Getting to ERs Takes More Time

The closure of six emergency rooms in Los Angeles over the last 18 months has increased the time it takes paramedics to get patients to hospitals, the Los Angeles Fire Department said Monday.

Fewer emergency rooms means paramedics must sometimes drive farther to deliver patients and scramble to find facilities that can accept them, officials said.

The average drive time for Los Angeles paramedics as of March 2004 was eight minutes and 23 seconds, the lowest it had been in several years.

“But now it’s creeping up again because of the closures,” said Capt. William N. Wells, who addressed the issue at a city Fire Commission meeting. “Instead of eight minutes away, we have to drive nine, 10, 11 minutes away.”

And that’s just getting ambulances to the hospitals. Because the remaining emergency rooms have more patients waiting, paramedics often have to wait longer to hand over their charges to hospital staff. Last year, city ambulances waited an average of 35 hours a day for beds to open at local hospitals. Wells said the average wait was longer this year but he did not yet have final numbers.

The increased driving and wait times not only can affect patient care but also can cause ambulances and paramedics to travel out of their designated coverage zones, leaving less protection in case of a major fire or accident, said Los Angeles Fire Chief William Bamattre.

About 28 patients a day handled by the Los Angeles Fire Department would normally have gone to the emergency rooms in East Los Angeles, Gardena, Century City, Van Nuys, Duarte and Granada Hills that have been closed. Now they must be taken to neighboring hospitals.

The situation could worsen early next year as two more emergency rooms -- at Robert F. Kennedy Medical Center in Hawthorne and Suburban Medical Center in Paramount -- are scheduled to close. That will leave Los Angeles County with 75 emergency rooms, down from 94 a decade ago.

Hospitals all over the county are now filling up faster, said Cathy Chidester, assistant director of the county’s emergency services agency.

“It used to be that the times you had to wait in an emergency department were pretty much located in the inner-city area,” she said. “As time has gone on, it has spread out.”

Officials at the Los Angeles County Fire Department said they too have to drive farther to find open emergency rooms and have to wait longer at them, but said they did not have specific statistics.

“Any time there’s a delay, there’s a concern,” said Inspector Ron Haralson.

Fire officials said the extra drive time should not alarm the public because most paramedic calls don’t involve patients who face immediate threats to their lives.

In those cases, city ambulances sometimes drive up to 20 minutes across town to take an HMO patient to a specific hospital or to accommodate a patient’s request to go to his or her doctor’s hospital, Wells said.

Patients with the most serious injuries are taken to one of 13 trauma centers, which treat people with life-threatening conditions.

“Most times, there is no rush to get to a hospital,” he said. “The only real rush is the trauma patient.”

The possible closure of the trauma unit at Martin Luther King Jr./Drew Medical Center was a much bigger concern, Wells said.

King/Drew’s trauma unit handled 2,150 serious cases last year, including victims of car accidents and gunshot wounds.

In September, county officials announced their intention to close the trauma center at the hospital in Willowbrook, south of Watts.

Troubled for decades, King/Drew has been reeling in the last year from a series of lapses in patient care, including several that contributed to patients’ deaths, according to regulators. Adding to the problems, accreditors have ordered Charles R. Drew University of Medicine and Science, which trains doctors at King/Drew, to close three of its programs, including surgery.

County officials have said shutting down the trauma unit would allow healthcare officials to reallocate resources to other crucial hospital functions and to reorganize the institution.

Many local activists and politicians worry that the added time to take gunshot or stabbing victims to the next closest facility could lead to deaths.

California Hospital Medical Center is considering whether to join the trauma network and pick up 1,000 of King/Drew’s patients.

“California is welcome no matter what happens at King,” Wells said. “With the existing system, there is not enough capacity for the surges on Friday or Saturday night.”

The department-mandated limit for trauma travel is 30 minutes, he said. If paramedics cannot find a trauma center open within a 30-minute radius, they deliver them to emergency rooms, which are supposed to handle less serious problems, such as cuts and chest pains.

This already happens nearly every weekend, and paramedics try to deliver these patients to emergency rooms that are linked to trauma centers, Wells said.

If King/Drew closes, the situation will worsen, he said. City paramedics could end up delivering severely injured patients to emergency rooms at Memorial Hospital of Gardena or Daniel Freeman Hospital or Centinela Hospital in Inglewood.

“Those might not be set to take care of surgery right away,” he said.

The other alternative would be to deliver trauma patients to King/Drew’s emergency room, which would remain open. King/Drew might remain a de facto trauma center, he said. “They would receive some serious trauma without the capability or staffing to handle it,” Wells said.