NO ICU BEDS! When our rural Arizona hospital ICU is full, we medevac patients to different hospitals across the state, BUT NOT TONIGHT, because there were NO ACCEPTING HOSPITALS, so for an entire 12 hour shift we managed ICU patients, while treating other emergencies. 1/13

There was one patient MEDEVACED via helicopter with head trauma to another hospital who needed a neurosurgeon, not to an ICU b/c there were no beds, but to an emergency room where they were taken care of by another ER physician until a NEURO ICU bed opened up. 2/13

Where are these 175 available ICU beds in Arizona, b/c for a rural hospital not to find accepting hospitals is problematic. SHOW ME which hospitals have beds that are STAFFED with nurses, because a bed WITHOUT a nurse is like a plane WITHOUT a pilot – USELESS 3/13

There are also many types of ICU beds. Are they COVID ICU beds or non-COVID ICU beds? Neuro ICU, cardiac ICU, surgical ICU or medical ICU? Are they really ICU beds or just exist on paper, because there is no staffing? 4/13

When I was in NYC, all we saw was COVID, COVID, COVID. However, in Arizona due to relaxed COVID restrictions it's worse b/c we see 30% COVID & every other medical emergency – head bleeds, DKA, electrolyte abnormalities, strokes, car accidents, traumas, and overdose. 5/13

It's important to note that COVID and non-covid patients with head bleeds, respiratory distress, diabetic ketoacidosis, electrolyte abnormalities, strokes, car accidents, traumas, and overdose are ALL COMPETING for ICU beds. 6/13

Don't forget the ICU doctors, known as intensivists, are very scarce resources. It's unprecedented that Intensivists are tasked with managing critical ICU and COVID units at 100% CAPACITY for the unforeseeable future, which is overwhelming. 7/13

Each day more and more COVID patients are admitted, continuously consuming inpatient & ICU beds, until no more beds are available, so then admitted patients wait/“board” in the emergency department. 8/13

Admitted patients boarding in the emergency room leads to a DOMINO EFFECT of longer wait times for new patients to see a provider due to less emergency rooms available. 9/13

Rather than wait for rooms to be available, my colleague and I circumvented this today by seeing patients in the waiting room. 10/13

The technical name for flow of patients through the ER is “emergency medicine throughput” 11/13

As an ER doc, I’m worried because aside from hypoxic COVID patients we are still seeing a lot of aforementioned HIGH ACUITY emergencies and staff is getting sick. Our hospitals are ILL-EQUIPPED to manage a pandemic in addition to regular emergencies. 12/13

Nevertheless, at the end of the day, ER doctors and nurses are going to take care of your emergency, because that’s what we are built to do. BUT there are not 175 ICU beds in Arizona. /end