CUMBERLAND, Md. — Tom Hamilton and his ambulance crew were at the scene of an automobile accident with injuries Wednesday evening when they heard that the local hospital had gone “on diversion,” he said.
They were a couple of miles away from Paw Paw, West Virginia, and had a choice to transport their patient — who was not in serious condition, alert and able to talk — to hospitals in either Keyser or Berkeley Springs, West Virginia.
They chose Berkeley Springs, a roughly 30-mile drive over “very twisty-turny” roads, Hamilton, EMS chief for District 16, which is one of the largest service areas in Allegany County that covers Route 51 from the Cumberland City line to Paw Paw, West Virginia, said Friday.
“The only problem I had with it was we didn’t get Yellow Alerts from the hospital or communications center or Red Alerts,” he said. “It took an ambulance out of our service area for (more than) two hours.”
Hamilton, a paramedic for more than 25 years, had never experienced a local hospital’s “complete diversion,” he said.
“The part that disturbed me was when we did get to the Berkeley Springs … at least the nurses that we talked with was not aware that (UPMC Western Maryland) was on diversion and (Berkeley Springs) might be getting patients,” he said. “Something I will be finding out is, when they go to diversion, do they notify … hospitals that are reasonably close to us so that they know what to expect?”
The scenario further complicated an already stressed system.
“This is just a real rough time for anybody in emergency medical services,” Hamilton said, and added roughly 90% of emergency calls are for someone with a COVID-19-related illness.
“We not only face taking in the COVID patients in a very confined atmosphere, and I think the state does a real nice job of getting us (personal protective equipment) and things that we want, but I’d like to see more communication from our local health department on caseloads and … they should be able to tell you what area of the county is getting that COVID spike,” he said. “We have our protocols that we follow but (could) take a lot of extra precautions.”
More communication problems surrounded Wednesday’s hospital situation.
‘Higher level of consciousness’
The word “diversion,” used by local emergency and hospital officials, inaccurately conveyed the status at UPMC Western Maryland, experts in the field said.
Allegany County Department of Emergency Services radio communications shortly after 5 p.m. Wednesday said the hospital was “on diversion” and accepting only patients with life-threatening conditions including stroke and trauma.
At that time, UPMC officials issued the following statement that included:
“UPMC Western Maryland is currently operating under temporary EMS diversion. It is important to note this does not close the emergency department. When operating under diversion, all UPMC hospitals continue to accept any ambulance arriving on site, trauma, STEMI (heart attack), stroke and walk-in patients, and those with unique conditions suitable for treatment only at a UPMC facility.”
Those scenarios, however, contradict each other, with “diversion” indicating a hospital is not accepting any patients.
“In the context of the entire EMS system, the word ‘diversion’ means don’t go to such a place,” said Dr. Ted Delbridge, who has a background in emergency medicine and is executive director of the Maryland Institute for Emergency Medical Services Systems.
On Friday, he discussed how the emergency medical alert system works, and use of the word “diversion.”
“We don’t use that term because we want the decision to rest with the EMT or paramedic who is taking care of the patient,” he said.
Diversion of patients is typically more practical in urban areas where hospitals are located within minutes of each other, he said.
That system doesn’t work well, and is therefore rarely used, in rural areas such as Western Maryland “where the decision to not go to a particular place means 45 minutes longer,” Delbridge said.
He also talked of ways a hospital can communicate its immediate problems to an EMS system.
“Yellow Alert means that the emergency department is temporarily busy in such a way that managing newly arriving patients with urgent needs could be challenging and if there’s an option for the patient to go to a place that is less busy at the time it might be in the patient’s best interest,” Delbridge said. “That’s how EMTs and paramedics are supposed to interpret it.”
In the past six months, “UPMC Western Maryland has been on Yellow Alert for four hours,” he said of the Wednesday evening situation. “It’s exceptionally unusual.”
That’s because the hospital, and a handful of others in rural areas across the state, invested in themselves to serve their community, Delbridge said.
“They are far away from the next available hospital,” he said.
“They are not just an emergency department,” Delbridge said of specialized care including trauma, cardiac and stroke centers.
“They have a higher level of consciousness about their need to be available to the community all the time,” he said.
“They’re also the best hospitals at being prepared to accept newly arriving EMS patients on a regular basis,” Delbridge said.
Other alerts include Red, which a hospital uses to say it has no monitored beds available.
