Coping With COVID Overflow, EMTs Transfer Patients Out of Northern Tier Hospital

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BINGHAMTON, NY (WSKG) — As COVID-19 cases continue to rise, hospitals around the region are operating at or above capacity.

In Pennsylvania’s Tioga County, cases have grown steadily since late October. Numbers spiked last week when the county, which has fewer than 41,000 residents, saw 109 new COVID-19 cases in a single day. That’s according to data from the state’s Department of Health.

(AP Photo/David Goldman)

The rural county has a single hospital in Wellsboro. It’s part of the University of Pittsburgh Medical Center Susquehanna system.

The facility is a 25-bed critical access hospital, as designated by the Centers for Medicare and Medicaid Services (CMS). To receive CMS designation and benefits, eligible hospitals must have no more than 25 acute care inpatient beds, maintain an average patient length of stay, annually, of 96 hours or less, and be located at least 35 miles from the nearest hospital.

UPMC Wellsboro routinely transfers patients who need specialty care to larger hospitals across the Northern Tier and New York’s Southern Tier.

“Everybody is full”

EMTs carry out those transfers, delivering patients to health care providers across the region. Matthew Russell, a staff paramedic at UPMC Wellsboro and the chairperson of the Tioga County Emergency Medical Services (EMS) Council, said since COVID-19 cases began to surge, his team is transferring many more patients than usual.

“It’s just we don’t have the room. All our beds are full and that seems to be the common phrase from all the facilities,” Russell said. “Everybody is full.”

Nor is there a single area in the county from which Russell transfers patients.

“It has saturated the entire county,” he said. “There is no one corner or one little community that is better or worse off.”

UPMC Susquehanna has aided the Pennsylvania Department of Health’s contact tracing efforts by conducting its own for the network, which includes six hospitals across Potter, Clinton, Lycoming and Tioga counties.

David Lopatofsky, chief medical officer for UPMC Susquehanna, affirmed their testing did not indicate a single cluster of COVID-19 cases driving the spread of virus.

“We did see the uptick happening, but are not able to identify a single event,” Lopatofsky said.

COVID-19 hospitalizations in Tioga County increased rapidly after Thanksgiving. According to DOH data, up until Nov. 25, the Pennsylvania county hadn’t seen any hospitalizations related to the virus since mid-August. The number of hospitalizations on a 14-day average then spiked in late November, from 1 on Nov. 25 to 15 within three weeks.

Over the last few weeks, the Wellsboro hospital has operated between 95 and 110 percent capacity.

UPMC Wellsboro in Tioga County, Pa., is a 25-bed critical access hospital without the infrastructure to convert beds for overflow patients. (Provided by UPMC Williamsport)

“Similar to across the rest of the nation and the state, we are certainly experiencing the highest numbers and more crunch for capacity than we’ve been in anytime during this entire pandemic,” he added.

Limiting infrastructure

The majority of patients in the hospital’s six adult ICU beds are COVID-19 positive, according to Lopatofsky. State data show fewer than one adult ICU bed has been open and available in the county since the end of November.

Lopatofsky said over the last few weeks, there have been occasions when UPMC Wellsboro had more patients than beds.

Some hospitals have coped with the recent surge in hospitalizations by converting unused space, but UPMC Wellsboro doesn’t have the needed infrastructure. Instead, they must transfer patients to other hospitals in the UPMC network.

The closest one, UPMC Cole, in Coudersport, is a 50-minute drive away. UPMC’s largest facility, in Williamsport, is an hour’s drive south of Wellsboro.

Russell said it’s not uncommon for paramedics to take patients to farther hospitals outside of the UPMC system, like Robert Packer Hospital in Sayre or Guthrie Corning. With most of UPMC Susquehanna’s hospitals hovering around 90% capacity, those options are necessary.

“We have to start, or our physicians have to start, looking at facilities that are farther away, which increases our transport times as well,” Russell said.

Greater distances, however, limit the number of patients EMTs can transport in a day.

An ongoing EMT crisis

Prior to the pandemic, Tioga County relied heavily on volunteer EMS agencies to meet needs his hospital-based department could not, Russell said. However, there’s also a shortage of volunteers that predates the pandemic.

“The number of volunteers has dwindled drastically across the nation, not just here in Tioga County,” Russell said. “It’s a dying breed.”

He said part of the reason for the shortfall is economic; families could once live on a single income.  Now, they need two incomes, or more, to survive. That means fewer people have time to go through EMT training and volunteer in their communities, Russell explained.

“Now you add in the pandemic and fear of, ‘I’m going to put my PPE on and I hope I’m going to do it right every single time so that I don’t bring anything home to my family,’” Russell said.

The hospital’s professional ambulance service conducts transfers for all patients with confirmed cases of the virus. That way, fewer volunteer EMTs risk COVID-19. They can also then stay available in their communities for 911 calls, Russell added.

Russell said doing so comes with a learning curve, but it’s nothing EMTs and paramedics weren’t ready to handle.

“While we never anticipated it, we signed up for it,” he added. “That’s kind of the attitude most of us take.”