COVID-19 Crisis: Rural Hospitals Have Nowhere to Send Critical Patients

The surge of COVID-19 cases across America is creating a challenge as hospitalizations are now at a record level. The crisis is hitting rural hospitals especially hard, as many aren’t equipped to handle critical patients.

Alan Morgan, CEO of the National Rural Health Association, says rural hospitals are designed for primary care and general surgery, not for pandemic surges.

“Standard protocol is once you need a ventilator and ICU treatment, you are transferred to a larger facility,” says Morgan. “We're [in] really uncharted territory now, from a rural standpoint.”

As rural hospitals try to navigate the crisis, many are coming up with a plan to care for patients in their facility, as urban hospitals are also at capacity.

“Already, a lot of our members are putting in plans, knowing that they won't be able to transfer patients to urban hospitals,” he says. “You have to understand it's not even just about the pandemic anymore. We still have farm accidents, car accidents, motorcycle accidents. The need for trauma services continues.  The need for ICUs continues. But now we have this pandemic, just making it [a] non-sustainable situation.”

One hospital seeing the situation worsen is Regional Health Services of Howard County, located in Cresco, Iowa. The one hospital is the only ambulance service, public health department and hospice care for the entire county.  The facility includes 19 beds, and sends its sickest patients to larger hospitals, but now, that’s in jeopardy.

“The biggest concern in the last week is when we call and ask for them to help to take care of our patients who are maybe sicker than we're used to taking care of, they don't have beds for us and so that's where the strain really comes on,” says Dr. John Kammerer, Family Medicine, Regional Health Services of Howard County.

Morgan says the rise in cases means hospitals are at a crisis point. Earlier this year, he says the hotspots in rural America were limited. He says today, the situation is reaching a crisis level across the entire country.

“The story has changed so much now from where it was back in April,” says Morgan. “Back in April, we were dealing with hotspot surges in Indiana, in the South in Florida, and we were able to redeploy staff and actually be able to ship in supplies as needed from regional areas. The problem we have right now is staffing.”

Morgan says when every region is seeing a surge of COVID-19 cases, redeploying staff is no longer an option.

“That’s where we're getting the real problem,” says Morgan. “You can always add more beds, but you are limited by the amount of staff you can actually throw at this.”

Morgan says that while all areas are seeing more COVID cases, the upper Midwest and Midwest are getting hit the hardest, which includes Indiana, Iowa, Missouri, Kansas, Nebraska, South Dakota and North Dakota.

“Those are the places where it has gotten so bad in many of these communities, that they're not able to refer patients to adjacent urban communities,” says Morgan. “And when you do that, you really run the risk of having your mortality rates increase to really an unacceptable amount.”



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