Transporting COVID-19 patients long distances to regional city hospitals...

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Marcus Aurelius
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5:20p, 5/20/20
AG
I am curious to others opinions re this because it is happening here. A nearby city with approximately 6 hospitals is having a late surge in COVID-19 and they claim to have one ICU bed left. Their plan announced by their mayor today is to refer new cases to my city area hospitals. A 2 hr ambulance ride. Our volume has been constant. However, our ICUs are full now after elective cases and other diseases have rolled in finally. Our COVID-19 unit is full. We were empty for weeks in the lock down stage.

Correct me if I'm wrong but hasn't the precedent been in other cities like NY and NOLA to have been prepared with make-shift hospitals in convention centers, etc? Or were they shipping out patients in ambulances? How about federal assistance? Also seems like major exposure risk to EMS crew.
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GE
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7:22p, 5/20/20
AG
Not qualified to offer an opinion on this but will anyway. If the numbers overall are expected to be low enough seems it would be more economical to use nearby facilities rather than building new or makeshift ones. Obviously in a city like NYC that is impossible
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fightingfarmer09
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In reply to Marcus Aurelius • 7:26p, 5/20/20
I don't see the big deal. Where I live, if I need anything remotely invasive I'm going to have a 60-90min ambulance ride to the nearest major city.

Much of the country is this way.
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Marcus Aurelius
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In reply to fightingfarmer09 • 7:39p, 5/20/20
AG
This (overrun city) is a major metro city. Not a rural hospital situation. 6 hospitals. Numerous ICUs. Full array of specialists.
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Marcus Aurelius
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7:59p, 5/20/20
AG
Anyway. Feel for these patients. I believe we can take some of them. I don't know what best answer is. Just frustrating on my end to be seeing some stability in my community. If not some hope for this dissipating. Yet now facing the possible burden of another large population. For reference population : they 400K +, we 1 million or so.
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JB!98
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In reply to Marcus Aurelius • 8:03p, 5/20/20
AG
Marcus Aurelius said:
Anyway. Feel for these patients. I believe we can take some of them. I don't know what best answer is. Just frustrating on my end to be seeing some stability in my community. If not some hope for this dissipating. Yet now facing the possible burden of another large population.
We live outside of San Antonio. My wife and I have a pact that if something major ever happens, load me in the back of the truck and take me to SA. I think our county hospital still utilizes leeches and other methods for common ailments.

12 years ago when my son was born, I broke land speed records getting her to NC Baptist. Thought I was going to have to deliver him myself at a couple of points. Only took 12 more hours once we got there!
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Fitch
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8:07p, 5/20/20
AG
In Houston there was an overflow hospital constructed with FEMA reimbursing 75% of the cost. Didn't see a patient, thankfully.
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Not a Bot
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8:16p, 5/20/20
AG
One of the things that bugs me the most is how many people are still staying in ICU for for so long. Would have thought we'd be getting them out sooner by now after we figured some things out. Hang in there.
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eric76
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In reply to fightingfarmer09 • 8:22p, 5/20/20
AG
fightingfarmer09 said:
I don't see the big deal. Where I live, if I need anything remotely invasive I'm going to have a 60-90min ambulance ride to the nearest major city.

Much of the country is this way.
Around here, they were sending so many by ambulance that a number of the emt's got tired of it and quit.

As I understand it now, they usually use a medivac helicopter instead.
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Duncan Idaho
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8:50p, 5/20/20
I am in your metro area and I just saw a local news segment with SV hospital encouraging people to come into the ER when they needed and not to worry about getting covid. The finished off by saying they have plenty of capacity and not to worry because it was nothing like NYC was.




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Marcus Aurelius
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In reply to Duncan Idaho • 8:57p, 5/20/20
AG
That's good. Because we are full. Expect them to go mainly to downtown..............
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ham98
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10:12p, 5/20/20


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gomerschlep
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In reply to Marcus Aurelius • 8:17p, 5/21/20
AG
I'm a Flight Paramedic (in North TX for reference).

