Where is the Ambulance?
The stories are heartbreaking. In Georgia, a man died in the hospital after an ambulance failed to respond to multiple 911 calls despite dispatchers’ repeated assurances that it was on the way. In Cleveland, the victim of a hit and run died a minute before a delayed ambulance finally arrived. Ambulances are taking longer to respond, delaying onsite emergency care and timely transfer to medical facilities.
In Boston, the median arrival time for an ambulance dispatched for a life-threatening emergency grew significantly in 2022 to 7.7 minutes. And, in some neighborhoods, response times were about 30% higher than that figure. This is an issue that has been brewing within the EMS field for some years, largely fueled by EMS worker shortages, especially in rural areas. EMS workers are some of the lowest paid and hardest working people in the medical field. Just ask them.
More recently, though, the situation has been significantly worsened by the trickle-down effect of understaffed and overcrowded hospitals, nursing homes, and rehabilitation centers. And a key choke point is the hospital emergency department itself.
According to a recent Boston Globe article, hospitals’ inability to discharge patients to understaffed nursing homes and rehabilitation centers has created a critical capacity problem, keeping patients in the emergency room long past the time they should be moved. “The hospital capacity crisis is slowing ambulance response times across Greater Boston by forcing EMS workers to stand in line, sometimes for hours, inside busy ERs until overwhelmed hospital teams can take over their patients’ care.”
The result is that emergency calls, which could typically be managed in under an hour, are now taking much longer because EMS personnel and their ambulances are held up at the emergency room waiting to offload/transfer the care of the transported patient. The effect of these longer wait times is when another medical emergency arises, those EMS crews and their equipment are not available to respond.
When someone’s life is on the line, every minute counts. According to the Globe article, one emergency services director had this to say, “Even two minutes is a really long time if you are with someone suffering cardiac arrest, so any delay is going to be associated with worse outcomes…the brain can last four minutes without oxygen [in] a normal situation, but it’s really hard to expect a meaningful neurological recovery if they’ve been without oxygen for more than four minutes.”
In a study published by the Journal of the American Heart Association, researchers found that a patient’s chance of surviving 30 days after experiencing an out of hospital cardiac arrest decreases as ambulance response time increases even if CPR is being performed on the patient.
While the COVID pandemic may be over, the medical community’s care challenges have persisted. The medical and emergency response communities need to urgently address the ongoing cascade of staffing and response issues that are leading to extended wait times for patients. In a CNN Health article, an emergency physician commented in early 2021, which still holds true today:
“As Americans we assume we always have access to care…We’re now at the precipice that we warned about, that if we lose enough access, it’s going to be access for everybody. And we could lose lives. We could have permanent damage.”
