Elsevier

Annals of Emergency Medicine

Volume 80, Issue 4, October 2022, Pages 301-313.e3
Annals of Emergency Medicine

Health policy/original research
Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain During the COVID-19 Pandemic in the United States

https://doi.org/10.1016/j.annemergmed.2022.05.036Get rights and content
Under a Creative Commons license
open access

Study objective

One in 4 deaths from COVID-19 has been attributed to hospital crowding. We simulated how many ambulances would be required to rebalance hospital load through systematic interhospital transfers. We assessed the potential feasibility of such a strategy and explored whether transfer requirement was a helpful measure and visualization of regional hospital crowding during COVID-19 surges.

Methods

Using data from the United States hospitals reporting occupancy to the Department of Health and Human Services from July 2020 to March 2022 and road network driving times, we estimated the number of ambulances required weekly to relieve overcapacity hospitals.

Results

During the peak week, which ended on January 8, 2021, approximately 1,563 ambulances would be needed for 15,389 simulated patient transports, of which 6,530 (42%) transports involved a 1-way driving time of more than 3 hours. Transfer demands were dramatically lower during most other weeks, with the median week requiring only 134 ambulances (interquartile range, 84 to 295) and involving only 116 transports with 1-way driving times above 3 hours (interquartile range, 4 to 548). On average, receiving hospitals were larger and located in more rural areas than sending hospitals.

Conclusion

This simulation demonstrated that for most weeks during the pandemic, ambulance availability and bed capacity were unlikely to have been the main impediments to rebalancing hospital loads. Our metric provided an immediately available and much more complete measure of hospital system strain than counts of hospital admissions alone.

Cited by (0)

Please see page 302 for the Editor’s Capsule Summary of this article.

Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at https://www.annemergmed.com/editors.

Author contributions: KLHI coordinated the study, programmed and performed the primary data analysis, created the figures, and drafted the introduction, methods, and results sections; AMD contributed to the design of the methods, verified the analysis, and drafted the discussion section. MES performed the geospatial analyses and contributed to the design of the methods. DLS conceived and supervised the study and contributed to all portions of the manuscript. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. KLHI takes responsibility for the paper as a whole.

All authors attest to meeting the four ICMJE.org authorship criteria:(1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Dr. Ioannides was supported by the National Clinician Scholars Program at the University of California, Los Angeles. Dr. Schriger is partly funded by an unrestricted research grant from the Korein Foundation and serves as a deputy editor for Annals of Emergency Medicine, but, of course, recuses himself from any matters relating to this manuscript.

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