Last week, the Riverside County Board of Supervisors approved its response to the April grand jury (GJ) report titled, “You Call 9-1-1: Then What? Riverside County Emergency Department Delays May Impact Your Care.”
Without any discussion, the board approved the response unanimously.
The report had four findings and three recommendations to address its findings. The county agreed with the majority of findings and recommendations.
The first finding related to the GJ’s concern about patients remaining on gurneys for a long period before their transfer from the ambulance to the hospital facility. However, the county’s response corrected this slightly.
While a hospital may not have immediate room to place a patient, the transfer of actual care occurs when “… EMS personnel arrive in the [emergency department] and provide a patient report to ED staff. Universally, ED medical staff are using that report and visual assessment to ‘triage’ patients upon arrival.”
The response also noted that hospital emergency department staff will assess the patient’s condition and apply triage based on the conditions provided in the patient’s report that the ambulance EMTs provide.
The county’s response to the recommendations was positive, but qualified. The first recommendation was “Riverside County Board of Supervisors to review. approve, and support programs, including telehealth and Safety-Net Ambulance Programs, throughout Riverside County to alleviate ambulance patient off load delays.”
While the county acknowledged agreement with the concept, its response noted this needed further analysis. The Emergency Medical Services Agency already collaborates with all the partners — hospitals and fire departments. These steps would benefit from an update to the current EMS Strategic Plan which the county hopes to have completed by the end of July 2024.
For example, telemedicine is already implemented in some county areas and nearly all hospitals and insurers offer some form of telemedicine, according to the county. With regard to EMS telemedicine, the county said models have been tested and it continues to look for viable telemedicine solutions.
These agreements will be presented to the Board of Supervisors within the next year.The GJ then recommended the county encourage other hospitals to implement procedures to reduce ambulance wait times similar to the Riverside University Health Systems’ and other high-performing hospitals’.
In this case, the county responded, “The recommendation has been implemented.” Senior county officials for EMS have held multiple meetings with leadership at hospitals that have a poor record on wait time.
During these meetings, the county said extensive discussions and reviews were had of the hospitals’ offload performance, data collection and metrics, improvement best practices and REMSA expectations for improvement.
However, the county EMS is not sure which hospitals have made the recommended changes.
The third and final recommendation proposed an interim solution: “RCFD [Riverside County Fire Department] and AMR [American Medical Response] to utilize available personnel to relieve delayed fire and/or ambulance teams at the hospital emergency departments.”
However, the county evaluated this recommendation and replied that it would not be implemented since it is not warranted.
The principal reason is that the governor’s State of Emergency during the COVID pandemic was rescinded in March. During its application, more paramedics6could be found through various channels, such as AMR and the State Medical Mutual Aid System and they could help local hospitals with emergency patients.
With the termination of the emergency order, though, the county expects local hospitals to hire their own EMTs. But confirmation of these steps is not available.
“… REMSA and all EMS system partners wholly disagree that it should be EMS provider agency staff that is utilized. All EMS providers within the County are currently experiencing staffing shortages. Utilizing their staff to support underperforming hospitals would further degrade EMS system resource availability.”
But extended wait times are not a unique Riverside County problem. In January 2021, the state Assembly Committee on Emergency Management held an oversight hearing on the impact of ambulance patient offload delays (APOD) on emergency responses.
This year, Assemblymember Freddie Rodriguez (D-Pomona) introduced Assembly Bill 40 to address this issue. In May, the Assembly passed the bill and forwarded it to the Senate where several committees have reviewed it.
Besides telling local EMSAs, such as Riverside County’s, to set an ambulance patient offload time (APOT) of 30 minutes, AB 40 requires acute care hospitals with emergency departments to meet that standard 90% of the time. Also, hospitals would be required to develop an APOT reduction protocol by June 1, 2024, file the protocol with EMSA and require EMSA to monitor monthly APOT data to ensure the standard is being met.
After the Assembly passed AB 40, Rodriguez said in a press release, “Our communities expect and deserve immediate emergency transport and a hospital ready to receive them for treatment when they call 9-1-1. Unfortunately, non-urgent calls and other factors put immense pressure on our EMS system. AB 40 and AB 296 will alleviate these pressures, getting our first responders off the wall and enabling our system to run efficiently and effectively.”
Sidebar:]
Riverside County’s Emergency Medical Services Strategic Plan revision
The Emergency Management Department has already selected a contractor to lead the review of the next version of the EMS Strategic Plan. Through a competitive process, AP Triton LLC was recently selected as the primary consultant to review and complete an updated five-year EMS System Strategic Plan. The contract period is for one year ending on July 31, 2024.
More information, visit http://riversidecountyca.iqm2.com/Citizens/Detail_LegiFile.aspx?Frame=&MeetingID=2791&MediaPosition=765.401&ID=22525&CssClass=.
