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No Room in the ER

Patient diversion and long waits at area emergency rooms cause problems for paramedics.

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At least once a week, the Memphis Fire Department (MFD) runs out of ambulances to send into emergency situations and has to rely on private ambulance companies.

During these times, all 33 of the fire department's ambulances are waiting to unload patients — sometimes for several hours if the patient's condition is not critical — at local hospital emergency rooms.

"I've had ambulances waiting for five or six hours at some hospitals, waiting for beds," says Gary Ludwig, deputy chief of emergency medical services for the MFD.

Years ago, hospitals with full emergency rooms began sending ambulance patients to other hospitals with shorter wait times. Ambulance drivers also can access a database that shows which emergency rooms are full.

"The issue with this now is that demand exceeds the supply at every emergency room in town," says Joe Holley, medical director for all the ambulance services in the county. "Diversion no longer helps the system. In most cases, any place we take a patient is in just as bad a shape as the place that diverted the patient."

When contacted, spokespeople for Methodist Hospital, the Med, and St. Francis Hospital said their emergency rooms never turn anyone away. Holley says if a patient insists on a particular hospital, the ambulance driver will take them to that hospital whether it's full or not. By law, the ER cannot turn away any patients once they come through the doors.

But Holley says patients who do not have a preference or those involved in serious accidents are often diverted before they arrive at the ER. Hospital staff also divert patients when they fear the person has a condition they cannot treat quickly.

For example, if a man is involved in a rollover vehicle crash, the paramedic may call a hospital to let them know the victim has stable vital signs but is suffering from neck and leg pain.

"The hospital's concern is that they might have trauma that's not apparent at the scene," Holley says. "They fear that patient would come to their facility with something like a ruptured spleen and need to get to an operating room. So they divert them to the trauma center at the Med. Then when it turns out that the patient only has a broken leg, the Med becomes overwhelmed with all this stuff that doesn't require their expertise."

St. Francis spokesperson Marilynn Robinson says they only divert their pregnant patients, and only when all their maternity beds are full. But Baptist East has a firm policy against any patient diversion.

"We have a philosophical difference with other hospitals in this and other communities," says Dana Dye, chief nursing officer at Baptist. "We are always open to accept patients."

Unlike some other hospitals, Baptist also unloads ambulance patients on arrival to free up the ambulance for other calls.

"We have a triage nurse who greets the ambulance and decides what kind of bed the patient needs," Dye says. "If the patient doesn't need to be seen right away, we take them off the ambulance and put them in a waiting area. The community is not well serviced by ambulances waiting at emergency rooms."

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