We have been flying COVID positive patents from small rural hospitals this whole time. Transporting these patients is an infection control nightmare for a number of reasons. I have tried to argue that they all be going b y ground however have been met with resistance from our administration (shocker).

The issue is that most ground services in our area are not trained or equipped for critical care or ventilator management, and many counties West of us typically only have a few ambulances to service the entire county at any specific times, and their management won't let them go on 5 hour round trips to come to DFW. If the patient is intubated they will be flown more than likely.

I read a great article about a massive transport operation that took a ridiculous number of patients out of NYC in one night bye air and ground. They called it "NYC's Dunkirk Moment"
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Marcus Aurelius
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In reply to gomerschlep • 8:28p, 5/21/20
AG
Thx for what you do. But to clarify - this is a metro of 400K people. State capital. Not a rural city.
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chris1515
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8:30p, 5/21/20
AG
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
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eric76
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In reply to chris1515 • 8:33p, 5/21/20
AG
chris1515 said:
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
I think that the first covid-19 death in Texas County, Oklahoma had an address in Texhoma but was actually living in Oklahoma City and hadn't actually been in Texhoma for a while.
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Duncan Idaho
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8:39p, 5/21/20
Spain Park had their graduation this past weekend. They distanced during the ceremony but it was "back to normal" right after it was over.

I fear the "late surge" in your OP may be an "leading edge"
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Marcus Aurelius
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In reply to Duncan Idaho • 8:41p, 5/21/20
AG
Yeah MB is having it in the football stadium spaced.
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gomerschlep
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In reply to Marcus Aurelius • 9:18p, 5/21/20
AG
Understood, just wanted to offer a little insight into what EMS looks like at the current time.
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gomerschlep
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In reply to chris1515 • 9:20p, 5/21/20
AG
chris1515 said:
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
From what I understand, it is counted in the county where the patient originates, however I could be wrong about that.
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Marcus Aurelius
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2:08a, 5/22/20
AG
https://www.cnn.com/2020/05/21/us/montgomery-alabama-icu-bed-shortage/index.html
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KlinkerAg11
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In reply to Marcus Aurelius • 6:19a, 5/22/20
AG
Is this a perfect storm of normal icu load and a nursing home outbreak?
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BiochemAg97
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In reply to chris1515 • 7:27a, 5/22/20
AG
chris1515 said:
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
I know in central Texas most/all COVID patients are being consolidated into Travis county hospitals. I found it odd one day when the news reported the number of hospitalized patients in a 4 county area without breaking out by county and I started looking into it.

Travis County was reporting all hospitalization in TC hospitals on their dashboard. Williamson County was reporting for all cases that originated in WilCo. Not sure is TC would be reporting deaths that occurred in the hospital from a transferred patient, but I would suspect yes. There is certainly a possibility of double counting if you add up from all the counties. However, I doubt the state dept is double counting deaths by adding the two counties together as their process wouldn't be see what various counties report on their website.
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ETFan
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In reply to gomerschlep • 9:57a, 5/22/20
gomerschlep said:
I'm a Flight Paramedic (in North TX for reference).

We have been flying COVID positive patents from small rural hospitals this whole time. Transporting these patients is an infection control nightmare for a number of reasons. I have tried to argue that they all be going b y ground however have been met with resistance from our administration (shocker).

The issue is that most ground services in our area are not trained or equipped for critical care or ventilator management, and many counties West of us typically only have a few ambulances to service the entire county at any specific times, and their management won't let them go on 5 hour round trips to come to DFW. If the patient is intubated they will be flown more than likely.

I read a great article about a massive transport operation that took a ridiculous number of patients out of NYC in one night bye air and ground. They called it "NYC's Dunkirk Moment"


I don't see this process slowing down any time soon. Just to the East of DFW where I work we have 7 vents, 10 ICU beds for a county of 80k. We can send some even further East to Smith. Like you said, it would be a 4 hour+ trip for us to send by ground to dfw.
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Rachel 98
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In reply to BiochemAg97 • 11:39a, 5/22/20
AG
BiochemAg97 said:
chris1515 said:
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
I know in central Texas most/all COVID patients are being consolidated into Travis county hospitals. I found it odd one day when the news reported the number of hospitalized patients in a 4 county area without breaking out by county and I started looking into it.

