On Tuesday evening, as emergency room waiting lists grew longer and longer, the Sacramento County Emergency Medical Services Agency made a game-time decision to enact its Level Two Expanded Emergency protocol to address the uncommon surge in patients.
It was the first time in more than five years that action of this level was required, officials said.
Starting in the early evening, UC Davis Medical Center began experiencing what it called an “extremely high patient volume.” Ben Merin, EMS coordinator for the county, said the facility was not alone.
“Every health care area was really busy yesterday,” he said. “It was raining, there were car accidents. Hospitals go through this regularly, there are upticks and slows. Yesterday was just a day when everything came together.”
When a facility reports concerns about high volume to the county, as UCD did Tuesday night, EMS can make a decision to put that hospital on diversion. That would mean closing that emergency room to new, noncritical patients, and routing all ambulances carrying noncritical patients to the nearest equipped hospital. Facilities would continue to take critical patients even during high-volume periods, Merin said.
Tuesday night, however, all the local hospitals were so busy that putting UCD on diversion would have just inundated the nearest facility and caused a cascade after that, he said. Instead, EMS chose to enact the level two plan, which mandates that noncritical patients be evenly distributed throughout all the emergency rooms in the county.
The county told each hospital to enact its surge plans, or individual protocols for handling busy nights. They also took charge at their control center, at UC Davis Medical Center, to keep an eye on how close to capacity each hospital was, Merin said.
Each time a paramedic picked up a patient, he or she called the control center to find out which facility to deliver to in order to keep the patient numbers evenly distributed. Normally, the paramedic would drive the patient to the nearest facility, or a facility of the patient’s choosing.
“The hospitals see surges all the time,” Merin said. “They manage those surges individually, just fine, all the time. Tuesday night it happened to be enough of the hospitals surging that it had a communitywide impact. So rather than having diversions happening, we enacted protocol to control that.”
But even with the even distribution protocol, the high volume was problematic, said Dr. Justin Wagner, medical director of the Sutter Emergency Department, in an email.
“This caused tremendous strain on the other hospitals in Sacramento County, which had to pick up the slack,” he said.
The emergency patient distribution method lasted for about four hours, and ended at 9:40 p.m. Tuesday. After that, ambulances returned to delivering patients based on standard protocol.
At UC Davis, eight elective surgeries that had been scheduled for Wednesday were canceled. The emergency department is accepting noncritical patients, but is taking patients transferred from other hospitals only on a limited basis, according to a statement from the medical center.
“As with all other hospitals in the Sacramento area, UC Davis Medical Center is experiencing an extremely high patient volume,” the statement said. “UC Davis Medical Center staff are working around the clock to ensure that every patient receives the appropriate level of care during this extraordinary period. Patient safety remains the hospital’s No. 1 priority.”
Kaiser Permanente issued a statement Wednesday saying its emergency department was no longer experiencing a surge. Dignity Health did not make representatives available for comment.