What happens when all of Redding's ambulances are busy or stuck at hospitals?

Mike Chapman
Redding Record Searchlight
A Dignity Health mobile intensive care unit leaves Mercy Medical Center in Redding on Wednesday, March 11, 2020. Paramedics, law enforcement personnel and other first responders in the Redding area are considering the potential impact of coronavirus.

On Wednesday afternoon, an emergency services dispatcher in Redding announced the city was at a Level Zero, a code term meaning no ambulances were immediately available for pressing medical calls.

Minutes later, Redding police received an urgent report of a gunshot victim along a city street.

Fortunately, the police call turned out to be a false report and an ambulance crew wasn't needed even if one was free.

Private ambulance crews are finding themselves swept up as more Shasta County residents fall ill to COVID-19 or need to quarantine in greater numbers. Short staffing and other pandemic-related reasons are creating a strain as the medics run from call to call in not only Redding but throughout the western United States.

Ambulance workers have dwindled because some of them are either sick with the virus themselves or have to quarantine because their partner or a family member got sick. Also, there's just fewer medics in the profession because the pandemic stalled their training.

Compounding the burden, paramedics and emergency medical technicians (EMTs) often find themselves sitting idle outside Redding's two major hospitals while they wait for an available bed.

"Currently, ambulances are being held up to three hours before they are released to go back into the system and respond to other emergencies," said Jason Sorrick, a spokesman for American Medical Response (AMR) whose ambulances serve Redding.

American Medical Response spokesman Jason Sorrick

"This contributes significantly to Level Zero events, places fatigue on our EMTs and paramedics, and greatly strains the EMS system," he said.

When a Level Zero alert is announced, it's because all ambulances are either responding to calls or being held at the hospital waiting to unload a patient, Sorrick said.

"Statewide the whole system is stressed," he said.

Sorrick said wait times outside hospitals ebbs and flows. "Some days we'll have higher call volumes than others," he said.

Nonetheless, Sorrick is emphatic about one thing: People should call 911 right away when there's a health emergency.

"We'll get the resources to you to ensure we can make that transport happen however the system is operating and get you the care you need and get you to a hospital," he said. 

Wednesday afternoon in Redding was particularly busy for first responders. Several people called for shortness of breath, a mental health patient needed to be picked up from a county site on Breslauer Way, a veteran needed a transport from a health-care facility and a 28-year-old pregnant woman called for help after feeling contractions and had to pull to the side of Airport Road.

'Every hospital is now impacted'

Sorrick is an AMR spokesman out of Sacramento but since his is a national company, he's able to report what's happening on the entire West Coast.

He said the bed delay was so bad recently at a Fresno hospital that an ambulance crew had to wait 24 hours with a patient. The crew was relieved by others while they stayed with the patient to give them a break.

"Every hospital is now impacted. Every hospital is now short-staffed. That's really what's causing that strain," he said.

An AMR crew would not just drop off a patient at an emergency room.

"We have an ethical obligation to maintain custody of that patient," Sorrick said.

Hospitals sometimes have triage tents for the overload.

Challenges at Mercy Medical Center

Robert Folden, the chief operating officer at Mercy Medical Center in Redding, said during a media briefing Wednesday that his hospital's ambulance operation has not had major staffing difficulties and that it's been able to run the same number of ambulances.

It has four ambulances during the day — sometimes a fifth — and two ambulances at night.

Robert Folden, chief operating officer for Mercy Medical Center, speaks at a COVID-19 press conference on Monday, March 23, 2020.

Folden says having enough staff, though, is more than a local issue.

"There is a national shortage of health care workers, whether it's RNs, respiratory therapists, clinical lab scientists, EMTs or paramedics. All of us across the board are challenged from time to time in one specialty or another," he said.

Pandemic cuts into workforce

Shasta County health officials reported last Wednesday a record number of COVID-19 patients had been admitted to intensive care units at area hospitals. In its latest update, public health said 88 patients were in the hospital because of COVID-19, with 23 of them in ICUs as of last Thursday. Three of the hospitalized patients were under the age of 25, including one who is under age 18. All told, the county had 969 active cases.

Sorrick said it's not entirely COVID patients that are contributing to the ambulances' call volume, but a lack of employees at AMR.

