Critically ill, injured wait up to six hours, techs say

By Cy Ryan

Tuesday, March 8, 2005 | 10:41 a.m.

CARSON CITY -- Critically ill or injured patients must wait as long as six hours on ambulance gurneys in hospital emergency rooms in Southern Nevada before being admitted, a group of emergency medical technicians told lawmakers Monday.

Mike Myers, assistant chief of Las Vegas Fire & Rescue, told the Senate Human Resources and Education Committee that he gets his ambulance patients to the hospital in six minutes, but then there are long waits before the hospital accepts the patient.

Brian Rogers, vice president of Southwest Ambulance, told the committee that all the hospitals are crowded now and there is no longer a chance to divert patients to another hospital. He estimated that 70 percent of the patients now wait 30 minutes or more before they are accepted into the emergency room.

The group of ambulance crews is asking for a bill to require hospitals to take the patients within 15 minutes so that ambulances, both private and public, can get back into service sooner.

But Bill Welch, president of the Nevada Hospital Association, said hospital emergency rooms are so overcrowded with patients that they are "like a war zone," Among other things, hospitals are trying to recruit more nurses to remedy the situation, Welch said. Nevada has the "worst nursing shortage in the country," he said.

One way to motivate hospitals to do better would be to fine them for not admitting ambulance patients soon enough, Sen. Maurice Washington, R-Sparks, said. Welch objected to that suggestion, saying a fine is punitive action for somebody who has done something wrong. He said the hospitals are operating at maximum to handle emergency cases. Hospitals, he said, don't deserve to be fined.

Ambulance crews do face fines for not meeting deadlines, Rogers told the committee. Ambulance crews are required to transport each patient with a life-threatening to a hospital within 9 minutes, he said. Any longer and the company is fined $11.71 a minute.

Steve Kramer of American Medical Response testified that "high acuity" patients can wait anywhere from one to eight hours, while the emergency technician is providing the care. These technicians are not licensed to provide such care for such extended periods.

Rusty McAllister, representing the Professional Firefighters of Nevada, said one ambulance company in Southern Nevada has lost $5 million to $10 million because of the hospital wait time. The vast majority of hospitals in Clark County are reporting record a profit, he told the committee.

McAllister said there are new hospitals and trauma centers opening in Southern Nevada "but we can't get patients into the emergency rooms."

Welch said the ambulances are only one source of the patients filling up emergency rooms. Most are brought in private vehicles. He said every patient must be medically screened. He said allowing triage centers to do the screening would relieve some of the load.

More than 50 percent of those who come to the emergency rooms, he said, are seeking treatment for "non-emergencies," and patients with mental illnesses are taking up as much as 30 percent of the beds in the emergency rooms.

But Rogers said the problem of long waits at emergency rooms started before the mentally ill began arriving at hospitals.

The uninsured and those on Medicaid are now seeking their primary care at emergency rooms, rather than from private physicians, Welch said.

Sen. Barbara Cegavske, R-Las Vegas, said, "All of us feel frustrated" by the problems in the emergency rooms. She said there were 11 quick care centers in Clark County and maybe some of the patients could be treated there.

Rogers said all of the quick care centers close at 7:30 p.m. When the centers are open, ambulance crews can suggest to patients that they try the centers, but the final decisions belong with the patients, he said.

And Sen. Joe Heck, R-Las Vegas, who is a consultant to the Clark County Health District and involved in EMT care, noted that quick care centers are not licensed as emergency centers. And, he said, if the patient shows up at a quick care center late in the day, then he or she must be transported to a hospital when the center closes.

Myers told the committee the non-urgent care patient is "not an issue." For instance, those with a laceration might have to wait a long time before being admitted to the emergency room. But he pleaded with the committee to work something out to get critical patients into the emergency rooms and off the gurneys in the ambulances.

The committee members said they will hold work sessions to find a solution.