1.6.21 Press Event Ambulance wait times

County of Santa Clara
January 6, 2021
Press Conference: Post-Holiday Surge Causes Hours of Waiting for Ambulance and Hospital Care

Just going to give everybody a minute to get set up  I'll start by saying happy new year and let me just talk about the purpose of today's press conference.

I know that people ... first of all my name is Cindy Chavez. I'm on the Board of Supervisors. I'm president of the Board of Supervisors until next Tuesday, so um so I'm really delighted to be with all of you, uh to talk today, but the. But the um point of today's press conference is to have a conversation with the public about what we're experiencing in the hospitals, and I know that people are, they don't want to have their, our, us wagging our fingers at you, and this is not about new rules, this is really about sharing with you what our health care system is experiencing, and asking for your leadership and helping us, as a community to address it.

We know that we're we're seeing a continued surge, and this is critical right now, because the county is busy doing two other things, getting people vaccinated, and making sure that we have people continuing to get tests, so we want to continue to ask the community to get tested, and vaccines are beginning to be administered.

But today's focus is on our emergency medical system, and you're going to hear today from doctors and our county council just to help everybody navigate through the next few weeks and to better understand what we're experiencing. I first want to say a very sincere thank you to our healthcare personnel. They have been complete heroes, and I'd like to introduce Dr Ahmad Kamal, Santa Clara County's CVODI-19 Director of Health Preparedness, then Dr Jeffrey Chen from Santa Clara Valley Medical Center's emergency room, then Daniel Franklin the EMS Duty Chief of Santa Clara County, and our closer today will be our County Counsel, James Williams. So with that, let me begin by asking Dr Kamal to come forward.

Dr Kamal: Thank you, Supervisor Chavez, and good morning everybody. Our health care system continues to be under an enormous amount of strain every day in our county more than 1,000 people are diagnosed with COVID-19 and more than 100 people are admitted to the hospital every single day. This surge has been relentless and it has not stopped, and it is training our health care to a breaking point. As of right now, patients are waiting in emergency rooms to be admitted because there are not enough beds for them. As of right now, staff are being pulled from other areas of the hospital to provide care to critically ill patients, this means that other patients who also have needs are having to go without. Hospitals are cancelling surgeries. Hospitals are cancelling outpatient visits these all have effects, and we cannot have it continue. We need to all work together to contain the surge, and give the hospitals a little bit of breathing room, so that they can recover and go on with other other critical tasks that our healthcare delivery needs to do, including vaccinations, including testing, and including outpatient care. We know how to do this. We've done it before. We did, we did it in the spring

It's been a long, hard winter. In many ways January maybe the hardest month for us yet, with the impact of three holidays being seen in the hospitals. Please, we're asking everybody do what you can, wear your masks, wash your hands, socially distance, and avoid large gatherings, and together we can help these hospitals avoid further strain and avoid our physicians having to make further difficult decisions, when it comes to caring for our community. Thank you.

Dr. Chen: Good morning, everybody. My name is Jeff Chen. I'm the E. D. Medical Director, here, at valley medical emergency department. um I'm here today to speak to everybody about what we're experiencing in the emergency department. In the ER, we've been fighting this fight for almost a year now. It hasn't gotten any easier, if anything, has gotten harder as time has gone on. The staff is fatigued, they are tired, they are drained, physically, emotionally in every way you can possibly imagine, but they continue to stand they are day in day out, resolute, to make sure that the highest quality care is rendered to every member of this community who needs it. We're resolved to get this done, but we need everyone's help. The ER is full. Folks are waiting for beds. We've got, we are getting really creative with places to see patients, and patients are suffering. COVID is no joke. Folks are struggling to breathe. Folks are gasping for breath. Some folks look like they are drowning while they're sitting there in bed in front of us, and there's a very finite amount we can do to fight this new virus. So everyone likes to call the emergency providers, the healthcare heroes, the first line of defense against COVID! Folks, I'm begging everyone to help us out here, because we're not the front line we're the last line we need everyone's support so that we can continue fighting for and with everyone here. Thank you.

