This afternoon, the Rochester New York area experienced a foreshadowing of what medical care might be like during a pandemic. It wasn’t pretty.
Rochester and Monroe County are in the grips of influenza. The local hospitals are overflowing with folks complaining of cough, fatigue, aches and pains and for many elderly, confusion and disorientation.
As the demand builds at each hospital’s emergency department, they go from “green” to “yellow” to “red”. By law they cannot refuse a patient, and even when red the patients keep coming.
Ambulance crews had their usual wait times grow, and grow again, until some crews were waiting at triage for four hours. Each crew waiting at the hospital meant that an ambulance was not available to take another call.
About 2:30 pm I was called in to the East Rochester Ambulance base by our captain. At the time of the call, ER had the only staffed ambulance on the east side of Monroe County, with over a dozen ambulances from volunteer agencies tied up on calls and no ambulances available from either commercial ambulance service.
Shortly after my arrival, I was dispatched by the county, with my driver, to Penfield Ambulance to cover their district and that of West Webster. All four of the ambulances that would normally cover those two areas were tied up.
We were finally released about 6 pm, as ambulances came back into service from the hospitals. It had been slightly busier than normal today and that added patient load would normally have been covered by mutual aid from corps not overloaded and the two commercial agencies. Between the crowds at the hospitals and the busier call volume, EMS services became very scarce for about three hours.
People expect that if they don’t feel well, they will be able to go to the hospital, by ambulance. On a day like today, it is easy to see how this expectation will affect medical care when a real crunch, a pandemic, happens.
What would the next step have been? The logjam was the emergency departments. How can they assess and treat patients faster? Having done this for a dozen years, I could sympathize with a desire to tell many of the patients to go home and come back when they’re sicker. Feeling lousy isn’t fatal, nor is a runny nose or a cough or a cut finger or feeling depressed.
The emergency departments locally are new or nearly new. And the demand has already outgrown the supply. Patients wait, sometimes for a day, to get admitted to a real hospital bed from the E/D.
Quasi governmental agencies determine the number of in-patient beds, and E/D beds, and they keep closing hospitals and removing beds in an effort to keep health care costs down. Since they also control the revenue streams for the hospitals, it’s a real mess. Demand is always greater than supply. The hospital must stay open, without staff or beds for all its patients and it cannot add either without a long fight with an unelected governmental agency or agencies.
For three hours today, if you lived in the wealthiest suburbs of Rochester, your emergency care was dependent upon the fates and whatever ambulance within twenty miles was available. If you got to a hospital, you would have waited hours before being seen by a doctor.
And this was just a taste of things to come.