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Voices In Emergency Medicine

Emergency Physicians and Nurses are accustomed to working in difficult situations. During the initial COVID-19 wave, many areas across the country experienced conditions only seen in war zones. As the situation improved, their stories were told across multiple media channels and publications.

Currently, the delta COVID-19 variant is sweeping the nation. Hospitals are at capacity and COVID patients are being either housed in emergency rooms, waiting rooms or being sent home. Some have chosen to propagate the notion that this is a false narrative and that the delta variant is not causing any strain on our healthcare system. In response, the question “How bad is it where you are?” was posed to Emergency Physicians across the country. This page represents a collection of quotes from their answers. Real people, working in real emergency departments, all across the United States.

Please, get vaccinated, wear your mask, and join us in praying for our country and the world.

If you work in an emergency department and would like to submit a quote or story, please use this submission form.

TN /

This week we have had 80-95 patients in a 43 bed ED with ALL care in the waiting room and some patients on nasal cannula oxygen (tanks) in the waiting room for 12 hrs +.

ICU overbooked, no in-patient beds and resident physicians so overwhelmed they were not able to stay on shift. 

ANYONE not critically ill gets sent home. 

FL /

No one comes off the ventilator this wave. NO ONE. We are at 35 ventilated patients for COVID since Aug 1, ZERO successful extubations (removal from ventilator). 100% death rate.

FL /

We have 10 COVID deaths daily. The morgue is full and we need to rent a mobile freezer for storage of bodies.

We have a full hospital, and there is no room to take in anyone from the surrounding area.

We send home people with oxygen who we would previously have admitted, daily.

I see people daily who are taking ivermectin, antibiotics, supplements, experimental therapy, and completely ignoring the one thing that has been shown to make any significant difference and actually save lives… vaccination.

This situation is tragic, almost hopeless. And no one wants to listen.

FL /

110 bed hospital
170 admitted patients

Two days ago admitted three unvaccinated, sick but not intubated patients under 40. Today all three dead.

COVID-19, we are not winning.

FL /

The answer is not more ECMO (a machine to oxygenate the blood and bypass the lungs). We don’t have staff to care for basic nursing needs at this point. Cost of vaccine vs cost of ecmo in both dollars and the human cost of it are staggeringly different. In any disaster situation you are potentially faced with limited resources. Covid has created a disaster situation and those that have chosen not to vaccinate have compounded that. Limited resources means you use what you can on the most likely to survive. It sounds cold but it’s the reality. We are all doing our best and we aren’t rationing care based on vaccination status at this time but the unvaccinated are creating a situation where they are causing us to ration care in general. It sucks and the reality is we can’t save them all.

AZ /

I grew up in Oklahoma, lived in Missouri for the past 10 years, have spent most of my life in the Midwest and South. I very much felt what you are feeling right now. I tried hard to protect my community in MO/OK from COVID – I went to local government meetings, was active on social media, I was interviewed by the local paper. Most people just did not want to believe that it was real. The moral injury was too much, so this is what I did – I moved. I now live in northern Arizona and work full-time at an IHS hospital. The local people where I work on the reservation saw the devastation that COVID brought, and they responded as well as they could to protect their communities. There was never any politicization on the reservation over COVID. It was simply about protecting their family, elders, and community. Do unto others as you would have others do unto you – isn’t that what we’re all supposed to do? The vaccination rate of adults on the reservation is higher than virtually anywhere in the US – somewhere around 75% or so. We see only a handful of cases now. The worst is over, here. I feel grateful to be working here. It has done wonders for my mental health. Keep fighting the good fight. But if you have to move to protect your family, your sanity, and your moral conscience, then go.