Daniel Franklin: Good morning. Daniel Franklin, EMS Duty Chief for Santa Clara County. As you've heard our healthcare system is currently inundated with patients this also includes our 911 system, and how it's impacted us, is with the hospitals continuing to fill with patients, we have less beds available in the emergency departments to transition care from our ambulance crews to the hospital staff. This has increased our wait times at our hospitals with our ambulance patient offload. What this means for the public, is we've had experienced less ambulances available in our 9-1-1 system because they're currently waiting at hospitals. What we are asking the public to help us with is to think about calling 9-1-1 and if you do need to call 9-1-1 think about whether or not it's an appropriate use of 9-1-1 services. Every day we get many calls into our system that are really not 9-1-1 life-threatening medical emergencies, oftentimes these could be handled through an urgent care clinic, by contacting your primary care physician, and setting up an appointment, and so if you are going to be utilizing 9-1-1, we just ask that you think about it and say okay "is this truly necessary?" or "is there another avenue where i could seek care?" We want to be able to have ambulances available in our system to handle every life-threatening emergency. We want to be able to take care of those that live work and play in our system, but we need the public's help in doing so i as you heard from our health care professionals, we need people to mask up, we need people to social distance, we need everyone to come together and help stop the spread. We just want you to be aware that it is also impacting the 9-1-1 system! We are going to continue to do everything that we can to help those that need our true life-threatening medical emergencies, um so please just help us with stopping the spread, and think about whether or not it's truly a necessity to call 9-1-1 or not. Thank you.

James Williams: Good morning. My name is James Williams, and i'm the County Counsel for the County of Santa Clara. You heard this morning about the strain that the number of cases and COVID hospitalizations is putting on our entire health care delivery system, including our ems system, when you call 9-1-1 and need emergency medical care. We are at an unprecedented level of cases and hospitalizations coming out of the thanksgiving surge, and we are extraordinarily concerned about what might be coming in the next few weeks, cases that we are yet to identify, coming out of the holidays and new year's, and what that might mean for increased hospitalizations a few weeks, thereafter, starting from what is already an unprecedented high level of hospitalizations that is putting so much strain on our health care system. What does that mean to people like you and me? Well, it's not just a matter of ensuring access to care for people with COVID-19, although that is of course, very, very important. But we take for granted having access to an ICU bed, having access to a paramedic, and an ambulance, having access to whatever care we need walking into an emergency department at a hospital, whether it's a car accident, a heart attack, a stroke, any other thing that might happen to one of our loved ones or ourselves, at a moment's notice. We take for granted that we have access to world-class top-notch care with all of those resources fully available, and unfortunately, right now, although we still have that world-class dedication and professionalism, we have incredible strain on the system, and with that strain the access to those resources is inherently diminished. As a community, we know what we can do to beat back COVID-19, and as vaccination programs ramp up in the coming weeks and months, we know that the tools that we have that work today, right here and right now, those tools are to stay at home unless you're doing essential business, and when you're out an essential business, to where your face coverings, maintain social distancing. We know all that! But it's hard. Months and months and months in, it's hard uh when we're seeking the you know the hope of the vaccinations coming in the next, coming months, but between now and then, we want to get there together as a community, with all of our friends, all of our family, all of our loved ones, and the way we can do that is by doing what we so successfully did in March and over the summer, and once again, beating back this surge in COVID-19 cases and hospitalizations, but then I'm going to turn it back over to Supervisor Chavez.

Sup. Chavez: Great. Thank you.

So if if there are any questions, we're happy to answer them. If you're watching on Facebook, you can text Beth Wellon at 408-660-5174, so are there questions from anyone?

Media question: (too low to hear the question)

Sup. Chavez: Are you talking about in terms of EMS services? I'm gonna, I think i'm gonna turn that over to James, just to make sure he's we're accurate about that.

JW: Yeah so we don't we don't have a new update uh regarding Kaiser, um other than we're continuing our investigation, as cases are reported in, and we know that Kaiser is continuing its testing. uh as I think they have shared that they're they're doing comprehensive testing, as that outbreak continues. It's a really tragic situation, and you know, we do of course monitor outbreaks at work sites, including healthcare sites across the county, and, and look right now with the level of cases that we have, there are a lot of outbreaks at work sites, including healthcare settings all across the county. uh There is a very high level of COVID transmission right now in the community. uh There's never been a higher level, and so we're seeing that, certainly true, at different healthcare settings, but at every single kind of work site that's open. There's just a large, large, large volume of cases.