A hospital can also use a Mini Disaster alert to declare a physical plant problem such as a power outage.
“And then the EMS system itself can place a hospital on Reroute,” which generally means the facility is overwhelmed at the moment, he said.
“That happens all the time in the Baltimore-Washington corridor,” Delbridge said. “The emergency departments get really busy.”
The alerts are not a mandate to divert ambulances, however.
“The hospital doesn’t have that power or that authority,” he said. “The only time they really do that is when they … say ‘it is physically unsafe to come here.’”
In those cases, of Mini Disaster, “that’s relevant to tell the public because what you’re saying is you’re totally unsafe,” Delbridge said. “So, everybody should know you’re unsafe.”
‘Sooner rather than later’
Flintstone resident Todd Bowman is a paramedic with 18 years of experience.
He worked for Allegany County as an EMS lieutenant and the Department of Emergency Services public information officer from 2017 to 2021, and prior to that, he served in the same capacity in Washington County.
“I can’t remember a time that a community hospital in the western portion of Maryland, like UPMC Western Maryland, was on diversion,” he said, and added that a hospital diversion in Western Maryland is extremely rare because there is only one local hospital.
“It is important to add that with Wednesday night’s diversion at UPMC Western Maryland, the facility continued to receive patients that had the potential to deteriorate rapidly and without warning,” Bowman said.
“Long transports may be detrimental to their health and recovery,” he said. “In many cases, treatment needs to begin within a certain time frame, sooner rather than later.”
If a true diversion were to occur, emergency officials should be transparent with the public about the situation and what steps are being taken to keep the community safe.
Bowman believes an agency should dedicate someone to assist the news media and ensure correct information is published or broadcast in the most efficient manner possible.
“When an agency fails to communicate with the media, misinformation from unknown sources can circulate causing more harm,” he said of rumors on social media.
He also talked of how EMS units and hospitals in the tri-state area communicate with each other.
“Maryland has an excellent communication system for EMS in the field to communicate with Maryland hospitals,” Bowman said.
It’s much more challenging to communicate with out-of-state hospitals, however, because only a Maryland physician can direct a Maryland EMS clinician to transport a patient to a neighboring state.
“We can’t take orders from a Pennsylvania or West Virginia physician,” Bowman said. “We have to consult a Maryland-based hospital if we’re requesting orders, whether that be medical orders, a transport destination or some sort of specialty care.”
When a community hospital, like UPMC Western Maryland, goes on diversion it has the potential to put a strain on the pre-hospital EMS system in the surrounding area by creating longer transport times and decreasing the amount of available transport units in the immediate area, he said.
In early 2020 statewide pandemic planning meetings, medical directors advice recommended EMS agencies plan to double their current staff, Bowman said.
Having that increased staffing would be ideal in a circumstance such as Wednesday’s UPMC Western Maryland incident, he said.
It would allow departments that have extra resources, such as ambulances, to put them in service so there would be no lapse in services while units are committed with longer transport times, Bowman said.
‘Never an official diversion’
Allegany County resident Robby May serves as the state advanced life support education coordinator for the University of Maryland, Maryland Fire & Rescue Institute, where he oversees all paramedic education in the state.
He’s also a paramedic in Allegany and Garrett counties.
“There was never an official diversion,” May said of UPMC Western Maryland’s event Wednesday and added “diversion” means a hospital will not accept patients, which “was never the case in Western Maryland.”
“I think there was a lot of misconception in the public that ambulances just couldn’t go to (UPMC Western Maryland) during that time,” he said.
“What the state says diversion is, and what Red and Yellow alerts are, are two different things,” he said.
“I’ve been in EMS for 18 years in Western Maryland and I don’t know of anytime where we’ve ever been on a true diversion,” May said.
COVID-19 adding to problems
“The rural parts of the state right now have a higher (COVID-19) case rate that the more urban, suburban parts,” Delbridge said. “That folks in Allegany (County) in particular have a lower vaccination rate than other parts of the state is really problematic and it is undoubtedly stressing out the hospital.”
Combine that with the fact that folks are more active in the community now than in the past several months, and the burden on the local hospital and EMS system accelerates.
“What’s different is that, last fall and winter people were hunkered down,” he said. “Now they’re out and about and it’s not just COVID they’re getting. They’re getting other respiratory viruses and they’re crashing their cars and getting other kinds of things they get when the world is on the move.”
Currently, the EMS system across the state “is busier than it’s ever been,” Delbridge said.
