ER change could free up ambulance crews

Emily Richmond and Ed Koch

Wednesday, Feb. 5, 2003 | 11:30 a.m.

Clark County Health District is expected today to approve a plan that would allow ambulance teams to leave patients at hospitals within one hour of arrival even if the person's care has not been transferred to the emergency room staff.

The move comes as ambulance companies report crews waiting as long as five hours at Las Vegas Valley emergency rooms for patients to be seen, delaying response times to other 911 calls for help.

Rory Chetelat, manager of emergency medical services for the Health District, said this morning that a protocol could be approved today to free up ambulance teams.

"On average, about 6 percent to 7 percent of emergency medical services personnel are waiting more than one hour and, in critical times, we have been close to 100 percent," Chetelat said. "We have to address that critical period, but there is no one-step solution to the problem."

Currently, he said, there is no protocol in place other than the ambulance personnel deliver a patient and wait. Chetelat said the average wait is about 30 minutes.

"We are not talking about leaving the acute patients -- they get seen right away," he said. "We are talking about the patients that are awake, alert, stable -- maybe have a broken finger or a persistent cough -- and are low on the triage priority list."

Steve Peterson, chief executive of American Medical Response, said he's had crews wait at much as five hours to transfer care of patients to emergency room staff. In the past month there have been at least six instances where the number of ambulances available to respond to 911 dispatches reached one or fewer, Peterson said.

"I hate to think of the patient out there who is in true need and isn't receiving a timely response," Peterson said.

But Dr. Dale Carrison, University Medical Center's emergency services director said today that he found the proposal "deeply troubling."

"It's never a good idea to abandon patients at an overcrowded emergency room where they may not get seen right away," Carrison said.

Allowing paramedics to leave patients after one hour won't solve the underlying problems of emergency room overcrowding, Carrison said.

With UMC facing a $37 million budget shortfall, staffing levels are expected to be cut -- not increased, Carrison said.

"No matter when the paramedics drive off, we're still not going to have enough staff or enough beds for all the patients who need them," he said.

The one of the biggest drains on emergency services at all of the valley's hospitals is what medical professionals call "frequent fliers" -- a group of several hundred habitual public drunkards and mentally ill patients who regularly arrive via ambulance.

Because UMC has no psychiatric emergency services -- those are provided by the Nevada Department of Health and Human Services -- the ER staff ends up "baby-sitting" until one of the handful of beds opens up at a state facility, Carrison said.

Last Friday UMC had 15 mentally ill patients arrive, taking up bed space for anywhere from 30 to 60 hours, Carrison said.

Other hospitals report similar problems.

Peterson confirmed that the frequent fliers make up about 80 percent of the 911 calls.