Media question: (too low to hear the question)

JW: uh We, we are aware of an of a number of cases at St Luis. They have a comprehensive testing program. All the county hospitals do, and have for quite some time, and so those do catch uh cases, and I believe currently we're aware of about eight cases on the staff there.

Media question: Any other cases showing up at all at other hospitals.
JW: I don't have the exact data on that, except to say that there are regularly cases at hospitals, and that's actually one of the reasons why the federal government and state government have prioritized health care workers in phase 1a of vaccination, and we're very pleased that many acute care hospital workers have already received their first dose of the vaccine. Now it will take time for that to be effective, because they need to also get their second dose, and it takes you know several days after that to reach the the um level of immunity that's been described in the very studies. But we're on that pathway, for that workforce, which is of course, extremely pivotal at this time, when those same systems are under strain.

Media question: Can you talk about or paint the picture of what the ICU/ER situation looked like pre-thanksgiving and then the the past couple weeks ramping up? compare and contrast, what it was like from then until now?

Dr. Kamal: As far as a number of cases is concerned, to give you perspective, before Thanksgiving and in October, we were hovering about four to five cases per hundred thousand people, and now we're well above 50. It is ten times worse than what we had before. This has been a very long pandemic, but January is by far the most challenging month we've had, and the reason we're talking to you today, is as awful as it is, it could get worse, and there's no other way to say that. Right now, we haven't been in a situation where there's two people gasping for breath and only one of them gets a ventilator, we could get there.

Media question: ... situation, how unusual was that spike there and to what extent are other ERs around the county uh vulnerable uh susceptible to the same kind of scenario?

Dr. Kamal: So all the emergency rooms and all the hospitals do have employee testing programs that are mandated at various government levels, but as James said, when you have so much gold in the community, we are all vulnerable. We're vulnerable if we're in an emergency room. We're vulnerable in the community. We're vulnerable everywhere, so clearly, the way to really address these hospital outbreaks, is to control covid in the greater sense, and to reduce the transmission that's happening everywhere.

Media question: And more patients every day does that also ramp up the risk for health workers at these hospitals?

Dr. Kamal: absolutely exhausted health workers, people who are just rushing from patient to patient, people who are having to rapidly turn over beds ... none of this is conducive to having the level of care that we would expect, and as you've heard today, we have amazing healthcare professionals, working in world-class hospitals, but every system has its limits. We are pushing that limit right now. And we talk a lot about crisis care and surge care, and even though things like sharing ventilators or rationing ventilators, are the extreme example of that, there are levels that are happening now. You're seeing it in people waiting in ambulances for hours. You're seeing it in people sitting in beds and gurneys in emergency rooms who do belong in an ICU bed, so we definitely have a lot of concerns about where we are, and we have great concern about where this could be headed.

Media questions: (unclear, multiple people asking at once)

Sup Chavez: You know i think that you know one of the concerns that i have as a member of the board of supervisors, is making sure that all of the hospitals, and everybody who has access to vaccine, is getting that vaccine out as quickly as possible. I think right now, the, our staff and the staffs of the hospitals are working really hard to collaborate. What, but the reason that you heard that term about finding, was my concern, that if in fact we find a lack of collaboration that, i'm, myself and other colleagues on the board, are going to be asking our staff to be much more aggressive in ensuring that vaccine gets out, using whatever means that are available to us to do so.

Well right now, right now, everybody's doing what they need to be doing. If we get a sense that people aren't getting that vaccine out as quickly as we can, then we're going to be acting, or we'll be asking as a board for the staff to act. um are there any other questions, because i know Beth has some. oh kit i'm sorry.

Media question: Yes um it seems to me just from looking at the dashboard, like the uh the daily case count and the rolling seven day average, seems to be trending down a little bit, am i, am i crazy when i see that? and what are you attributing that to do you think that, is just um holiday sort of break time in in the testing? or is the vac, or are we seeing some effect from the vaccine right now?

Sup. Chavez: Well i think i'm going to let James.