The best way folks can help is to “get a COVID-19 vaccination and … get a flu vaccine this year,” he said. “Otherwise, we’ll be having this conversation a few months from now and the hospitals will just be overwhelmed and we’ll be in serious distress everywhere.”
‘We need to know’
After learning of UPMC Western Maryland’s “diversion” alert Wednesday, Frostburg resident William Neil, 71, on Thursday said he called the hospital and asked for details about the incident and whether it was driven by the county’s high COVID-19 case rate.
“I went through four or five people,” he said. “Nobody would answer the question (and) we need to know that.”
Ann Bristow is a member of the Women’s Action Coalition, Greater Allegany County.
The group in November sent a statement to several local leaders including county commissioners and health department officials “to express our extreme concern in regard to the seeming lack of leadership in (Allegany County) in regard to the COVID crisis.”
She said contrasts in communication policies between WVU Medicine and UPMC “are noteworthy.”
Mark Boucot, president and chief executive officer of Garrett Regional Medical Center and Potomac Valley Hospital in Keyser, West Virginia, has directly answered questions from the Cumberland Times-News, whereas UPMC Western Maryland typically has not.
“Boucot has been much more forthcoming,” Bristow said via email Thursday.
Joy Kroeger-Mappes is co-founder and past chairperson of WAC.
“Good medicine care requires trust that the medical institutions and practitioners provide us with factual, evidence-based information we need to make decisions that truly are in our best interest,” she said via email Thursday. “A sense of trust is required. If UPMC Western Maryland is not sharing accurate information, or, currently, any information, with the public, what trust any of us have had is steadily eroded.”
Dr. Judy Stone is an infectious disease specialist who spent 25 years in solo practice in Cumberland and is a Forbes.com senior contributor for health care issues.
She questioned UPMC’s Wednesday statement that it was on diversion but accepting patients with “unique conditions suitable for treatment only at a UPMC” facility.
“What does that mean? There are no such conditions I can think of,” Stone said via email Friday.
“UPMC is undermining the trust of the community by refusing to answer simple, straightforward questions,” she said.
Cases and vaccinations
According to Allegany County Public Schools, for the week of Sept. 10-16, Fort Hill High School met the Maryland Department of Health definition of a school-wide outbreak of COVID-19.
The district had one school that met the definition of a classroom/cohort outbreak due to two or more individuals that tested positive for COVID-19, and the Center for Career and Technical Education had two cohorts that met the definition.
ACPS had 10 staff members and 81 students reported as positive for COVID-19, two staff members and 280 students were identified as a close contact to a positive person, and eight staff members and 249 students were identified as having COVID-19 symptoms.
“ACPS quarantined any close contacts of the positive cases, and we are continuing to contact trace and quarantine for any positive case,” the school system’s public information officer, Mia Cross, said via email Friday.
MDH on Friday reported 1,525 new COVID-19 cases, 12 new deaths and 12 fewer hospitalizations across the state in the past 24 hours.
The daily positive case rate was 4.45% statewide, with Allegany County at 11.46%, Garrett County was the highest in Maryland at 15.45% and Washington County was at 7.89%.
The seven-day moving average COVID-19 case rate per 100,000 people was 20.72 statewide, Allegany County was second highest in Maryland at 64.92, Garrett County was at 50.22 and Washington County was at 44.92.
The Allegany County Health Department reported 98 new COVID-19 cases and four additional deaths in the past 24 hours.
ACHD offers free, walk-in COVID-19 vaccinations Wednesdays at 12501 Willowbrook Road, Cumberland.
From 9 a.m. to noon, the Moderna and Johnson & Johnson vaccines are offered and from 1 to 5:30 p.m., the Pfizer vaccine is offered to people age 12 and older.
Anyone under age 18 must be accompanied by a parent or legal guardian.
Drive-thru COVID-19 testing is offered at the Allegany County Fairgrounds, 11400 Moss Ave., Cumberland, from 2 to 7 p.m. Mondays, and 8 a.m. to 2 p.m. Wednesdays and Fridays.
No appointment is needed, but pre-registration is strongly encouraged to minimize wait times at the clinic.
Pre-register for testing at health.maryland.gov/allegany and click the pre-registration link under “COVID-19 Information” on the right side of the page.
To learn more about COVID-19 testing and vaccinations in Garrett County, call 301-334-7698 or visit garretthealth.org.