Rising To Meet The Challenge

With a rise in the number of people living on the East End on a full-time basis, the need to expand emergency room medicine and services existed before the onset of the COVID-19 pandemic in March 2020. But the resulting global health crisis brought that need into even starker relief.

Fortunately for East End residents, local emergency room doctors, nurses and support staff, hospital administrators, and ambulance companies and EMTs have been rising to meet that need.

While the COVID-19 emergency is over, the specter of another pandemic is never far from the minds of health care workers and leaders who so recently lived through it.

In a video conference roundtable hosted by The Express News Group on October 5, a group of doctors and leaders from local health care facilities discussed the challenges they faced during the pandemic in providing emergency medical care, and how they’ve been meeting those challenges over the last few years, both before, during and in the aftermath of the pandemic. They also discussed what the future holds for the field of emergency medicine in the area.

Work remains to be done, but the leadership shown by hospital administrators, the dedication of talented doctors, nurses and EMTs, and, most of all, the commitment they’ve demonstrated to working together in an increasingly collaborative way, means that both residents and visitors on the East End can continue to expect a high level of care if and when the need for emergency medical services arrives.

The panel discussion included: Peconic Bay Medical Center Executive Director Amy Loeb; Dr. Fredric Weinbaum, the chief medical officer, chief operating officer and interim chief administrative officer of Stony Brook Southampton Hospital; Dr. Darin Wiggins, vice chair of emergency medicine at Stony Brook Southampton Hospital; Missy Hesler, president of the Sag Harbor Volunteer Ambulance Corps; and Joseph P. Louchheim, a volunteer paramedic with the Bridgehampton Volunteer Ambulance and former assistant captain. Louchheim is also the former publisher of The Press News Group, the company that preceded The Express News Group as the publisher of The East Hampton Press, The Southampton Press and 27east.com.

In a video conference panel discussion in front of a live audience, moderated by Express News Group Deputy Managing Editor Brendan O’Reilly, and with an introduction from Express News Group Co-Publisher Gavin Menu, the health care professionals discussed what they’ve seen on the East End, particularly the explosive growth during the pandemic, and how it has led to a growing number of ER visits for critical care patients.

Loeb spoke about the ways Peconic Bay Medical Center has risen to that challenge recently, calling the evolution “remarkable.”

“We’ve become a trauma center, and we’ve become a semi-receiving center able to take care of people having heart attacks,” she said. “The subspecialists we’ve been able to recruit have enabled us to provide better care closer to home, which is key for us.”

Loeb pointed out a key statistic: The hospital has cut in half the number of transfers out of its ER over the last few years. “Our ability has grown, and our mission to provide care here in the community is being fulfilled more and more every day,” she said.

Expansion and improvement of ER services has been happening at Stony Brook Southampton Hospital in recent years as well, and Dr. Wiggins spoke about how crucial that has been for the well-being of East End residents. He said the hospital’s ability to do cardiac catheterizations on site has been a huge development.

“Formerly, we’d have to ‘drip and ship,’” he said, referring to the process of stabilizing a cardiac patient and then transferring them via ambulance to the nearest cardiac catheterization lab, which was 45 minutes away. “And time is muscle,” he said, referring to the fact that when blood vessels are blocked for a prolonged period of time, the heart muscle can start to die.

Updated ambulance protocols have been key in that race against time as well, Wiggins said, meaning a patient can be in the cardiac cath lab within 15 minutes of arriving at the ER door.

Stony Brook Southampton Hospital also became both a trauma center and stroke center in recent years, and Wiggins said the integration of residency programs has been “tremendous.”

“It raises the level for everyone when you have residents around and you have to teach,” he said.

The simple fact that there are more hands on deck in the Emergency Department is vital as well. “During my first shift 25 years ago, I was the only doctor awake for 45 miles, and I was kind of alone,” Wiggins said. “If I wanted help, I had to start waking other people up. Now, there are four or five other doctors in the hospital with me. It’s incredibly helpful.”

Weinbaum pointed out that for the East End, the integration with Stony Brook Medicine is what has made many of the expanded services in the hospital and in the Emergency Department in particular possible. He added that the increased use of telemedicine has been key as well.

