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EMS providers brace for impact of ED shutdown

Rochester Business Journal
May 10, 2013

Lakeside Memorial Hospital's closure will stretch the resources of emergency medical services, but EMS providers say it isn't clear how much the loss of the Brockport hospital's emergency department will strain their organizations.
 
Most immediately affected by the loss of the emergency department are the village of Brockport, which includes SUNY College at Brockport, and the Brockport Volunteer Ambulance Corps Inc., which serves both.
 
The 15 or 20 extra minutes it takes to transport Brockport patients to Strong Memorial Hospital or Unity Hospital would not be the only time added to calls, said Brockport Ambulance president David Rice.
 
Longer wait times in the Rochester and Greece hospitals' crowded emergency departments add at least an hour more, turning an hourlong trip to Lakeside into a wait of two hours or more.
 
With one or both of the company's two ambulances tied up for longer periods, the corps could face challenges to maintain adequate coverage.
 
Effects of the Lakeside shutdown are likely to ripple out, complicating emergency medical service in the rest of Monroe County and in eastern Orleans County, Rice believes.
 
Though town and village volunteer companies and the for-profit Rural/Metro Corp. and Monroe Ambulance are individually responsible for specific parts of the region, the individual services form a whole whose parts often coordinate services, Rice said. A shortfall in one spot would be felt throughout.
 
"What happens to one part affects all the others," he said.
 
Added travel and wait times for Brockport's volunteer EMS providers also concern James Sauberan, chairman of the Brockport Fire Commission. EMS coverage of the village and its 8,000 residents is complicated by SUNY Brockport, whose undergraduate population roughly equals that of the village, he said.
 
Monroe County EMS coordinator Tim Czapranski shares their concerns. A critical factor, he said, is "drop time"-how long ambulances are out of service as they deliver patients to emergency departments.
 
EMS providers say dealing with the emergency departments of the big hospitals that serve Rochester often is more time-consuming than they might like. Turnaround times of an hour and a half to two hours are typical, and waits can be longer. Lakeside's department had the county's fastest turnaround times-roughly an hour in and out, on average. Extra travel time and extended drop time will challenge the Brockport volunteer company, Czapranski said.
 
Slower wait times at the city's big hospitals are not the result of inadequate emergency room capacity, short staff or inefficiency.
 
"The problem is there aren't enough hospital beds," Czapranski said.
 
Hospital officials have long acknowledged their institutions' struggles with occupancy rates routinely exceeding 100 percent. A shortage of beds for the admission of patients from an emergency department slows that department's operations.
 
Each of the four hospitals directly serving the city of Rochester-Unity, Rochester General, Highland and Strong Memorial-has completed a multimillion-dollar expansion of its emergency department and taken steps such as adding beds near the department to better accommodate patients who cannot be admitted. But EMS drop times can still be long.
 
Unity's occupancy rates have gone down, Unity CEO Warren Hern told the Rochester Business Journal recently. But the numbers look better only because the hospital is putting more patients under observation. The Greece hospital's actual occupancy rate is rising, he conceded.
 
It is not clear what further role Monroe Ambulance might play in western Monroe County. As an EMS provider under contract to the town of Sweden, which surrounds Brockport, and to Clarkson, which abuts Brockport, Monroe Ambulance temporarily has stationed an ambulance at the Lakeside emergency department to accommodate any people seeking service there since the hospital's closing. But that was slated to end today.
 
The two-week Lakeside watch has been uneventful, Monroe vice president Thomas Coyle said. But flu season is past and the college is about to wind down for summer break, so EMS providers recently have been in a lull of sorts, he added. Coyle expects demand to pick up and sees the additional wait and travel times because of Lakeside's closure as potentially troublesome.
 
For now, Brockport Volunteer Ambulance plans to continue its role as the village's EMS provider and expects to provide full coverage, Rice said.
 
Monroe stands ready to provide backup coverage as needed, Coyle said.
 
Despite voicing concerns, Czapranski said he is confident the area's EMS providers will pull together to meet challenges as they arise.
 
"We've survived upsets before. We managed when Genesee and St. Mary's (hospitals) closed," he said. "I'm sure we'll do it again."

5/10/13 (c) 2013 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email service@rbj.net.


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