ambulance service covering a large swath of southwestern Colorado received a call that a patient needed an urgent transfer from the hospital in Gunnison to a larger hospital with a prescription. intensive care unit 65 miles away in Montrose.

The patient – a 78-year-old man – has atrial fibrillation, Irregular heart rhythms are not usually life-threatening. But for patients like this with chronic health conditions, a history of cardiovascular problems, and high blood pressure, the condition can trigger a stroke or heart failure.

Workers from Gunnison Valley Health Paramedics swept the drunken patient out of the hospital and into the cold night air. AnnieGrace Haddorff, the emergency medical technician on the call, helped get the patient into the ambulance and jump into the driver’s seat. Paramedic Alec Newby came in behind and hooked the patient to the blood pressure cuff; a pulse oximeter, which measures heart rate and blood oxygen saturation; and an electrocardiogram, which records the electrical activity of the heart.

“Your heart is clearly upset,” Newby told the man as the electrocardiogram confirmed atrial fibrillation.

The ambulance pulled up U.S. Highway 50 in an hour and 15 minute drive through clusters of homes among rolling sage hills, the vast Blue Mesa Reservoir, and Gunnison’s Black Canyon, with its spiers Cliff.

The patient was stable enough for the long trip, covering only a small portion of GVH Paramedics’ 4,400 square mile service area. It is more than twice the size of Delaware and is the largest response area for ambulance service in the whole of Colorado. A typical fire or emergency medical services response area is between 100 and 400 square miles.

Each time a patient has to be transported to another medical facility, Gunnison Valley Health Paramedics has fewer vehicles to respond to emergencies in an area more than twice as large as Delaware.(Helen Santoro for KHN)

In recent years, conveyance or transfer of capabilities, also known as IFT, like this has become increasingly common among GVH Paramedics, forcing the team to drive far beyond its already large area. . Before the pandemic, moving house numbers had increased as Gunnison County’s population was steadily growing, more tourists were drawn to places like the popular Crested Butte ski resort and GVH Paramedics. expanded its services to larger metropolitan hospitals outside of Gunnison County.

But now, the team is being called upon to move patients more often and longer distances, because hospital beds in cities relatively close to Montrose and Grand Junction are filled with 19 patients. The team was regularly asked to drive patients to Denver, about 3 hours and 40 minutes from Gunnison.

Officials from the ambulance service worry they may find themselves unable to respond to an emergency because of their resources, which include six ambulances but just enough staff to operate three of the ambulances. that car, tied up in a long-distance transfer.

Trips that used to be two and a half hours to Montrose are now much longer excursions, “and that takes resources from this community,” said CJ Malcolm, head of emergency services. . “We’ve done that before, but now the state of being affected is so great, it’s like an everyday part of our lives.”

Before the pandemic, all ambulances would disembark on 911 or IFT calls less than 10 times a year. It’s happening with greater frequency now, says Malcolm. In those cases, GVH Paramedics relies on the emergency response team at Crested Butte, about 28 miles from Gunnison, or delayed patient response.

In 2018, GVH Paramedics performed 166 IFTs, requiring travel of nearly 40,000 miles and a total of 987 hours of ambulance operation, according to data collected by the team. Last year ended with 260 IFTs, more than 70,000 miles traveled and a total of 1,486 hours of ambulance operation. That’s a 50% increase in time on the road.

“Whenever we have an ambulance or two on the IFT, this leaves a large patch of land with only one ambulance to respond,” said Malcolm. “This is a moderately scary position where we could easily have two or three 911 calls in a row.”

For example, in August, Gunnison Valley Health hospital transferred more than 60 patients, 37 of which were transported by GVH Paramedics. That meant at least once a day that month, a GVH Paramedics crew took a patient out of town, Malcolm said. And if the crew members don’t plan to return to Gunnison before 1 a.m., they must spend the night in a hotel to avoid having to drive along craggy mountain roads while getting too tired.

GVH Paramedics’ service area includes nearly all of Gunnison County, a large portion of Saguache County, and parts of Montrose and Hinsdale counties. It includes mountain ranges, canyons and vast high desert regions. With approximately 6,600 full-time residents and a university, Gunnison is the largest town the team serves. The surrounding towns – including Tin Cup, Pitkin and Ohio City – are villages with a few hundred people or former mining towns where artifacts from the boom era outnumber the inhabitants.

The November 26 drive to Montrose took an hour and 15 minutes for the Gunnison Valley Medical team. (Helen Santoro for KHN)

GVH Paramedics’ 21 full-time employees and 10 to 20 individuals working as needed all have certifications in wilderness and remote medicine skills, including rapid water, ice and avalanche rescue. . In response to the growing requests from IFT, they have added one additional employee to each shift and off-shift staff are being called in to assist.

As the pandemic drags on, the number of IFTs will likely continue to grow. By mid-November, the number of people hospitalized with covid-19 in Colorado was amazingly tall, approaching the December 2020 high of 1,847. Hospitalizations remained above 1,500 through the end of the month. As a result, 93% of the state’s acute care hospital beds and 94% of ICU beds were in use as of November 30, according to data from Colorado Department of Public Health and Environment.

“I don’t think we’re going to see capacity concerns ease any time soon,” said Cara Welch, senior communications director for the Colorado Hospital Association.

It adds stress to those seeking care because the pandemic and other respiratory viruses, such as respiratory syncytial virus, are circulating in the state, Welch said.

Kelly Thompson, chief operations officer for CareFlight of the Rockies, an air ambulance service that operates in Colorado and other parts of the West, agrees with this assessment. “We have transported a large number of sick children with RSV, and you need to be more concerned about this,” Thompson said. “That is a big concern. This is a time when we have a lot of sick people.”

In early November, to manage escalating concerns about hospital capacity, Colorado hospitals and the health system activated tier 3 of the state’s patient referral system – highest level. That means that patients with and without drives can be moved without their consent from a hospital that doesn’t have enough capacity to a hospital with more space. Hospitals can also send more severe patients to medical centers with more specialized care.

When GVH Paramedics crew members approached Montrose with their patients over a recent holiday weekend, Newby phoned the hospital to let staff know they were coming. They pulled up to the emergency room entrance, and Newby and Haddorff ushered the patient into the ward. Montrose hospital staff took over, transferring patients from bed to bed as Newby updated them in the patient’s medical record.

Soon they were back in the ambulance, heading home. Haddorff said: “IFT can be stressful as she navigates the winding mountain road in the moonlight.

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