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As emergency volume grows, patients wait outside

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HUDSON—Challenges facing Columbia County’s Emergency Medical Services (EMS) include diversions between hospitals, wait times, specialization, and increased call volumes, EMS Coordinator P.J. Keeler reported to the County Public Safety Committee meeting July 20 and in a telephone conversation July 28.

“Our system has worked and is still working, but we want to make it more efficient and respond more quickly,” he said. The system had a major overhaul 12 years ago, but now, “the world has changed, and healthcare is changing rapidly.”

When a hospital learns a patient is coming, it determines whether it has a bed available in the appropriate unit and whether it can serve the patient’s needs. If not, it tells the ambulance—whether en route or already in the hospital parking lot—to divert to another hospital. From Columbia Memorial, most diversions go to Albany Medical Center, St. Peter’s Hospital in Albany, Ellis Hospital in Schenectady, or Northern Dutchess Hospital in Rhinebeck. And, yes, the patient may get billed for the extra travel.

For most diversions, the patient stays in the same ambulance. Air lifts are only for “very critical cases,” Mr. Keeler said.

Some hospital beds are filled with people who should be in nursing homes, but there are not enough beds in nursing homes, he added.

In addition, hospitals are getting specialized, and patients in need of some types of care are sent directly to the hospitals specializing in that care. For example, Mr. Keeler said, if somebody walks into Columbia Memorial Hospital with a heart crisis, they are sent by ambulance to Albany Medical or St. Peter’s, because those are the ones for cardiac treatment.

Concerning another specialty, somebody at the July 20 meeting remarked that Columbia Memorial ordinarily no longer handles live births, and that the ability to deliver one’s baby at the local hospital influences where people choose to live.

Once at the hospital, the off-load time is the amount of time the patient waits in the ambulance in the hospital parking lot. Almost every day, Columbia County ambulances experience at least one off-load time of one-to-two hours, Mr. Keeler reported. During the off-load time, the patient is not with a doctor, and the ambulance is occupied and cannot go on other runs.


‘The world has changed, and healthcare is changing rapidly.’

P.J. Keeler, coordinator

County Emergency Medical Services


Columbia County has on the average 12 to 15 ambulances available on a typical day, Mr. Keeler estimated. He has seen times when all but two of the ambulances are occupied.

Furthermore, the volume of calls for EMS has increased 145% over the past 10 years, Mr. Keeler reported. One reason is simply that the “demand for emergency services has increased.” EMS posts some ambulances in rural communities “where services are sparse” so that they will be closer if 911 calls come.

All these situations are occurring at a time of “staffing crisis.”

Meanwhile, tele-med is here. For now, 911 callers are offered tele-health instead of an ambulance, “when resources are depleted” and the case appears “very low severity” and not immediately life threatening, Mr. Keeler said. After all, an emergency room wait can take three hours.

To help it do the best it can amid changing circumstances and decisions made by others, EMS is planning to consult with Fitch, which has advised medical-related services around the country.

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