The rising flood of coronavirus patients has prompted Orange County’s Health Care Agency to warn that emergency room backups have ambulances waiting “hours” to offload patients and that the county’s critical care network “may collapse unless emergency directives are implemented now.”

The grim assessment was sent to Orange County’s 26 emergency receiving centers, as well as ambulance companies and 911 paramedic providers, late Wednesday, Dec. 9, by Dr. Carl Schultz, director of the agency’s emergency medical services.

“The health care system in Orange County is now in a crisis resulting from an overwhelming increase in the number of COVID-infected patients,” Schultz wrote.

In some cases, ambulances are being diverted from full emergency rooms, forcing them to transport their patients elsewhere, with some paramedics “waiting hours” to get their patients from their vehicles into the ER, Schultz said.

In the memo, Schultz urged hospitals that haven’t yet done so to activate their pandemic surge plans, expand their patient capacities by setting up alternate treatment areas and cancel all elective surgeries, as was done earlier in the pandemic to keep beds open.

Hospital systems that serve Orange County largely have crafted their own surge plans in cooperation with county health officials and other health care networks.

“To those facilities that have activated these initiatives, all healthcare partners and the citizens of Orange County are grateful,” Schultz wrote. “To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now.”

Ambulances now are allowed to travel more than 20 minutes from their standard destination in order to avoid emergency room bottlenecks and can move on to another hospital if a patient has waited more than an hour to get into an ER.

Schultz warned emergency room leaders that refusing to offload patients from a 911 dispatched ambulance for more than an hour and causing paramedics to move on to the next hospital is a violation that could warrant a state Department of Public Health investigation.

The average patient offload time, starting the clock when an ambulance’s wheels stop to when the crew places their patient on an emergency room gurney, rose to 20 minutes this week from 13 minutes two weeks ago, according to county reports.

This week, representatives of various health care networks – Kaiser Permanente, Providence, UC Irvine – that run some of the county’s largest hospitals said they were carefully tracking the ebb and flow of patients each day to staff the right number of beds to handle the surge.

By Tuesday, nearly three-quarters of beds were full at Orange County’s hospitals.

For months, even during the pandemic’s summer surge, medical centers held bed occupancy steady between 60% and 70% as patients came and went and staff shifted beds around depending on need. But since Dec. 1, the share of full beds has not dropped below 71%.

By Wednesday, the tally of COVID-19 patients in hospitals had never been higher at 974 people, now well above a July peak of 722. About a quarter of those patients were in intensive care, which state health officials have thrust into the spotlight as a vital determiner of how a county is weathering the end-of-year coronavirus storm.

This is a developing story.

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By Arlene Huff

Arlene Huff is the founding member of Golden State Online. Before that She was a general assignment reporter. A native Californian, she graduated from the University of California with a degree in medical anthropology and global health. She currently lives in Los Angeles.

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