Ambulance image by Camilo Jiminez on unsplash.com

For the fourth time in 18 months, the Central California Emergency Medical Services Agency has implemented its Assess and Refer Policy in efforts to alleviate hospital strain. 

Dan Lynch, EMS director, said the policy is in effect for Fresno, Madera, Tulare and Kings counties. Upon an ambulance arriving to a patient who calls 911, the emergency medical team will assess whether it’s an emergent scenario that requires patient transport to the emergency room. 

According to the Fresno County Department of Public Health and the Central California Emergency Medical Services Agency, emergencies qualify as trouble breathing, persistent pain or pressure in the chest, new confusion, bluish lips or face and inability to wake or stay awake. 

Ambulance providers are being directed to respond to calls, and if the patient meets criteria with non-emergent medical conditions, they will be referred to a nearby urgent care, clinic, telehealth service or private physician.  

“We are really working very, very hard to try to keep people that do not need to be at an emergency department out of the emergency department. It’s very, very important,” Lynch said. 

The Central Valley is experiencing a triple threat, as Lynch described it – increased emergency calls, overwhelmed emergency departments and a skeleton crew at the hospitals. Because the hospitals are full, patients get admitted but have nowhere to stay except in the emergency room beds until other beds open up. In some hospitals, ICU patients are taking up emergency room beds. 

It’s not uncommon for ambulances to wait hours in order to turn over their patients to hospital staff. 

“We see ambulances getting stuck in a hallway of a hospital sometimes up to four hours,” Lynch said. 

“You can’t just drop and go – you actually have to turn over to a team member who’s responsible for the patient’s care,” said Interim Health Officer Dr. Rais Vohra. 

To combat this problem, the state has supported hospitals with special staff – Ambulance Patient Offload Teams. Since hospitals are already worn thin, these supplemental health care workers will help meet that guideline so ambulances can transport more patients. 

Lynch said there are more than 350 Covid-positive patients in the hospitals, which sets the Valley back to similar numbers in September when the Delta variant was rampant. 

“We’re expecting this to get worse before it gets better, and so we’re preparing for that,” Lynch said. 

Lynch said implementing the policy cuts the transport volume by about 20%, or about 60 patients a day. 

“It may not sound like a whole bunch of patients in the grand scheme of things, but it does make a difference,” Lynch said.