Helen Santoro, Kaiser Health News
HANNISON – The night after Thanksgiving, a small ambulance service that serves a vast area in southwestern Colorado received a call that a patient urgently needed to be transferred from a hospital in Gunnison to a larger intensive care unit 65 miles outside Montrose.
The patient, a 78-year-old man, suffered from atrial fibrillation, an irregular heartbeat that is usually not life-threatening. But in patients like this one with a history of chronic illness, heart disease, and high blood pressure, the disease can cause stroke or heart failure.
Gunnison Valley health workers dragged the patient, who was on a gurney, out of the hospital into the cold night air. Annie Grace Haddorf, the emergency doctor on duty, helped load the patient into the ambulance and jumped into the driver’s seat. Paramedic Alec Newby sat in the back and tied the patient to a blood pressure cuff; a pulse oximeter that measures your heart rate and oxygen saturation in your blood; and an electrocardiogram, which records the electrical activity of the heart.
“Your heart is clearly pissed off,” Newby told the man when the ECG confirmed atrial fibrillation.
The ambulance pulled onto US Highway 50 to drive in 1 hour and 15 minutes past clusters of houses amid wormwood hills, the vast Blue Mesa Reservoir, and the rocky spiers of the gaping Black Gunnison Canyon.
The patient was stable enough for the long trip, which covered only a small portion of GVH Paramedics’ 4,400 square miles. It is more than twice the size of Delaware and is the largest emergency response area in all of Colorado. A typical fire or medical emergency response area is 100 to 400 square miles.
In recent years, inter-network or IFT transfers like this have become more commonplace for GVH paramedics, forcing the team to travel far beyond their already vast area. Before the pandemic, remittances surged as the population of Gunnison County grew steadily, more tourists were attracted to places such as the popular Crested Butte ski resort, and GVH paramedics expanded their services to larger metropolitan hospitals outside Gunnison County.
But now the team is being urged to move patients more often and longer distances because hospital beds in the relatively nearby cities of Montrose and Grand Junction are filled with COVID-19 patients. The team must regularly transport patients to Denver, which is about three hours and 40 minutes from Gunnison.
Ambulance officials fear they may be unable to respond to an emergency because their resources, which include six ambulances but enough personnel to operate three of those vehicles, involve long-distance travel.
What was once a two- or three-hour trip to Montrose is now a much longer excursion, “and it requires the resources of this community,” said C.J. Malcolm, Chief of Emergency Services. “We did it before COVID, but now the condition is so badly affected that it has become a daily part of our lives.”
Before the pandemic, all ambulances will simultaneously make calls to 911 or IFT less than 10 times a year. Now, Malcolm said, this is happening more and more often. In such cases, GVH paramedics rely on the emergency response team at Crested Butte, about 28 miles from Gunnison, or delaying patient response is delayed.
According to the data collected by the team, GVH Paramedics delivered 166 IFTs in 2018, which required nearly 40,000 miles of travel and a total of 987 hours of ambulance operation. Last year ended with 260 IFTs, over 70,000 miles of track and a total of 1,486 ambulance hours. This is 50% more time on the road.
“Every time one or two ambulances leave for the IFT, there is only one ambulance left on the vast tract of land,” Malcolm said. “This is a mildly intimidating situation where we can easily get two or three emergency calls.”
For example, in August more than 60 patients were transferred to Gunnison Valley Hospital, 37 of whom were admitted by GVH paramedics. This means that at least once a day this month, a GVH paramedic team has been taking a patient out of town, Malcolm said. And if the crew members are not back in Gunnison by 1 am, they must spend the night at the hotel so as not to drive on dangerous mountain roads, being overly tired.
GVH Paramedics’ service area covers nearly all of Gunnison County, most of Saguach County, and portions of Montrose and Hinsdale Counties. It contains mountain ranges, canyons and wide expanses of high desert. With about 6,600 permanent residents and a university, Gunnison is the largest city served by the team. Surrounding towns, including Tin Cup, Pitkin and Ohio City, are villages of a couple of hundred or former mining towns where boom artifacts outnumber residents.
GVH Paramedics’ 21 staff members and 10 to 20 people on an as-needed basis are certified in bushfire and rural medicine, including fast water, ice and avalanche rescue. To meet the increased demand from IFT, they have added one additional employee per shift, and non-working employees are called in to assist.
As the pandemic drags on, the number of IFTs is likely to continue to rise. By mid-November, the number of people in a hospital with COVID-19 in Colorado was staggeringly high, approaching the December 2020 peak of 1,847. By the end of the month, hospital admissions remained above 1,500. As a result, the Colorado Department of Health and Environment reports that as of November 30, 93% of hospital emergency beds and 94% of intensive care beds were in use.
“I don’t think we will see an easing of capacity problems anytime soon,” said Kara Welch, senior director of public affairs for the Colorado Hospital Association.
Adding to the strain are people seeking medical attention that they have postponed due to the pandemic and other respiratory viruses such as respiratory syncytial virus circulating in the state, Welch said.
Kelly Thompson, chief of operations for CareFlight of the Rockies, an aviation ambulance service operating in Colorado and other parts of the West, agreed with this assessment. “We are already transporting a large number of children with RSV who are sick and you have COVID on top of that,” Thompson said. “This is a big problem. This is the time when we have a lot of sick people. “
In early November, to deal with growing concerns about hospital capacity, Colorado’s hospitals and healthcare systems activated the third tier of the government’s patient transfer system – the highest tier. This means that COVID and non-COVID patients can be moved without their consent from a hospital that lacks space to a hospital with more space. Hospitals can also send sicker patients to health centers for more specialized care.
When members of the GVH paramedic team approached Montrose with their patient over a recent holiday weekend, Newby called the hospital to inform staff that they were arriving. They pulled up to the emergency room entrance, and Newby and Haddorf dragged the patient into the hospital room. Montrose Hospital staff took charge of moving the patient from the gurney to the hospital bed while Newby updated the patient’s medical records.
They soon returned to the ambulance and headed home. “IFT can be stressful,” Haddorf said as she maneuvered down the winding moonlit mountain road.
Kaiser Health News is the national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.
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