The calls have been relentless. This patient needed to be flown by plane to the Bay Area for care — did he have a crew? That patient was awaiting transfer by helicopter to Santa Barbara for treatment. Could they swing it?
“Everyone’s tired because this has been going on for so long,” said Sergio Cardenas, a longtime flight nurse who now serves as Reach Air Medical Services’ program director in Imperial County, a swath of agricultural land wedged into the southeast corner of the state against Mexico and Arizona that has become the California county hit hardest by the coronavirus pandemic. “We see this as a marathon, not a sprint.”
For years, the company has helped the state move patients from hospital to hospital, flying people who had suffered bad heart attacks or traumatic injuries that required more care than the county’s two hospitals could provide to places like San Diego or Palm Springs. Then COVID-19 hit. In recent weeks the company has been transferring patients overwhelmingly battling the highly infectious disease to distances farther than before — including to places such as Silicon Valley.
“COVID is a different animal,” Cardenas said.
According to the California Emergency Medical Services Authority, at least 15 people have been moved from Imperial to hospitals in the Bay Area. UCSF — which has relatively low numbers of coronavirus patients and can offer highly specialized care — said this week it had received at least three. Stanford has also accepted patients.
The process of transporting patients isn’t new to hospitals and health care workers, and California has a process in place for figuring out who should go where.
“As a state with a high risk of earthquakes and wildfires, this type of system enables us to respond to large-scale emergencies,” said Adrienne Green, UCSF Medical Center’s chief medical officer.
But with the number of coronavirus cases across the Golden State soaring above 237,000 and hospitals in Imperial County at capacity — and with nearby hospitals in Riverside and Los Angeles also filling quickly — the system has been tested as never before.
At least 500 patients have been transported out of Imperial County during the pandemic. One night, Cardenas said, his team mobilized five or six helicopters and three or four planes to move patients.
Before the coronavirus hit, transfers typically took three-and-a-half hours. Now, with flight nurses and flight paramedics having to put on and safely remove masks, gloves, gowns and goggles in the searing desert heat, the process can take hours longer. And at times, he’s had to tell hospitals they’ll have to wait because “we just don’t have anybody.”
Imperial has become the entryway for U.S. citizens living in Mexico seeking medical care. Around 7,000 people in the county have contracted the virus. More than 100 have died, with almost one in four people tested turning up positive.
Recently, Green said, Imperial County reached out to San Francisco’s public health department for assistance. So did Marin County, where an outbreak at San Quentin State Prison has sickened more than 1,000 inmates and sent officials scrambling to find hospital space, including by reopening a surge site at the beleaguered Seton Medical Center in Daly City. UCSF has taken at least four patients from the prison.
Hospitals can also reach out directly to other hospitals, according to Stanford Health Care’s associate chief nursing officer, Rudy Arthofer, who oversees transfer care at Stanford. And in a disaster scenario like the ongoing pandemic, state agencies can step in.
If a hospital needs help with intensive or specialty care, they request that. If they’ve run out of capacity more generally to provide what’s known as acute care, they will ask for help with that. Very sick patients in Imperial County might not be stable enough for, say, an airplane trip to San Francisco International Airport. So they might be transferred by ambulance to an adjacent county, like Riverside, instead.
But as fewer hospitals have space to accommodate transfer patients, the logistics of getting everybody the care they need get more complicated.
According to the state’s hospital data, Imperial, which has fewer than 300 beds and a couple of dozen ICU beds, was down to zero ICU beds on June 22, a figure that has since fluctuated but remained low. At the end of June, Riverside, which has roughly 385 ICU beds under normal circumstances, had filled nearly all of them. And health officials are warning that the more than 2,000 ICU beds in Los Angeles could be full in weeks.
As hospitals in the Bay Area prepare to accept more transfer patients, they’re also trying to balance the need to provide specialty care.
“As we begin to receive more COVID-19 transfers we are also trying to maintain our ability to provide this other much-needed service to patients across Northern California,” Green said.
Counties and hospitals keep track of not only how many beds they have available, but other resources like personal protective gear for health care workers and medication, like remdesivir, one of the first drugs that has shown promise to treat the virus but one that is in short supply.
“Because the number of COVID-19-positive inpatients at Stanford Health Care is still low (16 as of June 30), medication supply levels, including remdesivir, are not a concern in the decision to accept transfer patients,” Arthofer said.
The state is closely tracking and moving resources, too, from health care workers to equipment like ventilators to supplies. If local and regional resources run low, the state can step in to fill the request from elsewhere or seek assistance from the Department of Homeland Security’s national stockpile of supplies.
“This is a new day and age, and it’s been a lot of learning for everybody,” Cardenas said. “A lot of people say take care of yourself, but even on your days off, you’re not really off because you’re trying to prepare mentally for tomorrow.”
