Breyre Amelia M, Sloane Bryan, Herring Christopher, Backer Howard, McGinnis Thomas, Staats Katherine
University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
Stanford University, Department of Emergency Medicine, Stanford, California.
West J Emerg Med. 2021 Mar 25;22(3):608-613. doi: 10.5811/westjem.2020.12.49237.
Imperial County is in southern California, one of the state's two counties at the international United States-Mexico border. The county is one of the most resource-limited in the state, with only two hospitals serving its 180,000 citizens, and no tertiary care centers. A significant portion of the population cared for at the local hospitals commutes from Mexicali, a large city of 1.2 million persons, just south of Imperial County's ports of entry. Since May 2020, following an outbreak in Mexicali, Imperial County has seen a significant increase in the number of COVID-19 patients, quickly outpacing its local resources. In response to this surge an alternate care site (ACS) was created as part of a collaboration between the California State Emergency Medical Service Authority (EMSA) and the county. In the first month of operations (May 26-June 26, 2020) the ACS received 106 patients with an average length of stay of 3.6 days. The average patient age was 55.5 years old with a range of 19-95 years. Disposition of patients included 25.5% sent to the emergency department for acute care needs, 1.8% who left against medical advice, and 72.7% who were discharged home or to a skilled nursing facility. There were no deaths on site. This study shares early experiences, challenges, and innovations created with the implementation of this ACS. Improving communication with local partners was the single most significant step in overcoming initial barriers.
帝国县位于加利福尼亚州南部，是该州位于美墨国际边境的两个县之一。该县是该州资源最为有限的县之一，仅有两家医院为其18万居民提供服务，且没有三级护理中心。在当地医院接受治疗的很大一部分患者是从墨西卡利通勤而来的，墨西卡利是一座拥有120万人口的大城市，就在帝国县入境口岸的南部。自2020年5月以来，墨西卡利爆发疫情后，帝国县的新冠患者数量大幅增加，迅速超过了当地的资源承载能力。作为应对这一激增情况的举措，在加利福尼亚州紧急医疗服务管理局（EMSA）与该县的合作下，设立了一个替代护理场所（ACS）。在运营的第一个月（2020年5月26日至6月26日），ACS接收了106名患者，平均住院时间为3.6天。患者的平均年龄为55.5岁，年龄范围在19岁至95岁之间。患者的处置情况包括25.5%被送往急诊科以满足急性护理需求，1.8%的患者自行出院，72.7%的患者出院回家或前往专业护理机构。现场无死亡病例。本研究分享了实施该ACS过程中的早期经验、挑战和创新举措。改善与当地合作伙伴的沟通是克服初期障碍的最重要一步。
