Patient spike prompts ER diversion

EL CENTRO – A sudden spike in the number of COVID-19 positive individuals seeking emergency treatment on Monday night at both local hospitals prompted one facility to divert several patients outside of the county for treatment on Tuesday.

At El Centro Regional Medical Center, a total of 14 additional COVID patients presented themselves Monday night to the emergency department, adding to the 50 patients who were already hospitalized there.

The increase prompted ECRMC on Tuesday to transfer seven of those patients elsewhere to balance its resources so that it could keep responding appropriately to other types of medical emergencies.

“We are taking this one day at a time, and it’s unknown how long the diversion will last,” ECRMC Chief Executive Officer Dr. Adolphe Edward stated in an email.

A so-called diversion occurs when a hospital’s emergency department is unable to accept new patients by ambulance. When both hospitals are on diversion status, ambulance patients will be taken to the nearest available hospital.

Locally, the patients were being transported by AMR, a medical transportation provider under contract with the county and hospitals.

The influx of individuals seeking emergency treatment locally is attributed to residents of Mexicali who are U.S. citizens and who were reportedly turned away from hospitals there on Monday, Edward said.

At ECRMC, those who seek emergency treatment and are suspected of being COVID–positive will be triaged in tents that are set-up for that purpose. The patient’s disposition will depend on the severity of the disease, Edward said.

At Pioneers, an additional six COVID-positive individuals had sought emergency care between Monday night and Tuesday morning, prompting the facility to temporarily consider diverting patients as well.

By Tuesday afternoon, it was in the process of arranging rooms and staff to accommodate those individuals who had been waiting in the emergency room waiting for admission.

“I hope within hours, most will be placed and diversion will be cancelled,” said CEO Larry Lewis. “All our patients are currently being accommodated, but that’s not to say what might be arriving today and tomorrow.”

Should the need arise for Pioneers to divert patients, it would discuss alternate care sites with Scripps Health’s transfer center and expand beyond as needed, he said.

Lewis also clarified that even in the event hospitals are diverting COVID-positive patients from the region, those presenting symptoms should not seek care elsewhere if they have conditions that need emergency care, or require an emergency physician to advise.

“Making their own diagnosis could lead to critical errors,” Lewis stated in an email.

Currently, the county Emergency Medical Services Agency is working closely with local hospitals and EMS providers to monitor the situation.

As a member of the California Medical and Health Mutual Aid System, the county has access to additional transportation resources, including both air and ground ambulances.

As a result of the current situation, the EMS Agency requested and received an Ambulance Strike Team, consisting of a team of five ambulances with a team leader, to support the county’s EMS transportation needs, said Janette Angulo, county Public Health Department director.

On Tuesday evening, the county reported 902 total positive cases, of which 490 were considered active, and an increase of 16 from the day prior. Three additional deaths were reported on Tuesday as well, bringing the total to 18.

In Mexicali, a total of 1,463 positive cases were reported Tuesday evening, along with 134 deaths, the state government reported.

Public health officials tasked with interviewing COVID-positive individuals to determine who they have come in contact with before their diagnosis also record a patient’s city of residence.

For those who reside in Mexicali and may be hospitalized in the Valley with COVID-19, the instance would apply to Mexicali’s total of positive cases, said county Board of Supervisors Chair Luis Plancarte.

Between May 10 and Sunday, the seven-day average of daily percentage change in the total number of hospitalized COVID-19 patients was 1.4 percent, lower than the 5 percent maximum the state had established as a threshold for counties as part of its recovery plan, Angulo said.

Over the past three days, that average appears to have increased by about 48 percent, which could translate as a 7 percent, seven-day average, Lewis said.

“While this is not the official calculation, it may be fairly close,” he said.

Regardless of where a person resides, or the status of their health insurance, local hospitals are committed to providing care to those who need it, officials said.

Pioneers is currently equipped to manage 28 intensive care unit (ICU) patients, and on Tuesday had 11 total.

It is in the process of acquiring additional resources from the state that would allow it to accommodate additional patients. The hospital also has the capacity to operate 30 ventilators. As of Tuesday, 10 were in use, all of them by COVID-19 patients.

“The most critical resources needed right now are critical care nurses and respiratory therapists,” Lewis said. “We are expected to see some arriving from the state resources in the next few days, but are reaching out to registry agencies for a longer-term solution.”