Editor’s note: This story was produced in partnership with StateImpact Oklahoma.
As the demand for intensive care among Oklahoma’s coronavirus patients continues to surge, the system is seeing strain from beginning to end — from ambulance services, to small-town hospitals, to the state’s metro health systems.
Statewide, all indicators have been breaking records for the past several weeks. New cases, hospitalizations and ICU figures are climbing quickly and reaching new highs in both rural and urban areas. But the most recent spike in hospitalizations has revealed that when it comes to health care, the line between urban and rural blurs.
When hospitals and intensive care units are full, it doesn’t matter where the patient lives; it matters where they can find a bed. And as statewide ICU vacancy rates fall into the single digits, that’s getting harder to do.
Rural emergency responders described a system pushed to a breaking point as smaller facilities seek to transfer critically ill patients to larger hospitals in metro areas that can provide higher levels of care.
Oklahoma is in the midst of a surge of coronavirus hospitalizations, which are up almost 130 percent since Oct. 1. Last week, the state reported a high of 1,434 patients in hospitals because of COVID-19.
The coronavirus pandemic has placed strain on the two ambulance crews in Tillman County, on the Texas border in southwestern Oklahoma.
The county’s only hospital, in Frederick, closed its doors in 2017 because of low Medicaid reimbursement rates and a declining number of patients.
Tillman County EMS now transports patients to hospitals 37 miles away in Altus and 45 miles away in Lawton, but beds in both cities have been scarce the past few weeks, said Ralph Washburn, emergency medical services director for the county.
“And you have to just basically tell them, somebody’s got to take the patient,” Washburn said. “We can’t go much further with them.”
Many of the patients crews have transported are people over the age of 40 in respiratory distress from COVID-19, he said. Sometimes, hospital staff have determined a patient wasn’t sick enough to be admitted and Tillman County EMS transported them back home, only to receive another call from the same address a few days later.
Wahsburn doesn’t know what emergency responders will do if the situation gets much worse.
“What do you do after your surge has surged and there’s still more surge coming,” he said.
Sinor Emergency Medical Service, which has a fleet of 12 ambulances that serve 2,300 square miles including many rural communities in western Oklahoma, has had to transport patients to hospitals as far away as Amarillo and Tulsa the past few weeks—wherever there’s an open bed— said operations manager Johnny Red.
One of Sinor’s ambulances sat for three hours at OU Medical Center in Oklahoma City last week, waiting for a hospital bed to open up, Red said.
“If you’re parked at a hospital, you’re not serving your community,” he said. “So it just creates a lack of readiness.”
That lack of beds is striking smaller, rural hospitals and metro hospitals alike.
Jackson County Memorial Hospital in Altus had no open beds on Nov. 17 and Nov. 18, according to capacity numbers the hospital released on social media.
The hospital’s intensive care unit has been full of COVID-19 patients from Altus, as well as surrounding rural communities, hospital spokeswoman Amanda Reimer said. Jackson County Memorial has called larger hospitals as far away as Missouri to try to find open beds for critically ill patients.
“We’re even trying to look out of state and we don’t always find a place,” Reimer said. “We’re just doing the best we can.”
Angi Mohr is the president of SSM Health St. Anthony Hospital in Shawnee. Similarly, that hospital’s ICU has been maxing out. In normal times, that spillover would go to a hospital in the Oklahoma City area. But that hasn’t been an option either.
“There have been many days that have become almost impossible to find a bed in the metro area for sure, and our emergency department will then spend hours and hours calling the secondary larger hospitals,” she said. “We have even had to look for ICU beds out of state.”
Oklahoma public health officials and hospitals administrators have talked about that sparse space, reiterating that the physical bed isn’t the only issue.
Critical care requires a higher nurse-to-patient ratio. Mohr said that for COVID-19 patients, St. Anthony in Shawnee has maintained somewhere between a 1-to-1 and a 1-to-3 ratio depending on severity. That’s trying, even in normal times. Oklahoma has been in a nursing shortage for decades, and the pandemic has only exacerbated the problem. It has surged demand, of course, but it’s hurt supply, too. Statewide, nurses are being called away on travelling contracts to other states, quarantining themselves because of exposure to the virus, or leaving the field altogether.
Mohr noted that even though the hospital might have a physical bed, ICUs take much more equipment than a standard hospital room. Patients have significantly more monitors tracking their vitals. They tend to have several IVs infusing critical medications. In the case of COVID-19, they may need to be intubated or on a ventilator.
“It’s not easy to replicate an ICU room elsewhere,” Mohr said. “It’s not something you can throw some machines in and make happen overnight.”
In Oklahoma City, Dr. Cameron Mantor, OU Health Hospitals acting chief medical officer, said there have been times when the system’s hospitals have had to deny rural hospitals’ patient transfer requests because there were no available beds. In some cases, providers asked those hospitals if they could hold the patient until a bed became available.
Hospitals outside the state have asked OU to take patients.
“We’ve had several hospitals in Texas and Arkansas and Kansas calling us at times asking us if we can take care of their critically-ill patients because they in those communities are saturated and don’t have a bed for them,” Mantor said.
OU has at times held patients in the emergency room because there were no intensive care units available.
“The pipeline of patients needing our care continues to be wide open,” Mantor said. “Normally, if we have a disaster of some sort, it’s limited. But this is an ongoing significant increase in the number of patients in the community who are sick with the virus that need care, and it’s not going away. It’s only increasing.”
In Caddo County, a rural ambulance director said he’s had to make four-hour drives to take patients to open beds in Tulsa because there were none in central Oklahoma. The director asked that his name not be used because he wasn’t authorized to speak on behalf of his municipality.
There already were few intensive care beds available in his area before the pandemic, but the coronavirus has compounded the problem.
Not a day goes by where they don’t have to transport a patient sick with COVID-19 to a metro area hospital, the director said. On average the service is transporting patients three to five times each day.
“That’s a lot for us right now,“ he said. “As the pandemic rages on, we’re having to go further and further away.”