JW: so the question was related to the current case counts. A couple things first of all, we're definitely not seeing any effect from the vaccine. A very, very, very small portion of the population has been vaccinated, and essentially zero has received the second dose, so it's going to take some time. But the question was really, what's going on with the case counts, we had reduced testing over Christmas and New Year's, because of the holidays. Almost all testing providers were closed for the holidays, so we expected to see a dip in case counts, related to the reduction of testing, and we also don't expect to see cases show up on the dashboards for at least 10 days, two weeks has been more typical from when an event occurs, and that's been consistent throughout, and that's because it takes time of course for someone to test positive, and then it takes a little time for those results to come in and show up, as well. So if you put all those pieces together, I think we're not going to get a good picture of what may have happened or not happened, around the holidays and New Year's, probably until sometime next week.

Media question: (too low to hear the question)

JW: So the question's about the new state health order that was issued yesterday. This is an order addressing hospital surge, the state is mandating that hospitals that are basically in a formal crisis care mode, try to transfer patients out elsewhere in the state, and that hospitals that are not are mandated to try to accept those patients where possible, that will affect of course Santa Clara County, as well as all other counties in the State of California. We're still learning more about how that will exactly be operationalized, but it is dependent on the specific circumstances at each hospital, as well as with respect to each individual patient. A patient transfer is an individualized determination, and so those will be made through the normal state mutual aid systems.

Media question: (too low to hear the question)

JW:  So the question was about the the source of the outbreak at Kaiser, and all i can say at this time is that's still under investigation.

Media question: What are some of the things the County is doing to help the hospitals prepare, if this continues to rise? What are there some of the practical things?

Dr. Kamal: So the question is what is the County doing to help the hospitals prepare? so we have been working with the hospitals, since before March, to prepare for the scenario we are in right now, um specifically, we have helped them with procuring ppe, so that, if you remember back in the spring, there was a huge concern about ppe shortages. We are thankfully no longer in that state, where we have actually been able to procure ppe, and the supply chains have stabilized. Secondly, we have also helped with hospitals, in terms of preparing their surge plans, deciding how they will ramp down some services to make sure that they can accommodate the most critically ill patients. Thirdly we have worked with them on distributing some novel treatments for COVID-19, including antibody treatments, um including remdessevier, which have helped somewhat, in their ability to treat patients. And fourthly, and the most challenging, is around staffing and that's the one thing that has been really challenging throughout this pandemic, and we continue to work with them and with our state partners, in order to try to secure staffing, because that's really the rate limiting step right now, and how much the hospital are able to surge and unfortunately, unlike ppe and unlike medicines, you can't manufacture staffing in the factory. There's a limited amount out there, and we're doing our best to try to draw what resources we can and share them.

Medi question: ... order equitably going to be extended or as of right now does it expire on friday?

JW: so the question is, when does the the state home order expire? The order has been is in place here in Santa Clara County through the state's regional stay at home order that currently, it ends january 8th, but the state has made very clear that it will be extended if ICU capacity projections remain below 15%. The state has already extended it in southern California and central California, and we have every indication that it will be extended here in the Bay Area as well, because the hospitalization situation has not improved since it was issued.

Media question: (too low to hear the question)

JW: so that there's a question about vaccination distribution planning. The the planning, related to the vaccinations, is happening in phases so the the centers for disease control and prevention has issued specific guidance breaking up eligible populations into different phases 1a, 1b, 1c, 2. The state is developing guidance they've already issued the guidance for phase 1a, which is what we're in, which is healthcare workers and they're developing guidance with respect to the subsequent phases we have to build our plans based on that directive from the state and work is well well well underway to to provide for that including deep into phase 1b 1c and phase 2, which will be the general population. So it'll be some time, since we're still in the early stages of phase 1a, but we are very much know that that many people in the community are eager to be vaccinated, and we are very very eager to see vaccinations happen on a mass scale.

Sup. Chavez: just so we can respond to that one too. the Board, um both, Supervisor Sumidian and I have asked for the the both Supervisor Sumidian and I have asked for a plan to come forward to the public, even if it's not perfect, just to respond to that point, and recognizing that, if the more information that we can get out through all of you, so that people understand the vaccines are on the way, when their turn will be, that we think it's going to help people feel more comfortable and confident about how you know how long we're going to be suffering from COVID-19 as a community. The other thing i would just recommend is the the staff has done a tremendous job of really act pivoting with you know with vaccines arriving and and getting people vaccinated, and i think have done a really noble job if you look around the country we're a little bit ahead of everybody else, in part, because we have such strong leadership from from the County. That being said, on on Tuesdays at our Board Meeting, they're always at times certain there will be a discussion about vaccines and getting being able to get an update, so i would just recommend that at our Tuesday board meeting at one, that you tune in, you'll learn more about where we are with vaccines.