Travis County was reporting all hospitalization in TC hospitals on their dashboard. Williamson County was reporting for all cases that originated in WilCo. Not sure is TC would be reporting deaths that occurred in the hospital from a transferred patient, but I would suspect yes. There is certainly a possibility of double counting if you add up from all the counties. However, I doubt the state dept is double counting deaths by adding the two counties together as their process wouldn't be see what various counties report on their website.


Do you know which counties are sending to Travis? Maybe Bastrop and Hays? I assume that Williamson is keeping their own but I might be wrong.
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plain_o_llama
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In reply to gomerschlep • 1:08p, 5/22/20
Here is an account of people being Med-evac from New York City at the first of April
https://world.wng.org/2020/04/new_york_s_dunkirk_moment

What is different in the New York case is the big city was overrun and sending them out to the less
burdened burbs and small towns. Marcus is seeing flow in the other direction.

What we want to do over the Summer might be different from the Fall/Winter. I hope people are thinking and planning about all this.

<Edit> I got the above wrong. What Marcus is describing is flow from bigger to smaller just like NYC. mea culpas on reading comprehension
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ramblin_ag02
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In reply to gomerschlep • 1:13p, 5/22/20
AG
gomerschlep said:
I'm a Flight Paramedic (in North TX for reference).

We have been flying COVID positive patents from small rural hospitals this whole time. Transporting these patients is an infection control nightmare for a number of reasons. I have tried to argue that they all be going b y ground however have been met with resistance from our administration (shocker).

The issue is that most ground services in our area are not trained or equipped for critical care or ventilator management, and many counties West of us typically only have a few ambulances to service the entire county at any specific times, and their management won't let them go on 5 hour round trips to come to DFW. If the patient is intubated they will be flown more than likely.

I read a great article about a massive transport operation that took a ridiculous number of patients out of NYC in one night bye air and ground. They called it "NYC's Dunkirk Moment"


You must service our county! We have at best 3 ambulances to cover 920 sq miles, and 911 is their first priority over transfers. We end up playing with the helicopter crews a lot
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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BiochemAg97
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In reply to Rachel 98 • 1:31p, 5/22/20
AG
Rachel 98 said:
BiochemAg97 said:
chris1515 said:
For transports like this, what county would report the patient in their numbers? Especially if they pass away?

Could Dallas be overstated because 10 different counties are sending their worst cases to Parkland (or something like that)?
I know in central Texas most/all COVID patients are being consolidated into Travis county hospitals. I found it odd one day when the news reported the number of hospitalized patients in a 4 county area without breaking out by county and I started looking into it.

Travis County was reporting all hospitalization in TC hospitals on their dashboard. Williamson County was reporting for all cases that originated in WilCo. Not sure is TC would be reporting deaths that occurred in the hospital from a transferred patient, but I would suspect yes. There is certainly a possibility of double counting if you add up from all the counties. However, I doubt the state dept is double counting deaths by adding the two counties together as their process wouldn't be see what various counties report on their website.


Do you know which counties are sending to Travis? Maybe Bastrop and Hays? I assume that Williamson is keeping their own but I might be wrong.


IIRC the four counties mentioned by the news were Travis Bastrop, Hay and Williamson. I'm not sure if Williamson is transferring to travis, but when I noticed this a week or so ago, the numbers reported for the 4 county area were the same as the travis county dashboard. WilCo only listed ever hospitalized so it is possible WilCo didn't have any at that moment.
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gomerschlep
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In reply to ramblin_ag02 • 11:38a, 5/23/20
AG
I probably do.
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Sq 17
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8:19p, 5/23/20
back to op's point , having to take another urban areas patients after weathering your peak is not ideal. I am not certain but i am pretty sure the patients are crossing state lines and I doubt the receiving ERs are excited about more very expensive to treat patients rolling in from one state over
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