Covid surge impacts on ambulance cover and emergency department
CO WEXFORD was left without any ambulance cover for a significant period over the weekend as the Emergency Department (ED) at Wexford General Hospital struggles to cope with the demands of Covid-19, as well as all manner of other medical emergencies.
On Saturday night, the four ambulances serving the county were queued up outside the ED where they were unable to drop patients as a result of a combination of a lack of capacity and a need to enforce social distancing within the department.
A source close to the hospital described the situation as ‘chaos’ saying that it was now taking ambulances in the region of 2 hours to drop patients, as space needs to be found inside for them.
The ED currently has 12 separate rooms where patients can be put to separate them from others attending the hospital if they display any Covid ‘flags’ such as a cough or a temperature. While previously, patients would have waited on trolleys in the hall to be seen, social distancing requirements mean this is no longer an option and patients that arrive by ambulance must wait for a room to become free before they can be admitted to the emergency department.
Consultant in Emergency Medicine at Wexford General, Dr Mick Molloy once again urged people to only present at the ED in a genuine emergency and wished to get the message out that arriving at the ED won’t result in patients getting a Covid test any quicker.
‘The Covid tests aren’t done on site in Wexford, they have to go to Waterford which means a long delay before anyone can be admitted onto a ward in Wexford,’ he explained. ‘You have to have been tested before you can be put on a ward. In the past week, with the publicity around rising cases in Wexford, we’ve seen more people demanding Covid tests at ED. We don’t have the capacity to do that here. The public needs to understand that we can’t provide a rapid Covid test for the whole county.’
‘What we’re seeing is that a number of the people calling for an ambulance are people who could potentially get to the hospital under their own steam. There seems to be a perception that they will be seen quicker and get and get a Covid test right away if they arrive by ambulance and that’s simply not the case. We only Covid test people who are being admitted to in-patient wards. Genuine emergencies will still be seen quickly, but those who can afford to wait, will likely have to wait a long time.’
Speaking of the situation over the weekend, Dr Molloy said: ‘Capacity is a major issue. Previously you’d have patients examined in the corridor because there are no rooms available to see them. Things are made a lot more complicated by the current requirement to maintain distance with patients. We try our best to offload ambulances as quickly as possible, but on Friday night I was discharging patients from the back of the ambulance without them having visited the emergency department at all.’
Dr Molloy says that capacity at Wexford General is a major issue and one that goes back long before the arrival of Covid-19.
‘This hospital has a capacity in the region of 225 beds,’ he said. ‘I think at University Hospital Kerry, where there’s a similar population to Wexford, there’s 377 and they also have the Bon Secours in Tralee. Here we just have Wexford.’
‘On average we see around 123 or 124 people per day at the ED here. There certainly is a capacity deficit in smaller regional hospitals if you compare them to others. It’s something that was brought to the attention of the authorities a number of years ago, but the building programme is still awaited to deal with it.’
‘There are concerns that smaller hospitals are being left behind in responses (to Covid). It’s all geared up to respond in larger hospitals in the cities, but not by allocating funding and providing capacity in rural areas where there are not multiple options in terms of hospitals available to patients.’
Apart from capacity and the number of beds available to take patients, staffing is also another major issue for hospitals like Wexford General.
‘Another perspective is that if staff happen to contract Covid here and need to isolate, we don’t have the layers of people to cover these deficits like they do in Dublin,’ Dr Molloy explained. ‘There, people work between a multiple of hospitals. We need a contingency plan in place for the likes of Wexford General. In terms of nursing staff, Wexford operates with half of the staff of Dublin hospitals that would see similar amounts of patients. For that reason, we don’t always have the staff to answer medical queries from the public by phone or to provide information on family members that have been admitted to hospital. If we were to do that, we’d be on the phone all the time.’
Dr Molloy describes the issues facing Wexford General as ‘very complex’ and says that there is no quick fire solution.
‘We’re as busy and understaffed as we were last year,’ he said. ‘There would have been occasions where ambulances were backed up last year too. The only thing that’s new is the added difficulty of having to allow for social distancing.’
While things are only likely to get more difficult as winter closes in, Dr Molloy says that the only option is significant investment in hospitals like Wexford General.
‘It needs to be done properly,’ he said. ‘They will have to build on with the capacity to deal with another pandemic. We may get a vaccine for Covid next year and things will improve, but there will be another pandemic and we need the proper facilities and to be prepared.’