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Rural Neb. hospital patients face risky waits for ambulance rides to ICU beds

Patients needing specialized care staying longer at small hospitals
Posted at 6:05 PM, Oct 22, 2021
and last updated 2021-10-22 23:13:09-04

MCCOOK, Neb. (KMTV) — Most of Nebraska’s rural hospitals can patch a person up if they’re injured in a car crash. They can stabilize someone after a heart attack.

But rural hospitals aren’t equipped to do those things for long. That’s why small hospitals try to move their sickest patients to hospitals in larger cities.

This month, 3 News Now Investigators dug into delays that are keeping patients like these at rural hospitals longer.

We found small hospitals straining to offer more complicated care to sicker patients – and longer waits for ambulances to transfer patients to larger hospitals, too.

About a dozen lives a day depend on the 10 nurses and handful of doctors who do most of their work at McCook’s Community Hospital.

Some patients who seek help at small hospitals like this one need special care, the kind typically offered at larger hospitals in bigger cities. But what happens when they have to wait to go?

Here, that means three nurses and at least one doctor must care for a single patient, round the clock. Staff say this cuts into the care that other rural patients receive.

Julie Wilhelmson, who runs the emergency room here, says the patients who need higher levels of care might have had a heart attack, been injured in a crash or need a neurologist.

“In some cases, it could mean truly life or death for that patient,” she said.

Rural hospitals like McCook’s have emergency rooms. Larger hospitals like those in North Platte or Kearney, have intensive care units.

Problem is, many larger hospital ICUs filled up during the pandemic. And they’ve stayed busier than normal. Some have room for more patients, but not enough staff to care for them.

One local example: Nebraska Medicine recently stopped taking ICU transfers from other hospitals. They said most of the Med Center’s staffed ICU beds were full.

Fewer available beds force small hospitals like McCook’s to send patients farther, more often to hospitals four hours away in Omaha or Denver, even to Rapid City, South Dakota.

“We’ve had to train,” said Troy Bruntz, CEO of the McCook hospital. “We’ve had to get nursing comfortable that we might not be able to transfer the patient.”

Hospital leaders told 3 News Now Investigators that they called 23 hospitals over several days to find a bed for one patient. Many wait hours.

“I’ve been a nurse for 20 years. We’ve never faced this before, to this extent,” Wilhelmson said. “It was kind of a surprise to us back then if we even had to call three hospitals to get a bed.”

Marty Fattig used to work at McCook Community Hospital. He now runs the Nemaha County Hospital in Southeast Nebraska.

“The families are extremely fearful and anxious,” he said. “They simply don’t understand why we can’t just put them in the back of our local rescue squad and send them up to Lincoln.”

They can’t because it takes a higher level of training than most volunteer rescue squad members possess to transport a patient who’s already sick hospital-to-hospital, he said.

It’s a one-hour drive from Auburn’s hospital to Omaha and its many hospitals. But getting patients there from Nemaha County Hospital can take as long as eight hours.

Auburn, as a community, knows the risk of long waits. Last year, neighbors lost local farmer Mark McConnaughey at a Des Moines hospital after a delayed transfer from here.

He was airlifted to Iowa from Nemaha County Hospital after local nurses made five hours of calls to more than 20 hospitals. They think he had a breakthrough infection of COVID-19.

Experts say COVID-19 is still a key contributor to fuller hospitals. But several say that the health care people put off during the pandemic is contributing as well.

Even after nurses find someone a bed, some rural hospitals are waiting longer for ambulances to transfer people bloodied by broken hips or other serious ailments.

Former Lt. Gov. Rick Sheehy, a paramedic for three decades, works now in management for Midwest Medical Transport, one of the state’s largest private ambulance companies.

Many local rescue squads have chosen not to transfer patients from one hospital to another. They don’t want volunteers on the road that long. And some worry about liability.

Sheehy says private transfer ambulances are having to travel longer distances between calls and the hospitals where they drop patients off. That causes each call to take longer.

"So, if you’re looking though at southeast Nebraska, an ambulance may have to come from out of Lincoln to Falls City,” Sheehy said. “Well, that’s a two-hour travel time.”

Another issue during this pandemic has been that demand for paramedics is outpacing ambulance companies’ ability to hire them.

In the Omaha area, Midwest Medical Transport says it’s transferring about 60 people a day between hospitals. That’s double what it did last year. Its statewide numbers are up 30 to 50%.

Midwest Medical says it’s been hard to hire paramedics to live in rural areas. So they’re hiring people in Omaha and Lincoln and dispatching them from there.

Rural hospitals told us that calling for an ambulance on weekends is hard.

"They just tell us we don’t have a staff ambulance to send you,” Fattig said. “Sometimes they just say don’t call. We don’t have staff this weekend.”

That’s why Fattig and several hospital leaders have started hiring in-house paramedics, to fill in where the ambulance companies fall short.

In Auburn, the hospital will provide the medics that take care of patients in the back of the ambulance, and the local rescue squad will provide the ambulance and the driver.

Hospital officials in McCook say they are still planning to work with Priority Medical, a private ambulance company that bases an ambulance just blocks away.

Roger Nilsen, a paramedic in North Platte who filled in for the medic in McCook last week, said the company has a goal of responding to the hospital in 15 minutes.

But sometimes, he said, dispatch will let the hospital know how far out they are, or let them call other ambulance services to see if someone else can get there quicker.

“But sometimes they just have to wait,” he said. “It is what it is.”

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