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A Path Forward on Ambulance Patient Offload Times

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While the number of COVID-19 cases in California is beginning to taper on the heels of the largest surge since the pandemic began, hospitals continue to see high numbers of patients needing care — not unexpected since hospitalizations typically lag cases by about two weeks, and the backlog of patients needing other types of care remains long. 

The surge — paired with a nationwide shortage of health care workers (the health workforce is down some 20% over the past year) — has exacerbated the issues that slow the transfer of patients from ambulances to hospital emergency departments. Systemic factors also contribute to this problem, such as the inability to timely discharge hospitalized patients to skilled-nursing facilities or other post-acute care settings, and a steady influx of patients with behavioral health needs who are “boarding” in hospital emergency departments because of a lack of appropriate community-based settings. 

This is not a new issue — it’s one that firefighters and EMS providers have raised prior to COVID-19, and one whose solutions hinge on collaboration and partnership among those who transport patients and those at the receiving end of the route.  

There will be long-term work needed to address the systemic factors leading to longer offload times for hospital patients arriving by ambulance, but there are also steps that can be taken in the short term to mitigate challenges quickly. Earlier this week, in a joint letter with the California Professional Firefighters, CHA outlined a path for rapid relief and, in doing so, has begun to build a foundation for cooperative long-term reform. The letter proposes six measures to reduce systemic stress and improve patient care. At a high level, they ask the state to: 

  • Collaborate on a communication program to help educate the public on the appropriate use of the emergency medical services system and hospital emergency departments 
  • Augment budget support for short-term additional staffing (four to six weeks) for paramedics or higher medical authorities who can receive patients at the hospital 
  • Provide alternate destination flexibility in the form of directing the Emergency Medical Services Authority to create an expedited mechanism for a Local Emergency Medical Services Authority to implement alternate destination policies 
  • Allocate resources to select urgent care centers to facilitate safe and efficient EMS transport of patients not requiring emergency levels of treatment 
  • Institute policies to facilitate use of available fire department resources throughout the state 
  • Implement strategies to facilitate transfer of patients from hospitals to long-term care facilities and other community settings of care 

In addition to these immediate actions that have been requested, CHA and the regional hospital associations are continuing to engage with the state Emergency Medical Services Authority on an advisory committee examining the systemic challenges and potential solutions. That work is expected to conclude in June. We are also engaging with the state Legislature on this issue, to make sure legislators understand the nature of the concerns and what options may be available for relief.

Like so many challenges facing California’s health care system, the best answers will come when we can stand with our allies and partners to find solutions that meet the needs of the people we collectively serve.