“Another important element is the ability to use electronic means, so we can get an online consultation for things like pediatric emergencies with a pediatric specialist through telemedicine,” he said, adding that it can get the ball rolling on care, particularly in situations where a patient does need to be transferred for tertiary care.

Another big factor that will help address the continued need for expansion of emergency care is the opening of a free-standing emergency center in East Hampton. The center, which will be affiliated with Stony Brook Southampton Hospital, is set to open in late 2024, and construction began this fall. That will be a gamechanger, particularly for ambulance crews.

Weinbaum said the ER in East Hampton will provide “a world of difference” to ambulance crews to the east, giving them another option for delivering patients who need emergency care.

Louchheim said it will not only be crucial for patients but for the quality of life of the ambulance members as well.

“It’s more than getting the patient care quickly,” he said. “If you’re a volunteer in Montauk on a weekend, your return trip [from the hospital in Southampton], your ride home can be an hour, an hour and a half. So, from a volunteer standpoint, having a drop-off point in East Hampton is compelling.”

While area hospitals like Peconic Bay Medical Center and Stony Brook Southampton Hospital have made and continue to make big strides in terms of what they can offer and how quickly they can function when it comes to emergency care, one issue that remains a high priority, and a challenge, is making sure they have an ample number of well-qualified employees to bring it all together for patients. The affordable housing crisis and associated traffic woes have made both hospital staffing and recruitment of EMTs and drivers for ambulance corps a challenge, particularly as the number of residents living in the area continues to climb.

That population growth has not necessarily led to an influx of new volunteers for the ambulance corps, according to Hesler. “We were already struggling with low numbers before the pandemic hit,” she said. “We just recently have brought on two new members, but we are struggling.”

Ambulance corps have had to rely more and more on paid staff to fill in the gaps in recent years.

“Our call volume went from 780 calls in one year to 918 calls last year,” Hesler said. “That’s 200 calls more in one year, with only 25 square miles in our district.”

The challenge of getting crews out east, and the fact that many people must work two or even three jobs to afford to live in the area, and thus have no free time to volunteer for an ambulance squad, adds to the problem.

“We’re already well beyond a fully volunteer solution,” Louchheim pointed out. “I don’t think there’s a single ambulance company on the East End that doesn’t have some paid component. Most companies out here have 24/7 paramedic first responders on staff. There are some ambulance companies out here that could probably operate without volunteers. The difficulty is in managing that transition.”

More paid staff and fewer volunteers creates complications that might not be easy to untangle. Insurance can be billed to help cover those cost increases, but Hesler pointed out that relying on billing insurance could mean that some people might be deterred from calling an ambulance if they are not insured or are under-insured.

The ambulance staffing issue will continue to unfold over the next few years. When it comes to staffing hospitals and emergency center, Loeb spoke about ways to entice top-quality doctors and nurses.

She said that the newly expanded emergency room at Peconic Bay, which is currently under construction and set to be completed by next summer, is something the hospital is emphasizing during recruiting. Both Loeb and Weinbaum agreed that showing a serious commitment to caring for ER staff is crucial as well.

“What we learned during COVID is, there is a tremendous amount of resilience and grit about folks who work in hospitals,” Loeb said. “We need to take really good care of them and make sure they take care of themselves.”

She added that an increased focus on outreach in local schools has been a big part of Peconic Bay’s mission in recent years as well, in an attempt to create a local pipeline for hospital and emergency room careers.

The panelists all agreed that putting emphasis on the importance of primary care will be a huge factor in making sure emergency rooms aren’t overrun, and that who truly need emergency care can be cared for quickly and efficiently in area hospitals.

“When someone comes to the emergency room, we provide them help no matter who they are or what they come in for,” Loeb said. “However, we’ve been focused on that primary care messaging and getting that out to folks in the community, because if folks are getting preventative care and have their issues well-managed, the hope is that they don’t have to come to the ER.”

If and when they do, no matter what the situation, the health care providers who manage emergency situations say they will be ready.

“Flexibility is key,” Wiggins said, referring specifically to what they all learned during the gauntlet of the pandemic. “You had to make do — and we learned that you can.”