Palomar Medical Center in Escondido, Calif., undertook a historic EMS feat of transporting 130 patients via ambulance to their new, state-of-the-art medical facility. Rural/Metro Ambulance, one of the largest ambulance providers in the nation, undertook the transports with its subsidiary, Pacific Ambulance, and had all patients transported in about nine hours on Sunday, Aug.19.
The evacuation required 18 BLS and critical care transport/bariatric ambulances to transport the 130 patients from the existing Palomar Medical Center in downtown Escondido to the new 288-bed facility three miles away. Included in this group were about 60 patients who were Intensive Care Unit (ICU)/Critical Care Unit (CCU) level, making it especially crucial to plan accordingly and coordinate not only getting patients to the receiving facility, but to ensure they received exceptional care en route.
The Planning Process
The hospital evacuation involved staff of all levels, from field staff to management, working together with Palomar Medical Center operations staff for more than a year to carefully plan every detail of the transfer.
“Above all else, our guiding principle was that each patient be moved safely and with dignity,” says Director of Clinical Operations Improvement for Palomar Health Maria Sudak.
“We couldn’t be more ready,” says Rural/Metro Division General Manager Wayne Johnson as Pacific Ambulance crews assembled at the staging area, two blocks away from the downtown Palomar Medical Center at a local bank parking lot to minimize impact on the surrounding community. “In addition to numerous meetings, emails and phone calls during the past year,” Johnson adds. “There have also been two table top drills and one full mock transport drill.”
Nothing was left to chance; scenarios were planned and tested for every possible situation, and patients and their family members remained fully informed throughout the process. All efforts were managed as part of a streamlined operations scene from the second the first patient was loaded until the last patient was off-loaded.
The scale of the evacuation made this a closely watched effort by the community, the media and especially Palomar Health. Those in EMS deal with the unexpected every day, and with the assistance of Rural/Metro field supervisors and support staff from all agencies involved, no stone was left unturned.
“I visited all of the critical care patients we would be transporting the night before the evacuation,” said Pacific Ambulance CCT Coordinator Kelly Forman. “A patient using a balloon pump and her family were quite panicky and worried about the move. I couldn’t have been more pleased when I saw them all smiling and laughing just minutes into that visit and then after the transport.”
Evacuation Incident Command
Rural/Metro and Pacific Ambulance staffs were on-hand at 6 a.m. to greet ambulance crews and coordinate with Palomar staff to make sure the day went off without a hitch. To execute the scale of the operation, an EMS operation incident command center was set up in the basement of the downtown Palomar Medical Center from which all ambulances were dispatched using a radio channel separate from all other radio traffic. That way, all needs were addressed and managed accordingly.
Two paramedic field supervisors, Nick Price and Todd Smith, were in charge of assembling crews and managing incident command for the evacuation, ensuring that a high standard of patient care would not be compromised in any way.
Price and Smith were responsible for all day-of incident management logistics, including:
- Managing loading and off-loading times;
- Monitoring and addressing logistical needs for the ambulances, like medical supplies or mechanical issues with the rigs;
- Coordinating ambulances to ensure an adequate flow between facilities;
- Assisting with traffic flow for minimal impact on the surrounding community;
- Ensuring crews were comfortable in the 95-degree, humid weather throughout the day by providing refreshments and plenty of water;
- Facilitating communication between Rural/Metro, Pacific Ambulance and Palomar staff to address all needs and concerns, as well as provide updates to all parties throughout the evacuation process; and
- Escorting critical patients through their transports, including one balloon pump.
In addition to all the ambulance resources, Mercy Air, a local medical helicopter service, was also placed on standby should something unforeseen and uncontrollable hinder the evacuation, such as traffic jams or car accidents.
‘Hospital of the Future’
The new 11-story Palomar Medical Center was 10 years in the making and cost nearly $1 billion. The state-of-the-art facility, which is also the only designated trauma center in northern San Diego County, bills itself as “the Hospital of the Future,” and the emergency department/trauma floor is no exception, with features including:
- Forty-eight, larger-than-average treatment rooms equipped with cutting edge imaging and specialized clinical equipment;
- A dedicated trauma elevator from the rooftop heliport to the operating room;
- Six critical care treatment rooms; and
- One orthopedic treatment room.
The new hospital’s emergency department was even designed around the convenience of EMS professionals. For instance, the ambulance entrance has a one-way egress design that allows crews to back the ambulance in on an angle, allowing more ambulances to use the entrance at once. There is also a large mirror installed to increase safe egress in and out of the emergency department entrance. In addition, “no blocking” signs have been posted to increase access to ambulance-designated parking spots.
Perhaps one of the biggest takeaways from the Palomar evacuation was the way in which different EMS agencies worked together with their hospital partners. From planning to implementation to execution, all parties were communicating their needs effectively in the best interest of the patients, and it paid off in a big way for all involved.
“There were Palomar hospital guides and volunteers greeting EMS crews, guiding them in and out of the new facility, ensuring the whole experience remained coordinated and friendly,” said Rural/Metro Operations Specialist David Holladay.
One major reason the evacuation went as smoothly as it did was due to the ease of ambulances accessing the emergency department. “The CCU/ICU transports were made even more manageable due to the hospital installing a ramp right outside the cafeteria, which is in close proximity to both critical units,” said Forman.
As one of the largest EMS efforts of its kind in the nation, there were innumerable moving parts and people involved who made it happen. The world-class professionalism of all teams came together in Escondido to pull off the Palomar evacuation effort. “Even though we practice all the time,” Holladay reflected, “something like this [the evacuation] is a once-in-a-lifetime experience.”
Note: We thank Reema Makani Boccia for her editorial contributions, and we also acknowledge both Reema and Bobette Brown for coordinating access to report on this story.