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Amberwell hospital warns EMS staffing, equipment and regional capacity are stretching local transfers
Summary
Hospital leaders told Atchison County commissioners that a rising number of transfers and limited regional capacity are forcing outside ambulance services to handle many time-sensitive transfers, and that paramedic shortages, equipment availability and tertiary hospital backlogs are lengthening turnarounds.
Amberwell hospital leaders told the Atchison County Commission on Jan. 28 that a growing share of both non-emergent and time-sensitive emergent patient transfers have been completed by outside ambulance services rather than Atchison County EMS, and that region-wide capacity constraints and local staffing shortages are increasing delays.
The hospital presented a breakdown of transfers from August through December showing non-emergent and emergent transfers by day and night shift and by which agency completed each run. The presentation said many time-critical patients — for example, those needing immediate cardiac catheterization or stroke intervention — have required outside transport because the county’s EMS or regional air and ground resources were unavailable.
Hospital officials said several factors are driving the problem: the closest helicopter service previously based in St. Joseph no longer operates locally; tertiary receiving hospitals have been unable to accept transfers because of unusually high volumes; and Atchison County EMS is facing fatigue, long shifts and the potential retirement of at least one paramedic. Amberwell leaders also reported isolated equipment issues at handoff — for example, an IV pump malfunction during a STEMI transport that delayed the transfer — and said ventilators or pumps sometimes are not on the responding rig and must be provided by the hospital for transport.
"A lot of those are having to happen outside of our own county EMS," Amberwell's presentation said, noting the effects on door-to-door timelines for time-sensitive conditions. Amy Folsom, Amberwell's executive director of patient care services, and Alicia Sorensen, chief nursing officer, said the hospital wants to support EMS by sharing data and by working on contingency plans for very time-sensitive cases.
Commissioners asked for more granular counts of truly time-critical transfers (for example, strokes and STEMIs within the guideline windows) and for comparative data from other regional critical-access hospitals. Amberwell said it can provide: (1) detailed monthly transfer data showing reason and destination; (2) a breakdown of which transfers were emergent versus non-emergent; and (3) comparison figures from similar critical-access facilities. Amberwell agreed to send those data to the commissioners' shared address for review.
Hospital and county leaders discussed potential short-term and longer-term responses. Amberwell described recruitment and retention efforts (scholarships, sign-on bonuses and alternative schedules) and said expanding local clinical scope to reduce transfers could be a three- to five-year effort. County leaders asked the county counselor to review liability and credentialing questions if hospital nurses ride on county ambulances in exceptional situations, and requested an assessment of equipment needs that might require county funding.
Commissioner Campbell and other commissioners said the county will review the "critical numbers" — the count of time-sensitive transfers that cannot be handled in-county — before making any budget or staffing commitments. Amberwell reiterated that certain non-emergent cases can deteriorate quickly, blurring lines between emergent and non-emergent categories.
Amberwell also asked the commission to notify them immediately of any specific cases of concern so the hospital can investigate; the hospital offered to review a recent incident described by a commissioner in which a patient was reportedly returned to a nursing home and later required emergency transfer. Hospital leaders said they would investigate that event and asked the commissioner to provide the patient name and date.
The meeting concluded with an agreement that Amberwell will deliver the requested transfer data to commissioners@atcoks.org, that the county counselor will review cross-agency credentialing and liability for staff riding on transports, and that commissioners will consider equipment and recruitment needs during budget discussions.
The presentation did not produce a formal county action or vote; commissioners requested follow-up materials and signaled they would use the supplied data to evaluate next steps.
