Published in the July 12, 2017 edition
By MAUREEN DOHERTY
LYNNFIELD — With the impending closure of Union Hospital in Lynn by the fall of 2019, the Lynnfield Fire Department has an established protocol in place when selecting the appropriate treatment facility based on the medical needs of the patient.
This protocol, along with the current staffing status of Union Hospital, was discussed at Monday night’s selectmen’s meeting. According to Fire Chief Mark Tetreault, approximately 40 percent of the town’s ambulance transports continue to go to Union Hospital and this number has remained steady throughout the past year. He also told the board that patients transported to Union generally have routine medical conditions, as it is a community hospital, not a trauma center.
The chief added that they have not seen a reduction in the quality of the care received nor have town ambulances been turned away or redirected to other facilities even following layoffs at the hospital earlier this year.
Selectman Phil Crawford, who has advocated on behalf of the town with both the hospital and the state Department of Public Health (DPH) since Partners Healthcare and North Shore Medical Center (NSMC) announced its intention to shutter the Lynn facility and absorb those patients into Salem Hospital upon completion of its expansion project, said, “There is not a lot of change,” with the closure timeline.
Crawford stated that NSMC remains on target with the previously announced closing date in the fall of 2019, which is dependent upon the “timeline and the renovation and expansion at Salem Hospital.”
“Bob Norton was the prior president (of NSMC) that was working with us and was very open with us,” Crawford said. He added that after Norton retired NSMC’s new president, Dr. David Roberts, has continued that same openness.
Departments closed, building possibly sold
That being said, Crawford stated there are presently “several concerns” at Union Hospital related to staffing, the closure of entire departments and layoffs of staff.
He said both heart care and orthopedic rehabilitation departments were closed in March. “Those are two big departments. There (were) 150 layoffs between Union and Salem together,” Crawford said, adding, “I have not confirmed it but I have been told that the building has already been sold. I’d like to confirm whether it is in escrow or has actually been sold.”
Crawford said Union’s ER “still gets 65 to 70 patients day, which is a pretty robust emergency room. There are patients coming from Salem to Lynn Union that don’t want to wait at Salem because they are so backed up over there. You could be in there for hours waiting to see a doctor at Salem right now, so they’re actually driving themselves over to Union for a shorter wait time.”
In spite of the “rumors circulating out there” with regard to the hospital, Crawford said the care remains “status quo, but there are a lot of temporary nurses working at Union now because they have laid off so many full-time (nurses). You can see the changes starting to happen. We’re still concerned, and they’re concerned about whether they can have a full staff up until October of ‘19 because I don’t know how many people will wait to get out of there.”
“The other concern I have is whether or not there is going to be an emergency room available after that time frame. As much as the (state) Department of Public Health can say we’d like you to keep one there, there’s absolutely nothing binding to make them do it. There is no teeth in (the DPH) requirements. It is really up to the hospital,” Crawford explained.
Transports to 16 facilities
Chief Tetreault provided the board with a handout detailing his department’s usage of Union Hospital in comparison to all of the other medical facilities in the region.
“Over the past year, the Fire Department ambulance has transported to 16 different medical facilities. Roughly 40 percent of our patients go to Lynn Union Hospital,” Tetreault said, which means “60 percent are going elsewhere.”
“Over the past 12 months, transports to Union Hospital have remained fairly consistent. We haven’t seen any reduction in those numbers,” the chief stated.
“The determination regarding transportation to the hospitals is made by our medical providers in the field based on the acuity of the patient. State treatment protocols dictate how we make that determination. So we decide what is the closest appropriate medical facility,” the chief stated.
“I think we need to keep in mind Union Hospital is a community hospital. There are certain instances where the closest appropriate medical facility is not Union Hospital. For example, a cardiac patient, more than likely we are going to transport that patient to Salem,” Tetreault said.
“If we have a multi-system trauma we will probably transport that person to a trauma center and not to Lynn Union,” Tetreault explained, adding, “In this area we have access to the best medical care in the world, so if you have an eye injury, the place of choice might be Mass. Eye and Ear as opposed to Union. Most of our routine medical emergencies can go to Union Hospital. We have not seen change in the level of care provided by Union Hospital. We have not been turned away or redirected to any other facility. When they are the most appropriate facility, we transport there and they willingly accept the patient.”
Regarding his department’s transportation protocol, Tetreault said, “In a lot of cases it is the patient’s preference, or they’re being handled at Lahey so they would prefer to go to Lahey Burlington or Lahey Peabody. Their primary care physician could be at Melrose-Wakefield, so we’d go there.”
Crawford asked Tetreault: “Salem Hospital has already announced they’re going to disband the cardiac unit. What does that do to the cardiac emergencies that you bring? Is the next closest hospital still the North Shore or does that send you into Boston?”
Tetreault said, “I would think Lahey Burlington. I am not 100 percent sure on that. Definitely Boston; we are in very close proximity to Boston. If I’m having the big bad one, I prefer to go to Boston.”
Pat Campbell asked Tetreault how long it would take to transport a cardiac patient to Salem or Burlington.
The chief said he did not have “specific numbers” on the actual timing because it depends a lot on the time of day. But he explained an ambulance “with lights and sirens, we can move pretty quickly though traffic.” While traffic going in both directions can get “intense,” he did not think there would be an “appreciable difference, it is just a direction and traffic conditions can vary greatly.”
Campbell asked the board if the state Attorney General had “made a decision on closing the emergency room?”
Crawford explained that the AG “doesn’t make that decision. The Mass. Public Health division had asked them to keep that open, but they can’t make it mandatory, which is the problem.”
Mary Stewart asked Tetreault: “Did you say if it’s a severe situation that the patient can have a choice of where the ambulance goes or not?”
The fire chief said, “No, when it’s a severe situation generally our medical providers decide where the most appropriate medical facility is. If it is a matter of a stable patient and they have a preference, we do take that into consideration.”
LFD Transport Decision
The Lynnfield Fire Department’s transport decision for ambulance protocols is defined as follows:
Transport to the nearest appropriate treatment facility as defined in EMS regulations. In rare circumstances, delayed transport may occur when necessary treatment cannot be performed during transport.
• Request and use available Advanced Life Support (Paramedic) backup or intercept whenever clinically indicated and in accordance with these treatment protocols.
• EMS personnel shall make decisions about the destination hospital in accordance with the EMS System regulations and Department-approved point-of-entry (POE) plans.
• There are currently Department-approved condition-specific POE plans for trauma, stroke and STEMI (cardiac issues) as well as a POE for a patient’s other condition or need, not covered in the specific POE plans.
• Department-approved regional POE plans for trauma, stroke and STEMI identify specific hospitals to be used.
The EMT must be aware of all these POE plans affecting his/her service when choosing the appropriate hospital destination.
• EMS personnel may call medical control if they have a question about POE.
• Notify receiving facility as early as possible.
• Use of lights and sirens should be justified by the need for immediate medical intervention that is beyond the capabilities of the ambulance crew using available supplies and equipment.
