Is Your Hospital Diverting Ambulances Because of COVID-19?

hospital diversion — Louisville Metro EMS paramedics transport a woman suspected of having a severe COVID-19 emergency in Louisville, Kentucky. Kentucky is experiencing a surge in COVID-19 cases, having recently recorded more than 4,400 cases a day. Jon Cherry/Getty Images

The COVID-19 pandemic has claimed more than 670,000 lives in the United States to date. In terms of sheer numbers, it has become the deadliest event in U.S. history, surpassing the 1918 influenza epidemic and multiple wars.

As shocking as this number is, it doesn't capture the full scope of COVID-related casualties. Since the summer surge began in early August — due mostly to the delta variant — COVID-19 has overwhelmed hospitals and ICUs across the country.

The federal government's latest data shows Georgia and Alabama are still at nearly 100 percent of their intensive care unit capacity, while Texas hovers at more than 90 percent ICU capacity. Idaho is at 96 percent capacity. This type of surge has forced many facilities to go on diversion, leaving few resources for non-COVID emergencies. The Idaho Department of Health and Welfare (DHW) activated its crisis standards of care because of the massive increase of COVID-19 patients.

"You just get to the point where you can't physically take care of more people," says vice president of Northeast Georgia Health System Dr. John Delzell, who described the situation as "pretty dire."

So what happens when hospitals are so full?

packed ER — Patients lie on stretchers in a hallway in an overloaded emergency room at Providence St. Mary Medical Center amid a surge in COVID-19 patients in Southern California. Scenes like this are common across the U.S. where ICU bed capacity is at a minimum.
Photo by Mario Tama/Getty Images

What Does It Mean When Hospitals Are on Diversion?

Hospital diversion is rare, but not unprecedented. While it remains controversial in many states, it is never an option that medical facilities invoke lightly.

"Diversion" describes a situation when ambulance drivers are asked to avoid taking patients to a specific hospital. Under normal circumstances, paramedics are supposed to drive straight to the nearest hospital or emergency facility. But when a diversion notice is in place, they may have to break that rule.

Hospitals go on diversion when they have more patients than beds. Doctors operating under such circumstances will usually try to outsource their patients' care to another hospital, if possible, in hopes of getting them treated sooner.

"Diversion doesn't mean you can't come," Dr. Robert Jansen, chief medical officer for Grady Health System in Atlanta, said during an August news conference. "It's our way of communicating to the ambulances that we're full ... but we never turn anyone down."

Before COVID-19, diversions mainly occurred because of mechanical issues like power outages or flooding at hospitals. While overcrowding from a single disease has been historically very uncommon, it has happened. For example, hospitals in New York City diverted ambulances during the height of the AIDS epidemic. But diversions on the scale of the current COVID-19 wave are practically unheard of.

Overcrowded hospitals are forced to put patients wherever they can, often on hallway stretchers or in overflow tents. But in a packed ICU, patients may have to wait hours, "sometimes as long as a day" for a staffed bed to open up, says Dr. Blaine Enderson, vice president of the emergency trauma and critical care center at the University of Tennessee Hospital in Knoxville.

But in severe cases, a few hours could be the difference between life and death.

medivac patient — In some cases, hospitals administrators are forced to send patients to other cities to get care, oftentimes medevacking them out on flights, when they can find them an open bed.
Francine Orr/Los Angeles Times via Getty Images

Diversion and the Delta Wave

Since July 2021, COVID-19 cases and hospitalizations in the U.S. have skyrocketed. The delta variant is partly to blame, along with waning vaccination rates and relaxed mask and indoor gathering policies.

More than 90 percent of patients hospitalized with COVID-19 are unvaccinated, and the small handful of fully vaccinated COVID-19 hospitalizations are nearly all folks with multiple comorbidities.

During the latest wave, hospitals in states with low vaccination rates have been pushed to the brink. "Right now, 70 percent of our ICU beds house patients who are on a ventilator or breathing machine," Dr. James Shamiyeh, chief operating officer at the University of Tennessee Medical Center, said in a press briefing. "When we didn't have this amount of COVID, it was 36 percent."

In Georgia, about 13 percent of ICU beds statewide remain unoccupied. Only about 130 individual ICU beds are available in Kentucky as of Sept. 22. In August, Alabama ran out of ICU beds entirely.

"We just don't really have the resources and the staff to be able to handle these unlimited numbers of patients," says Dr. Mark Marsden, the chief medical officer for Ascension St. Thomas Hospital in Nashville, Tennessee. And it's not just St. Thomas. "Every hospital in the city, essentially, has been on almost continuous diversion for the last several weeks," he says. When every hospital is on diversion, it means that — effectively — none of them are.

Unfortunately, folks still need urgent care outside of COVID-19. On top of the virus, doctors must contend with the usual number of strokes, heart attacks, car accidents and other emergencies.

With too few beds to go around, these patients might not receive the care they need in time. In late July, a 12-year-old boy nearly died when his appendix burst while waiting for more than six hours in a Florida emergency room. And in August, U.S. Army veteran Daniel Wilkinson died of gallstone pancreatitis — a treatable issue — while his Texas doctors scrambled to find him a bed.

It's been 18 months since the coronavirus pandemic hit the U.S. Doctors, nurses and hospital staff around the country have been working tirelessly, putting their own lives on the line in order to save others. Now, many are physically and emotionally exhausted.

"Everybody's tired. Everybody's sad because so many people are dying," Marsden says. "So much of this is preventable, which is frustrating to health care providers."