The “golden hour” that EMTs have to bring west side trauma patients to a surgeon is more like 50 minutes, as ambulance drivers report regular delays in delivering patients to east side hospitals like Beth Israel and Bellevue.
EMTs and paramedics, who are more highly-trained EMTs, strive to get trauma patients to emergency rooms within the “golden hour,” the critical period in which a patient may need surgery to survive. It is not a literal hour: for someone hit by a subway train, the golden hour may be a frantic twenty minutes. But since the closure of St. Vincent’s hospital on West 12th Street last year, the timeframe has shrunk, whatever the specific number for a particular patient may be. And this is compounded by a rise in the number of patients at remaining area hospitals.
“[The extra driving time] can be costly in rush hour,” said Dan Riccobono, an FDNY paramedic. For heart attack patients, for example, he explains, “time is muscle.” The longer it takes, the more tissue dies. Riccobono feels the delay has not yet made a life or death difference for his patients—but “It’s costly in terms of [patients] returning to 100 percent,” he said.
Ambulances now take west side patients north of 34th Street up to Roosevelt Hospital at West 59th Street and patients south of 34th generally go to Bellevue, Beth Israel, or New York Downtown. The extra “call volume” and mileage has affected some EMS crews as well: EMT Hasani Branford used to take five or six patients to the ER in an eight-hour shift. Now he averages six to nine. “You get used to it,” he said. “It’s the new pace.”
Branford admits that the intensity of the work leaves him feeling stressed and overworked. He has to rush through meals or occasionally skip one while he’s on the job. “There was downtime and now there’s no downtime,” Branford said. “Mentally and physically, it takes a toll on your body.”
Hospital officials at Beth Israel on East 16th Street say the number of patients treated in the ER increased by 30,000 in the last year, bringing the total to 110,000. “That’s a significant increase,” said Dr. Marc Stoller, director of emergency medicine at Beth Israel. “We had a bump up right away. We picked up about half of [St. Vincent’s] patients without warning. Everything is fine, but it took a while.“
Beth Israel opened an expanded ER in early 2010, doubling the size of the existing facility at a cost of $35 million. “It was just serendipity,” said Stoller. “We had built the emergency department figuring we would be at max volume in about five years from now. But we’re at capacity now.”
To deal with the higher volume, Beth Israel brought on several new doctors and opened up around 30 more beds. “Initially the wait times went up. We’ve adjusted. We’ve adapted. That’s what emergency rooms do,” Dr. Stoller said.
The debate over what effect long cross-town ambulance rides and higher patient volume has on west side residents’ health care continues. “I would define it as a health crisis. It has had a devastating effect on the community,” said Yetta Kurland, a politically active lawyer and head of the Coalition for a New Village Hospital, a group protesting the closure of St. Vincent’s and demanding a full-service, community hospital for Manhattan’s lower west side. “There is a palpable anxiety from community members,” Kurland said.
Dr. David Kaufman, who is involved with the coalition and has a general practice in the West Village, responded with concern to EMTs reporting delayed delivery times, “How much was the patient affected by the 10-minute delay they admit to? If it’s an alcohol or drug overdose, sepsis with shock…that’s a big part of the ballgame.”
Kaufman sees longer wait times at several hospitals through his practice: He says he’s had patients wait in an area ER for 12 hours and walk out in frustration; one mother said she and her child spent eight hours in the Beth Israel ER, in “a scene that was just chaos,” according to Kaufman.
When asked about emergency room delays at Beth Israel, Dr. Stoller said, “We are not having increased waits. Just increased volume,” though he admitted, “It doesn’t mean it’s as good as it could be.”
St. Vincent’s Hospital closed on April 30, 2010 after operating since 1849. In 2009, St. Vincent’s discharged a total of 19,233 inpatients and had 758 beds. The busy hospital closed abruptly, citing financial difficulties and filing for bankruptcy. Rudin Management Co. has since acquired the site and is converting it into condominiums.
There are plans for a new emergency medical center in the O’Toole building on 12th Street and Seventh Avenue run by Northshore-LIJ Health System, but it will lack facilities for some heart attack patients and will only have two beds, a fact decried by critics.
Dr. Stoller agrees with the Coalition on one thing—lacking the support of a hospital, the small new facility won’t be any replacement for St. Vincent’s ER. “It’s not an emergency department, it’s an urgent care center,” Dr. Stoller said.