Emergency departments are well equipped to handle trauma and other conditions that require immediate care, but few were built or staffed to accommodate a fast-spreading, deadly virus.
Consider this: When an EMS squad arrives at New Hanover Regional Medical Center (NHRMC) or Novant Brunswick Medical Center (NBMC) with a patient with a broken arm or a foot that needs sutures, the handoff happens pretty quickly. But when an EMS unit arrives with a Covid-19 patient, all bets are off, as those people require special care and protocols just to get them into the hospital.
A major strain on the system
No one is more aware of the strain that puts on the healthcare system than officials at the area’s largest medical provider, Novant Health, which operates several hospitals in the area. And as a regional referral facility, NHRMC has been hit particularly hard. From the number of available beds to the staff necessary to provide the needed care, NHRMC is facing challenges as severe as those in — what we thought at the time were — the worst days of the pandemic.
During a news conference Wednesday, Dr. West Paul, senior vice president and chief clinical officer for Novant Health's Coastal market, said that the medical center’s main campus on 17th Street is adjusting its allocation of space to accommodate COVID patients more quickly. NHRMC also is trying to make the best use of its other campuses, including the orthopedic hospital on Wrightsville Avenue and Novant Brunswick Medical Center.
“We still see the majority of patients coming from New Hanover County,” Paul said Wednesday. “That being said, the counties in the surrounding areas have high case numbers.”
In the early days of the pandemic, a primary concern was that hospitals did not have the necessary intensive-care capacity to deal with the onslaught of a severe disease. Even with over 1,000 inpatient beds available in the region, the vast majority of care areas at Novant Health’s Coastal Group — including NHRMC, NBMC and Pender Memorial Hospital — are not designed to accommodate critical-care patients. But that is not as much of an issue as the overall lack of space, Paul said.
“This is far over the peak that we saw in December or January. So this is almost a new animal. It took probably a month and a half, two months to have a gradual rise and get those numbers up. It's taken one month (this time). Two weeks ago, we were at 47 patients, and now we're over a hundred," he said.
Paul continued: “I would like to reiterate that intensive care medicine is not a place. It's a function of what we do, so we can function in intensive care mode with our physicians and our nursing staff really anywhere. This is more of a space issue at this point.”
A ripple effect
The surge in Covid-19 patients that need hospitalization trickles down into the entire healthcare system. At Monday night’s meeting of the Brunswick County Board of Commissioners, emergency medical services officials painted a bleak picture of the impact Covid-19 is having on all patients who need EMS care.
In a briefing for the commissioners, Emergency Services Director Ed Conrow and EMS Deputy Chief Lyle Johnston said that with emergency departments backed up with Covid-19 and other patients, their squad trucks are spending more time than ever at EDs, waiting for hospital caregivers to provide a place for patients they are transporting as well as completing the necessary triage process.
“It’s not just Covid patients,” Paul said. “It was all of our ambulances that were coming in from other facilities. A lot of that has to do with our staffing. We like every other hospital in the state right now having issues with staffing. We do not see these numbers typically in our hospital or in our emergency department.”
Paul said that the area’s Novant hospitals are working with surgeons to scale back procedures that are not “time-urgent.”
“Our surgeons have been incredibly good at looking at their (patients) to say, no, this one can wait for two, three weeks,” Paul said.
Emergency rooms are stressed — but don't avoid them if you need them
Paul also urged the public to use the emergency room only for urgent medical needs. At the same time, however, he said those who have serious conditions should not be reluctant to visit the ED.
“I want to reiterate, if you have an emergency, if you're acutely ill, come to our facility. We've got the resources to take care of you,” Paul said. “This is just our due diligence of looking at how we manage our resources to make sure we can handle our Covid surge as well as every other acutely ill and urgent patient that comes in.”
Paul said that the pandemic has caused some people with serious conditions to put off needed care, leading to non-Covid-related trips to the ED.
“Our emergency department is quite busy, and it's not only Covid,” Paul said. “It's a lot of people that have put off attending to their chronic conditions and now they've become acutely ill.
When the ambulance comes in, there has to be a handoff and a triage that happens at the hospital, he said.
“If we don't have the nurses, if they're attending to someone else at the time, EMS members actually stay with that patient until we can have a handoff appropriately to our triage nurses to get them in. We are having those types of volumes within the ED," he said.
The Brunswick emergency services officials who briefed the commissioners said the complexity of dealing with a highly contagious disease as well as the sheer volumes of patients needing emergency care and transportation to a hospital has resulted in EMS vehicles tied up at hospitals, sometimes for hours. When an EMS squad is stuck at a hospital, that means they are not out in the field to respond to accidents, other trauma cases, and emergencies such as cardiac arrest, in which every second counts.
The problem is magnified in Brunswick, which, at 847 square miles, is one of the largest counties in the state land-wise. (Brunswick EMS officials said that 40% of the patients they care for are transported to Novant Brunswick Medical Center in Bolivia and 40% to NHRMC’s main campus. The rest are spread out among hospitals across the region — including McLeod Health Seacoast in Little, River, S.C. — and the state).
What can the public do to help?
As for how the community can help, Paul quickly points to the basics:
“We still need to continue the vaccinations. We know our vaccines ... may not be quite as effective against catching the virus, but they are absolutely effective against hospitalizations and spread,” Paul said, adding the important roles of masks, hand washing, and social distancing.
Hindsight's always 20/20, Paul said, but “I think we all knew in the medical and scientific community that if we could not get our vaccination rates up quickly, there was going to be the development of a variant that may have more resistance to the vaccine and may spread faster. That's just the natural history of viral illnesses.”
Editor's note: WHQR is working on a special edition of The Newsroom dedicated to questions, concerns, myths, and misinformation about Covid-19. Send us your thoughts at staffnews@whqr.org.
