L.A. ambulance crews struggle amid bottlenecks, surging call volume

Like hospitals, ambulance systems in Los Angeles County are buckling under the surge of COVID-19 cases.

Bottlenecks, extreme wait times and sickened staff are among the issues facing the county’s emergency medical technicians, officials said, with at least one EMT waiting as long as 17 hours to offload a critical patient.

“While we’re trained to deal with crises, something like this has never been seen in anybody’s lifetime that’s in healthcare right now,” said Tom Wagner, west group president of American Medical Response, one of the largest ambulance service providers in the county.

AMR and Care, the county’s other major ambulance service provider, are responding to a combined 1,500 emergency calls a day, officials said — roughly 30% more than in earlier months of the pandemic, when calls decreased during initial stay-at-home orders.

The Los Angeles Fire Department, which provides ambulance services within the city, is responding to roughly 800 to 1,000 emergency medical calls each day.

“It really has been a dramatic surge in the last six weeks,” Wagner said. “The relentlessness of it is really putting a pressure on folks.”

The flood of patients, along with increasingly sick healthcare workers and the region’s lack of intensive care unit beds, are resulting in crippling delays when it comes to offloading patients at hospitals.

Before the pandemic, an ambulance could be back on the road within minutes of arriving at a hospital. Now EMTs are regularly waiting four, five and even 10 hours to offload a patient, according to Jeff Lucia, Care’s communications director.

“That’s time that a patient is on an ambulance gurney, which is a little uncomfortable for them, at a hospital waiting to be brought in,” he said, adding that even if Care were to put more ambulances on the road, most would end up just “sitting there.”

Dr. Marc Eckstein, EMS bureau commander at the LAFD, said the delays are piling up so quickly that the city is working to implement a new policy that will allow ambulances at over-capacity hospitals to offload patients onto portable cots whereby firefighter EMTs can monitor four or five people awaiting admission at the same time. It’s something they’ve never had to do before.

“Desperate times require desperate measures,” Eckstein said. “The goal is to be able to accomplish our mission, which is to respond to 911 calls.... We need to get ambulances back out in the streets.”

Ambulance crews are also experiencing a reduction in staffing due to the spread of the coronavirus. More than 170 of the LAFD’s responders are in isolation due to COVID-19, Eckstein said. “Several dozen” of AMR’s 500 L.A. caregivers are in various stages of quarantine on any given day, Wagner said.

Officials said ambulance crews now must assume every patient they respond to is COVID-positive — and many are. On Thursday, public health officials announced that 1 in every 5 COVID-19 tests in the county is coming back positive.

The L.A. County Emergency Medical Services Agency this week issued a directive advising ambulance crews to conserve oxygen for patients whenever possible, but Lucia said the long waits outside hospitals are using up oxygen from the small portable tanks within ambulances.

Both AMR and Care said they have developed contingency plans to redistribute oxygen and PPE supplies, if necessary, to prevent dangerous shortages.

The county’s directive also advised ambulance crews to not transport patients who have a limited chance of survival — a scenario that is increasingly likely as the number of sick patients climbs. Eckstein said cases of cardiac arrest more than doubled in November and December compared with 2019, which he called a reflection of the impact of COVID-19.

Although people should seek help when they need it, Eckstein said, it is incumbent on them to call 911 only when there is a real or perceived life-threatening emergency.

“The system is being really taxed right now, and we want to make sure we have resources for those individuals who truly need our services,” he said.

On Friday, nearly 8,000 people were in L.A. County’s hospitals with COVID-19, according to The Times tracker, a 17.7% increase from two weeks ago.

As it stands, the flood of sick patients and the delays in turnaround time are proving challenging for even the most ready of responders.

“People tend to [become EMTs] because they want a career helping people,” Lucia said. “To be sitting outside a hospital with a stable patient, while you know people are out there calling 911 and waiting for ambulances, and you’re unable to get to them — that’s pretty hard on our crews.”

Los Angeles County reported more than 300 new COVID-19 deaths Friday, its highest single-day tally to date.