Over the last few days, COVID-19 patients have been forced to wait in ambulances for hours due to the difficulty of finding a hospital willing to accept them, as coronavirus wards across the country are flooded with new cases.
Although a system had been devised to divide patients among hospitals in order to spread the burden more evenly, that system has been failing in the wake of the sharp increase in patients. “The idea of distributing patients has become almost irrelevant,” said Dr. Rafael Strugo, medical director of Magen David Adom emergency service.
“Recently we’re seeing more and more cases in which we are referred to a particular hospital, and on the way there we get a message: ‘No, don’t come to us, we have no room.’ They’re in distress,” said Strugo.
“It has reached the situation that in some hospitals, security guards have been deployed to prevent the entry of ambulances with patients suspected of having COVID,” said a Magen David Adom official.
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Another MDA source said that the search for a hospital willing to accept a COVID-19 patient can put an ambulance team out of commission for four or five hours.
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Most of the patients being evacuated by ambulance are not in serious condition. Their transport to hospitals by the emergency service is part of a system that went into effect about two months ago to send patients from virus hot spots, where medical centers are facing overcrowding, to areas with fewer cases.
The MDA has informed the hospitals and Health Ministry that they will no longer agree to spend hours searching for a hospital to accept their patients – and will take them to the hospital based on the Health Ministry’s instructions – even if the hospital refuses to accept the patient. The ambulances will leave the patients at the entrance to the special coronavirus emergency rooms, where they will have to wait with the rest of the patients who arrived at the hospital on their own.
Health officials say there is a discrepancy between the way the hospitals are presenting the situation and the reality. “Some of the hospital directors are speaking with two voices: On one hand, they are sending a message that the overcrowding is bearable and they have the possibility of accepting more patients – both so that the public does not avoid coming to the hospital, and also to broadcast an optimistic spirit for the medical staff in the hospital. In reality, the situation is worse,” said a senior health system official.
It turns out that the hospitals that are listed by the Health Ministry as capable of accepting more patients are not really able to do so.
“Because the number of those hospitalized everywhere in the country has increased, the issue of regulating their distribution has become almost irrelevant,” says Strugo. “All the hospitals are muddling through and it’s impossible to play around too much. The greater the increase in the number of those hospitalized, the less the ability to regulate distribution and to transfer patients.”
According to sources in MDA and the health care system, with the increase in cases of illness and of the workload in the hospitals, the process of redistribution has become complicated. It is characterized by an absence of clear directives and a lack of coordination – which imposes the main task on MDA, complicates the process and is paralyzing an increasing portion of MDA’s capabilities and resources.
“A suspected or verified coronavirus patient requires evacuation to a hospital. The ambulance team approaches the hospital, which says that there’s no room and they have to evacuate to another hospital. And thus begins a process that lasts for hours. The driver begins to drive in circles or to stand at the side of the road with open windows, while the entire team remains fully dressed in protective clothing,” says an MDA source. “The MDA hotline starts looking for a hospital that can take in the patient. Every such evacuation puts the team and the ambulance out of commission for four to five hours.”
During that time the evacuated patient waits with the team. “Even after finding a hospital that is willing to take in the patient, and arriving there, it often turns out that the biological emergency room [an emergency room for suspected coronavirus patients] is crowded and we have to wait longer. It reaches a point where the patient, who has to wait inside the ambulance, can’t relieve himself. Sometimes, while we’re waiting, we get a disposal chamber pot for the patient and he has to relieve himself inside the ambulance, in front of the team,” says an MDA source.
MDA claims that the result is that after hours of waiting, the patients who were evacuated to the hospitals are in despair, and they leave the emergency room and ask to return home. “We get a situation where an 80-year-old man suspected of having the coronavirus is evacuated to a hospital far from his place of residence, spends hours waiting in an ambulance and in the hospital, and at the end of the day, after receiving the test results, has to return home because he doesn’t require hospitalization,” said the MDA source.
According to Strugo, “That isn’t done out of malice or deliberately. The hospitals really are overloaded. There are time lapses in the report of overcrowded conditions and the hospitalization and occupancy figures in the hospitals. And in many instances the hospitals have difficulty taking in patients despite the fact that their reported occupancy rate is lower. In recent days we’re already seeing an increase in the occupancy of coronavirus wards to 100 percent and more. Therefore, we have to find other solutions – whether by adding work slots for ambulance drivers or by expanding MDA’s abilities to carry out clarification and initial treatment in the patients’ homes.”
He says that the way in which the entire process is implemented is clumsy, and mainly undermines MDA’s availability for handling urgent cases. MDA suggests that the Health Ministry adopt the “MDA in the community” program, which was proposed several years ago, and includes the expansion of MDA’s ability to administer various tests in the patient’s home and prevent unnecessary evacuations to the emergency rooms. MDA has the ability to administer blood tests, coronavirus tests, sonograms and EKG tests if necessary, and to transfer the findings to doctors and use distance medicine.