What happens if you are involved in a car accident or fall and injure yourself? Emergencies aren’t something most people think about much, until they have one. Though you may not need emergency services today, you still expect them to be there when you do need them. It’s a good thing there are so many talented and dedicated people on the northshore working behind the scenes to make sure you get the care you need, when you need it.
Overcrowding in the ER
The northshore has faced many issues dealing with population growth since the event of 2005 called Katrina. But that’s not the only reason for overcrowding in the region’s emergency rooms. Other likely factors include an increase in people using the emergency room for non-emergencies, patient flow issues, and unusual events such as flu outbreaks.
“We saw an initial increase in volume due to Katrina because of a surge in population and migrant workers coming through,” said Dr. Chad Muntan, Emergency Department Medical Director for Lakeview Regional Medical Center in Covington.
“A problem unique to St. Tammany Parish is the influx of patients from Mississippi. They’re hitting all the emergency departments on the eastern side of the parish and they’re coming in without notification,” said Frank Jordan, EMS Coordinator for Fire District #4 in Mandeville.
“We prepared for the future of our community. Our patient volume in the ER is up 20 percent over last year,” said Tania Loumiet, RN and Emergency Department Director for the Louisiana Medical Center & Heart Hospital (LMCHH) in Lacombe, which completed a major expansion earlier this year, doubling the size of their ER department to 20 beds and making their ER the largest in the parish.
“We’ve definitely seen growth from five or six years ago seeing 30 patients a day to now seeing 50-60 patients a day,” said Muntan. Lakeview Regional’s ER has 12 beds and currently sees about 19,000 patients a year and according to Muntan, “We are right at our bursting point now”.
North Oaks Medical Center in Hammond has an emergency room that was designed to accommodate 40,000 patients a year, but is now serving 73,000 patients a year. Other area hospitals report similar trends.
“We are seeing record numbers of patients in the emergency department. Overcrowding has been an issue, but we have seen great improvements since a year ago due to new management techniques and some physical layout changes,” said Sam Caruso, Director at Slidell Memorial Hospital.
Area hospitals are doing what they can to address overcrowding by streamlining patient flow. Muntan said Lakeview has created a new 5-bed admissions area in their emergency department to increase efficiency and cut wait times. “All ERs struggle with patient flow. We try to be proactive,” said Loumiet of LMCHH.
Most area hospitals report they are not yet seeing much of an increase in the number of uninsured patients and most take a fatalistic attitude toward people using the ER for non-emergencies. “Probably 25 percent of the patients we see are really not emergencies. It’s always going to be that way, you’re not going to change it,” said Muntan.
Mental Health Issues Increasing
Mental health issues in the area seem to be on the rise as the economy worsens and people lose jobs and health coverage. Loumiet said she’s seen an increase in mental health patients on the northshore, especially since May or June of this year. “There’s really no place for them to go and the majority are uninsured,” she said.
Muntan said 75-80 percent of psychiatrists in the state left after Katrina and many haven’t returned. There’s meager preventative care and very few psychiatric facilities available. “They get to the breaking point and come to us after they’ve gone off the deep end. If we had ample psychiatrists in the area, much of this could be avoided,” he said.
Once a mental health patient enters the emergency department, they must be evaluated and if deemed appropriate, sent to a psychiatric facility. In the meantime, they are kept in the ER, with security, until a psychiatric facility can be found. This process may take two or three days and much of the emergency director’s time, tying up precious space in the ER and an ambulance to eventually transport the patient as far away as Shreveport or Lake Charles.
Where’s a Specialist When You Need One?
“The northshore’s biggest problem, by far, is the lack of specialists on call in the region’s ERs,” said Muntan, who noted that there are only three neurosurgeons for the entire area. “This is the biggest issue on the northshore, with no relief in sight,” concurred Loumiet.
Caruso also agreed that this issue is perhaps the most significant problem facing all hospitals in the area. The problem is particularly bad in areas like the northshore where specialists such as orthopedists are performing scheduled surgeries at physician-owned specialty hospitals and are no longer taking call at larger, full-service hospitals. “The emergencies still happen, but the ERs in the area may have, at best, limited coverage for certain specialties,” said Caruso.
So what happens if you need a neurosurgeon, an orthopedist, or some other specialist and there’s not one available nearby? “In many cases, the medics cannot find the proper care needed for a particular injury and the end result may be that the patient is airlifted to University Hospital in New Orleans to get the care needed,” said Jordan.
What’s the Answer?
While there’s no panacea for all these issues, vast improvements are being made in getting emergency patients the care they need in the most efficient manner possible.
In St. Tammany Parish, the areas where fire districts don’t have ambulances are served by Acadian Ambulance Service, Inc. The St. Tammany Parish Council is currently reviewing a proposal to enter into a new agreement with Acadian Ambulance to service specific areas of unincorporated St. Tammany and public comment is encouraged.
According to John O’Neil, Director of the Department of Fire Services for St. Tammany Parish, at issue is guaranteed response times for rural areas that are currently unprotected or underserved. “Overall we have a good system of teamwork with the fire districts working with the ambulance company. We save a lot of lives,” said O’Neil.
Also in St. Tammany Parish, a group of physicians and EMS personnel meet monthly to review healthcare issues and offer informal input and advice to the Parish President. “Now fire districts and Acadian are all on one set of protocols and the hospitals within the Parish are working together more than we ever have,” said Loumiet.
When this protocol requires physician intervention, EMS personnel call the Medical Control Line, which is a call center at St. Tammany’s Emergency Operations Center. Each of St. Tammany’s five ERs rotate staffing the Medical Control Line.
St. Tammany Parish also now has the STEMI Program which allows EMS personnel to set up and record a 12-lead Electro-cardiogram (EKG). The EKG information is then sent via email to hospitals, or even directly to a cardiologist’s smart phone, from an ambulance in the field. With this technology, physicians are able to interpret a patient’s test results long before he reaches the ER. “This cuts down on time and, in many cases, allows the patient to bypass the emergency department altogether and proceed directly to the cath lab,” said Jordan. “The patient’s treatment begins at home”. By January all of St. Tammany’s emergency departments should have the ability to receive this information.
And last, but certainly not least, is the statewide Louisiana Emergency Response Network (LERN) that assists in trauma-related emergencies. Region 9, which includes St. Tammany, Tangipahoa, Livingston, St. Helena, and Washington parishes, went online with LERN on June 15th of this year. LERN operates two call centers, one in Baton Rouge and one in Shreveport, to advise and assist EMS personnel on the best facility for trauma victims at any given time and place within the state, based on their specific injuries. Every hospital emergency department keeps information on staffing, wait times, and specialist availability up-to-date in the LERN database.
“LERN helps us make the decisions that need to be made in a critical situation – to get that patient to the hospital that has the appropriate resources to deal with that patient,” said Jordan. “What LERN allows us to do is bypass the closest facility if it does not have resources available. Before, by law, we could not bypass a facility,” he said.
“They’re asking the paramedics to change the way they’re thinking in the field. They’ve done a wonderful job in the short time they’ve been around,” said Loumiet. “We have definitely stepped in the right direction. A few bumps in the road are to be expected because it’s a very complicated system,” said Muntan, who is also Vice-Chairman for LERN’s Region 9. “Hopefully in the future LERN will take over stroke and cardiac intervention. We would like to see LERN get involved in this aspect of emergency care,” said Jordan.