A garage behind Sharp Chula Vista Medical Center houses portable sinks, room dividers and military-tested tents. The crucial emergency equipment can be assembled in a nearby parking lot to increase the facility's capacity during a disaster or outbreak.
Senior Safety Management Specialist Kathy Muth said the additional room allows the hospital to better treat a sudden surge of patients.
"It gives the emergency room a little bit of breathing space," Muth said.
The surge tents are one part of San Diego County’s capacity plan to deal with the ebb and flow of the region’s urgent medical needs, from an earthquake to the annual flu season. The disaster management tool relies on real-time data to alert officials the health care system is experiencing additional stress and outlines actions they can implement to alleviate the pressure.
Officials are paying close attention to metrics as the expected but unpredictable peak of flu season nears.
Dr. Kristi Koenig, medical director of the county's division of Emergency Medical Services, said one key indicator is the transfer of care rate, which measures how many minutes it takes for a paramedic to transfer a patient's care to hospital personnel. The wait time increases as hospitals become busier, which impacts ambulance response rates.
"Because it’s taking longer for the paramedics to deliver the patient to the health care team at the hospital, it also means that it takes longer for them to be available to respond to the next 911 call," Koenig said.
If the wait time reaches the designated level of 21.3 minutes and remains there for a specific period of time, that informs Koenig it's time to implement actions outlined in the capacity plan to alleviate the pressure. For example, Koenig may allow one paramedic — instead of the required two — to answer emergency calls if they're joined by an emergency medical technician, which has less advanced skills.
The plan is designed for any sort of disaster but was developed in 1997 to help manage a flu outbreak. It is continuously updated with lessons learned, especially from December 2017 when the county began to see signs of one of the most severe flu seasons on record. By the following March, more than 300 people had died.
Emergency Medical Services Senior Epidemiologist Joshua Smith said his office refers to that season as "flumageddon,"
"Our duty officers were being bombarded with reports," Smith said.
After it peaked, Smith looked back at 911 call volume, transfer of care time and other metrics to identify when the surge had started.
"What we were able to do is take the data from that year and look at it retrospectively and apply our current system of using metrics and trigger points and we realized we would’ve picked up the flumaggedon about two weeks early that year," Smith said.
Flu activity this year is above average but within the medical system’s capacity. That means at Sharp Chula Vista Medical Center, the surge tents remain in storage.
In the meantime, Dr. Karrar Ali, an emergency department physician, said the hospital already has an internal system to mitigate any patient surge from the flu. There’s a separate emergency department team to triage less severe cases.
"It became an asset, an indispensable asset during the flu seasons," Ali said.
Instead of waiting among patients in dire situations, most people with flu symptoms are diverted to a small staff that addresses only mid-level patients.
"I mean they’re in and out in a very short amount of time," Ali said.
The lower wait times keeps patients and emergency staff satisfied and helps prevent the county from triggering
A lower wait time keeps patients happy, boosts emergency staff morale and helps prevent the county from triggering its capacity plan.