Media question: (too low to hear the question)

Sup. Chavez: I'm going to let Dr. Kamal answer that.

Dr. Kamal: the county and other hospitals in the county have been using staffing agencies, and these staffing agencies source from all over the country. So we currently do have nurses working in our county from all over the country, however, the competition for these resources is quite intense, and um it's it's it's just a limited supply, in general, but we certainly are looking throughout the country to try to get staffing.

yeah the need is here right now, and so we certainly could use more nurses, and i think that we all know within california, southern california has perhaps even a greater need right now, but there is also a state level program of um calmat uh which can help with resources, as well, and we have been drawing down on that, as well. But you are right, in the sense that those resources do get allocated to great, places with the greatest need.

Media question: what is the average wait time right now for a bed at a county hospital once someone arrives at the ER?

Dr. Kamal: i don't have that data with me it's certainly something that the hospitals may be able to provide you what i can tell you is that the wait time in the emergency room is directly proportional to what's happening outside of the emergency room, so when you have a hospital that's full, and there are no beds available, that increases the wait time, so it's this continuum of care that starts, as Mr Franklin said, from the EMS system to the emergency room, to the hospital, and then to discharge. And that entire system right now is strained from beginning to end, and that's really what's causing wait times in the emergency room to increase.

DF: In regards to wait times that ambulances are seeing at hospitals ... during the month of December, we had, we actually have a report right now, that's been posted up on the santa clara county ems agency's website. You can actually get on there and see what the average wait time for each of our hospitals were, based upon what the ambulances were experienced. But we've seen wait times, anywhere between an additional 30 minutes, where we even had a case during the month of December, which it took eight hours to offload one patient, so it's it's been fluctuating, obviously based upon time of day and what the hospital is experiencing. um some patients, if they're a trauma, yeah they might be getting in very quickly, other patients with lower acuity uh lesser non-life-threatening symptoms, they may be waiting for quite some time. There's also a common misconception that if you go to the emergency room by ambulance that you're going to get seen quicker, and i want to dispel that, because that's not the case, the hospitals will triage each patient that comes in regardless if they're a walk-in or if they're brought in by ambulance, and then they're going to be treated based upon the acuity of the care that they need. So some of our patients we've been bringing in by ambulance have gone out to the waiting room, so just to make sure i dispel that.

Media question: follow-up question um of the of the calls that come into the 9-1-1 center, how many calls on a daily basis? and also you mentioned earlier, um the push to get more people to think before they make that phone call?

DF: yes

Media question: so what percentage would you say of the phone calls that come into the system, uh are are cases that can be handled by calling a primary care physician or going to an urgent care facility?

DF: Great question. um so we also have a report up on our agency website which is open to the public, anyone can get on there, it's called it, and it's you can actually see how many transports we have done each day, based upon, and also how many uh ambulances are being uh sent to each hospital. To give you kind of a figure, our, our current cancellation rate is about 33 percent, so one-third of the calls that we respond to, we actually do not result in a transport, but that could be for a multitude of reasons, it could be that the patient elected to have a family member drive them to the hospital, it could be that the patient didn't call 9-1-1 someone else called 9-1-1 on their behalf, and they truly weren't experiencing any medical emergency. um in the month of December, we were averaging about 230 transports every day in our 9-1-1 system, and then we're averaging about 350 to 400 9-1-1 requests each day in Santa Clara County. So just to give you some numbers. Anything else?

Media question: you have uh workers who are working at several different hospital,because of staffing,etc. is that going to continue given the current outbreak that we're seeing in kaiser St Louise etc?

Dr. Kamal: so it is true that many workers do work at multiple sites. There's really no way around that, given this tremendous staffing crisis we're in right now, we need all hands on deck, but clearly every place where a healthcare worker is employed, needs to have a comprehensive infection control program, needs to do testing to keep both the workers and the patients safe.

Sup. Chavez: Thank you everyone.

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