Patient transfers stretching resources

CNJ staff photo: Tony Bullocks Firefighter Mike Field performs a routine maintenance check on an ambulance at Station 1.

Sharna Johnson

Clovis ambulances are spending more and more time taking patients out of town, a dynamic that is starting to stretch resources a little thin.

In the last two years, out-of-town ambulance transfers increased 57 percent over prior years.

What that means for ambulance crews is more time on the road taking patients to facilities in Lubbock, Amarillo, Albuquerque and more, according to Fire Chief Ray Westerman.

Transfers by ambulance have always been an aspect of his department’s job, Westerman said, with patients sent to facilities that can meet specialized needs being a common occurrence.

Most, but not all transfers originate from the hospital, though sometimes the decision is made to transfer directly from an accident scene.

In prior years the city averaged about 550 transfers a year. In 2009, the number jumped to 724, then to 902 in 2010.

In addition, the department’s call volume increased by 10 percent, which by itself is not unmanageable until combined with the transfers, which take vehicles and personnel out of commission for extended periods of time.

“That’s a dramatic increase; it’s huge,” Westerman said. “It is virtually everything we can do to keep our heads above water with all the services we provide.”

The increase means more wear and tear on equipment and vehicles, higher overtime hours and when personnel are conducting transfers, the workload on the folks staffing the city’s six stations has a greater impact.

Last year, the department logged more than 250,000 miles on its ambulances alone and averaged 3 transfers per day to medical facilities that in some cases involve more than six hours round-trip.

“That’s a lot of miles,” he said. “It takes lots of oil and filters and tires and batteries and light bulbs and those types of things, (plus) labor and fuel. We’re feeling the budget (impact) but city hall is fully aware of that.”

Westerman said he believes growth at Cannon Air Force Base is a contributor to the increase in call volume because the population has risen.

“This increase in population is looking for health care that the community is not able to provide at those levels,” he said.

Clovis Fire Department provides fire and ambulance services within the city limits and throughout Curry County when volunteer services are in need of assistance.

The department’s ambulances also respond to Cannon when needed.

Patients are transferred to other medical facilities when their specific needs can not be served locally, typically when they need a specialized type care that doesn’t exist in Clovis, according to Hoyt Skabelund, director at Plains Regional Medical Center.

But Skabelund said he believes the increase is tied to changes in mental health services rather than reduced services at the hospital.

“This is one of the more stable, larger scopes of services we’ve had in the five years I’ve been here,” he said. “As long as our population increases, there’ll be proportional increases in those services.”

In 2009, Skabelund said the hospital added a clinical psychologist to its staff, then in 2010 brought in a behavioral health specialist and five, on-call behavioral health specialists.

The building of that infrastructure has led to more diagnosis of mental health issues, Skabelund said.

However because there are no inpatient mental health facilities in the area, he said the result has been an increase in transfers in an effort to get patients the help they need.

In 2010, PRMC data shows 169 patients were transferred for behavioral reasons compared to 118 in 2009, accounting for 41 percent of transfer orders.

Medical transfers ordered by PRMC increased by 74 in the last year.

“Behavioral health services are strained nationally and certainly within our states,” Skabelund said.

Westerman said he is taking steps to reduce the impact on his department, creating a shift of personnel to work during the period with the highest frequency of transfers.

They have also had to rely on other agencies for assistance, he said and some transports that range too far have had to be turned down.

The department has a $6.4 million budget that maintains six fire stations, a fleet of 51 units and 78 personnel.

Westerman said his department does not receive any reimbursement from the county or any other agencies.