"What's happening is the COVID patients are using the beds at the hospital and then you also combine that with the shortage of staff on both the hospital and on the EMS side, which is the result of the shutdown," he said.

Sorrick said the pandemic and resulting restrictions last year interrupted the pipeline of new hires because classroom time and other training had to be postponed. 

"Paramedic and EMT instruction can't be done remotely. That was shut down for a year," he said.

Paramedics require a higher level of education so they can perform advanced life support procedures such as administer drugs and insert IVs.

While EMTs can administer CPR, glucose, and oxygen, paramedics are qualified to perform the more complex procedures.

"Current employees who could not obtain child care or were just overwhelmed by the workload and risk also moved on," Sorrick said.Many of the potential medics moved on to other careers in order to make a living.

"We live by that pipeline for EMTs and paramedics. It's a feeder into other industries. It feeds into the fire service. It feeds into the nursing service. It feeds into physician assistants." he said.

As a result, AMR took on training of its own EMTs. To keep up, AMR crews are working overtime and taking on additional shifts. Some areas are running on 24-hour shifts.

When ambulances are backed up, Sorrick said a medic supervisor may be able to respond in a quick-response vehicle. A medical flight is also an option with severe medical calls.

"If we have to, we could load them up onto a helicopter if they're that acute in that type of situation, we could find a location for them to go," Sorrick said.

Behind the scenes

There are fewer AMR ambulance workers because they've been hit with the virus themselves or need to quarantine after being in contact with sick co-workers or family members.

"It just starts to snowball on you," Sorrick said.

Sorrick said his medics are helping out in hospitals where they can.

"As hospitals are short-staffed, they are using our crews to meet the needs of patients while at the hospital," he said.

Folden said with the sheer volume of cases coming through his emergency room, patients sometimes need to be put in an open corridor at the ER.

"When an ambulance arrives and they have a patient and I don't have a bed for that patient and they're not one of the most critical, unfortunately that EMS crew has to stay with that patient to make sure that they have an appropriate level of care," Folden said. "It's not uncommon really at any of our hospitals."

Ambulance crew shortages extend beyond the walls of the hospitals.

Now with wildfires, Sorrick said AMR crews can't help like they usually do during evacuations.

"We are having to decline requests for assistance for fire evacuations as we must focus on maintaining our EMS systems. Our firefighter partners assist us on medical calls, but now some of their resources are being diverted to wildfires," he said.

In Redding, for instance, about 65% of the 15,000 calls the fire department receives each year are medically-related, according to the city's website.

"We are a very busy system and at times of high-call volume, there may not be an ambulance or even a fire engine to respond to a call, Redding Fire Chief Jerrod Vanlandingham said in a statement.

Redding Fire Chief Jerrod Vanlandingham

As a rule, firefighters do not take patients to the hospital because the chief says they're not set up to do so.

COVID calls cause delays

Adding to the ambulance backup is the time needed to decontaminate after transporting a COVID patient. 

Personal protective equipment is especially important when responding to patients who may have the virus.

"You have to do that anyway, but with COVID you've got to be a little bit more extra cautious," Sorrick said.

"Now we have to decontaminate the rig (ambulance). We've got to decontaminate ourselves. You have to do all these additional things that just take more time before you get back in the system."

Mercy's Folden described the cleaning process as fogging the interior of the ambulances and needing a "dwell time," where the ambulances sit dormant before being wiped down. The process could take up to 45 minutes.

Not the 'new normal'

Shasta Regional Medical Center spokesman Ryan Waller says a lot of what Mercy's Folden says applies to his hospital too, but don't expect the bed delays to last.

"I don't think it's fair right now to say two- to three-hour waits are the new normal. We do have days where ambulances ... are waiting for beds and we have to prioritize who's sickest within the departments," Waller said.

He said, just like Mercy, SRMC will work with the medics to prioritize "when they tell us that, 'Hey there's calls pending in the community — no ambulances available — what can you do for us?"

"We'll extend staff out and do what we can to get those ambulances clear so they can be back in the community and responding," Waller said.

Mike Chapman is an award-winning reporter and photographer for the Record Searchlight in Redding, Calif. His newspaper career spans Yreka and Eureka in Northern California and Bellingham, Wash. Support local journalism by subscribing today.