JACKSON, Miss. (WLBT) - As COVID-19 hospitalizations hit record levels, Mississippi’s already-strained hospital system is struggling to provide ICU beds. With hospitals full, it is pushing patients who are waiting for admittance into the emergency room and forcing doctors to delay ambulance transfers, sometimes for hours.
“Everything upstairs in a hospital affects downstairs,” Wade Spruill said, describing the trickle-down effect that illustrates the interdependence of Mississippi’s health care and emergency response system.
Spruill serves as president of the Mississippi Ambulance Alliance, a network that represents about 90 percent of the ambulance providers in the state.
For him, the coronavirus pandemic has only exacerbated an already-burgeoning dilemma that EMTs know all too well: the logjam of ambulances that keeps some paramedics waiting hours for a hospital to transfer their patients inside and continue treatment.
Those delays are measured in what’s known as “wall time,” the amount of time between when an ambulance arrives at a hospital to the point at which the patient has been transferred into the hospital’s care.
“What we’ve seen is a gradual increase [in wall time] that, on March the 15th, went off the scale,” Spruill said. “Personally, we’ve had on at least one occasion in the last 30 days where our crew was 13th in line for offload times that exceeded five, six hours. That was one time.”
Spruill didn’t say what hospital that was but noted that he believes the staff there did everything they could to alleviate the backup of patients.
“It’s just too much water for the dam, you know what I’m saying? And what could they do? So we were stuck there. But the people back home that needed our truck don’t know that and they don’t know why you’re there, so therein lies our problem.”
A 3 On Your Side investigation in 2019 revealed some EMTs experienced waits of several hours at Jackson-area hospitals, leaving providers frustrated and their counties devoid of ambulance service while they were stuck waiting to transfer their patients.
In some cases, that means an entire county could be without coverage for hours.
“You better hope you’re not the third heart attack in the county that night or you’re gonna be waiting a very long time,” Ryan Kelly, executive director of the Mississippi Rural Health Association, told WLBT in 2019.
At that time, ambulance providers cited staffing shortages and administrative issues with the state’s hospitals as reasons for the delays, but those were never addressed.
Spruill, who served as Mississippi’s first EMS director, has spent the last 20-plus years working as chief executive officer for AAA Ambulance Service, a non-profit organization based in Hattiesburg that provides emergency services for nine counties.
His work with the Mississippi Ambulance Alliance has offered the opportunity to analyze wall time data from several different ambulance providers, including AMR and Pafford EMS, and present a more complete picture of how much their network of emergency response is affected.
What he’s received so far from providers is troubling, Spruill said.
“Up to 30 percent of all patients taken to facility X, they’re staying there on average 30 percent of the time greater than an hour,” Spruill said, meaning the patient is waiting that entire time. “That’s serious.”
Sometimes that means a COVID-19-positive patient must wait inside an ambulance with those two EMTs and a paramedic, increasing their risk of exposure, Spruill said.
“That’s certainly not what we would do in a perfect public health world,” he said. “[These crews] know they need to take care of their patient, and they’re wanting to help the ER staff, too. So they’re really in a box.”
Some of the wall time data Spruill has received goes back five years, which is why he maintains the delays existed before the pandemic, yet were never addressed.
Spruill did not disclose the name of any hospitals or regions where this problem is more pronounced, telling 3 On Your Side he didn’t want to throw anybody “under the bus.”
His eventual goal is to take that data and compile a report to give to the Mississippi State Department of Health and Mississippi Hospital Association, in hopes of determining a solution to the wall time problem.
He also wants the public to understand what these providers deal with every day.
“Most people don’t pay attention to healthcare needs until they need it and so ambulance services are a forgotten industry,” Spruill said. “You could be that person. Trauma doesn’t discriminate. It affects everybody. It doesn’t matter if you’re rich or poor. If you get hurt and need an ambulance, that’s our job. And that’s what we try to do. And we pride ourselves in doing that. What we get now is a situation that’s really out of our control.“