Emergency department staff at Providence St. Peter are responding to the greatest surge in COVID cases since the pandemic first began, as they face hallways full of waiting patients and some waiting in ambulances outside.
“The acuity that we’re seeing is vastly beyond what we’ve seen before,” Dr. Penelope Goode told The Olympian. “Now with the recent uptick in COVID cases because of the delta variant, it’s just unprecedented — the volumes, the wait times and what we are having to do to try to safely care for these patients.”
Goode works in the St. Peter emergency department. She told The Olympian the number of patients coming through her department has ramped up in the last few weeks as Thurston County has seen the fifth wave of COVID-19 push transmission rates and case counts to record highs.
As the delta variant makes its way through a county population that is just 50.6% fully vaccinated, St. Peter has been inundated with more and sicker patients, nurse manager Arthur Andrews said.
Meanwhile, a similar situation has been playing out in hospitals across Western Washington and throughout the country, making transfers increasingly more difficult, said Providence spokesperson Angela Maki.
“We have hospitals calling us from surrounding states — Montana, Alaska, Northern California, Oregon — to try to get us to take their patients on any given day,” Maki said. “This is not a unique situation.”
The COVID-19 impact
Not all emergency room patients have COVID-19 but given the variety of symptoms that could be attributed to the illness, Andrews said they must treat many patients as if they have COVID-19 until proven otherwise.
Most patients, especially those that require critical care, are unvaccinated against COVID-19, Goode said. She urges all her patients to get vaccinated if they have not done so, saying the vaccines are safe and effective at preventing serious illness and hospitalization.
“When I paint the picture of the reality that exists right now … it’s like I’m telling them some brand new piece of information,” Goode said. “Their eyes get wide — it’s like they’ve never heard it before.”
Many get alarmed and say they will reconsider, Goode said. Most of those who are critically ill with COVID-19 tend to feel regret.
“The super sick ones, they ask, ‘Can I get it now? Can I get the vaccine now?’” Goode said. “They’re terrified and there is regret for sure that they passed the opportunity to get this life-saving vaccine.”
People’s resistance to the vaccine has caused many staff members to experience what Goode called “compassion fatigue.” Although they are doing their best to treat patients, she said the ongoing pandemic can take a toll.
“The nurses and techs and physicians and everybody who’s been working like a dog for 18 months are exhausted,” Goode said. “It’s such an affront to those folks that here is this treatment, this vaccine, that would make all the difference in the world and people are refusing to get it.”
Though there may be some side effects to getting the jab, the benefits vastly outweigh the risk, and the ramifications of not getting the vaccine are huge, she said.
“We’re begging you,” Goode said. “We’re begging you to get vaccinated because it is the solution to this problem.”
The St. Peter emergency department has about 40 beds, but lately they have been forced to use about 20 additional beds in the hallways, Andrews said.
Though the situation is tight, Andrews says there are contingency plans to use surge areas as needed.
“We open up those surge areas as we need to, to help accommodate those high numbers that we experience to try to give us a fighting chance in this surge that we have coming through the door,” Andrews said.
He said over 200 patients pass through the emergency department on an average day — about 25 more than before the pandemic.
However, Goode said the department is exceeding 100 patients in the department — in the waiting rooms, triage area, hallway beds and regular rooms — a few times a week.
“I’ll have a whole shift where two thirds of patients I see, I see in a hallway,” Goode said. “You just accommodate, and you sort of adapt to the situation to take good care of these folks, but the circumstances are not insignificant.”
A lot of inpatients are occupying beds in the emergency department because there’s not enough space in other areas of the hospital. Goode said this has caused staff to suffer a so-called moral injury.
“Everybody knows what needs to happen, knows how we want to take care of trauma patients, stroke patients, COVID patients and all that stuff, but we just don’t have the space to do it,” Goode said.
About 95% of the conventional ventilators at St. Peter are in use, Maki said. However, they have more contingency and crisis ventilators that they can use as needed.
“We have a lot of layers built in to be able to care for our community with ventilators, so we’re going to be able to have the ventilators if they are needed,” Maki said.
As a precaution, the hospital has requested more ventilators from the state, she said, but it’s still unclear if they will receive those soon.
Additionally, Providence can transfer ventilators between hospitals as needed, Providence spokesperson Chris Thomas said.
“St. Peter is the hub, the largest hospital in the five-county service area,” Thomas said. “So, the sickest COVID-19 patients often are transferred to St. Peter. That’s why a lot of ventilators would be used there versus at the other smaller hospitals that we can access ventilators from.”
Adequate staffing is another concern that has affected hospitals in recent weeks. Though Andrews acknowledged it has been a problem, he said instances of people leaving the emergency department have been “few and far between.”
Despite the obstacles, Goode and Andrews said staff have continued to push through these challenges to meet patient needs.
“Quite frankly, this is the toughest group of individuals I’ve ever had the privilege of working with,” Andrews said. “They inspire me to come to work every day and do the best that I can, with the job that they do for the community on a daily basis.”
Transport delays with ambulances
Patients arriving on ambulances sometimes have to wait with emergency medical service crews before entering the hospital. Andrews said this occurs when there are not enough beds to transfer patients, or they cannot safely wait in the triage area.
“Somebody could be in a car wreck and maybe they can’t sit up in a chair or they can’t go to the triage area,” Andrews said. “In those cases, we have to wait for a bed to open up before we can take them off the EMS transport.”
Kurt Hardin, director of Thurston County’s Medic One system, told The Olympian that transport delays have exceeded an hour at times, but new mitigation measures have lowered wait times a bit over the past month.
The Medic One system integrates 12 independent fire departments, two ambulance companies, hundreds of EMS providers and two hospitals.
He said Medic One has prepared a surge capacity transport unit and has arranged to have an emergency medical technician crew at St. Peter that can continue caring for a patient while the ambulance returns to the field.
However, these measures are not available every day because of staffing issues. Right now Hardin said they are moving staff around and looking to hire temporary EMTs to ensure these measures are available seven days a week.
Though there are transport delays, Hardin stressed that there are no response delays, meaning people can still reliably call for help.
“If you need EMS, call 911,” Hardin said. “We are responding. It’s just that we prioritize transport right now to those who are the most sick…
“I don’t want people to think you have to wait an hour or two for someone to show up.”