Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain During the COVID-19 Pandemic in the United States

Response to “Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain during the COVID-19 Pandemic in the United States”

“…I write to identify a limitation of the fine work of Ioannides et al, 1 which was not cited by the authors in their October 2022 manuscript, “Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain during the COVID-19 Pandemic in the United States.”…”

“…The authors offered data supporting the premise that in the United States, sufficient ambulance capacity has existed from the time of the pandemic’s onset to have enabled meaningful and useful “off-loading” of hospitals that had their capacities oversubscribed by patients with COVID-19. Ioannides et al 1 suggested that capacity existed for transferring patients from oversubscribed facilities to less burdened ones, an action which probably could have enabled better clinical outcomes. More importantly, such an “off-loading” of oversubscribed hospitals could also be employed as needed for future pandemics or disasters.…”

“…More importantly, such an “off-loading” of oversubscribed hospitals could also be employed as needed for future pandemics or disasters. Thus, Ioannides et al 1 have provided an important “road map” toward enabling better future health outcomes when regional or national pandemics or disasters result in clinical demands that are highly unevenly balanced across our nation or across its regions or systems.…”

“…The authors identified certain barriers that currently exist against a future implementation of their vision. They stated, “We hope that our results can foster political will for more organized bed reporting and transfer infrastructure, create local incentives to accept patient transfers, and potentially avoid future unnecessary deaths due to crowding.” 1 …”

“…Mindful of this, patients, or those acting as their proxy, could be expected to decline or resist transfer to a hospital that their insurer deems as “out of network,” potential clinical benefits of such transfers notwithstanding, because these patients’ “out of pocket” charges for “out of network” care would far exceed the charges they would accrue for “in network” care. Therefore, the recent passage of the “No Surprises” legislation to protect patients from excessive medical charges notwithstanding, it would be difficult to realize the vision of lower mortality and more efficient patient distribution, as articulated by Ioannides et al, 1 unless insurers could be persuaded or compelled to waive their rules designating and differentiating “in network” versus “out of network” medical care sources during a pandemic or natural disaster. 2…”