FL /

Unfortunately we are in the same boat here in Florida. Had a mother cuss me out that we diagnosed her child wrong since she was told her son had bronchiolitis but then she got a call he also had Covid. Not realizing the child has bronchiolitis caused by Covid. “F**k you bruh, Covid isn’t real. The vaccine killed my cousin” i just had to stand there and take it. So here in solidarity

TX /

Here in small conservative town . Not only do we see it all at work but we also have to endure it at home from family and friends. I also question daily how long I can keep doing this crazy job.

Unknown /

I hit a wall this week. It’s exhausting to have to deal with the sick and dying Covid patients, the terrible staffing issues/boarding (admitted patients waiting for a hospital room), and then face the political BS of the vaccines/masking issues. So frustrating and exhausting. I just keep thinking we have to eventually get through this. And we have to take care of each other and the rest of the staff around us who are having the same trials.

TX /

We are surging again but this time we have critical nursing shortages. The ICU has spilled into PACU. ORs have been severely reduced to emergent cases only. Just received word that we have 0 Pediatric ICU beds left in the state and we have very limited Pediatric capabilities.

The mental and emotional drain is hitting hard. Being in the area I’m in I obviously deal with many COVID deniers and deal with belligerent patients every shift. Had a COVID patient berate me last night for having a “I’m vaccinated” sticker my facility requires on my badge. He accused me of being a “GMO Human” since I received the vaccine, while he struggled to breathe.

The part that is draining me the most though is the incredibly high number of EMS and Nurses that have refused to vaccinate here and some EMS even refusing to wear an N95 when transporting COVID patients. For the first time in my career I absolutely lost it on a medic for not wearing PPE and transporting a KNOWN COVID patient that I had to intubate on arrival. We are so critically staffed for EMS that my partner that’s the medical director is concerned that if he starts chastising those not following his policies that we could lose even more staff. Never in my career did I think I would encounter anything like this. Our scribes are all quitting because the 9.50/hr ain’t worth it and I don’t blame them!

Worst of all is my kids are too young to vaccinate and are headed back to school as likely the only kids in class that will mask. We tried homeschooling last year and failed miserably. I’m terrified for my kids safety but equally worried about their mental health if they don’t get some socialization…

I see a location change coming for me in the near future if not a career change all together.

Stay safe out there and protect yourselves

MO /

No beds. Short on nurses on floors and ED. ICU patients with prolonged ED stay due to…no beds. We must stop the disinformation. This is not sustainable for our healthcare workforce

Just got the call that I may get called in for jeopardy shift (on call shift) tomorrow and literally started crying. I do not see an end to this broken system. It’s so disheartening. And the C suite has no idea of our burden, just asking for faster widget-making.

KS /

Pediatric Hospital – Our children’s hospital is full, boarding patients in the ED (admitted patients waiting for a hospital bed).

TX /

Pediatric Hospital – We are seeing large volumes. Holding pediatric ICU and medical floor patients patients in the ER most days (admitted patients waiting for a hospital room). Seeing much more affected younger patients with Covid than ever before.

Like everyone here, we live in two worlds. One world where everyone says it’s fine, traveling, going out to dinner, participating in activities like nothing is happening. The other at work where we are inundated with sick patients, long wait times, burnt out staff, lack of capacity, taking complex patients from outside our network due to lack of beds at their primary system.

TX /

Pediatric Hospital – we are getting killed. Holding admissions and ICU kids, increased number and much sicker COVID kids than previous waves. Ominous.

AL /

We’re trying to prevent people from dying, y’all, I don’t know how to be more direct and blunt. I don’t want people to panic, and I also don’t want people to die because our hospital is so full of people with COVID.

TN /

Trying to transfer a sick Covid + pt right now who needs an ICU bed. Have struck out with more than 7 hospitals. This is the first time I’ve ever dealt with this scenario. I’m sure it won’t be the last.

Here’s the number of available ICU beds:

Maury Regional 0
HCA Tristar 0
St Thomas 0
Vandy 0
NAMC in Florence, AL 0
Huntsville 0
Williamson County 0
Erlanger in Chattanooga 0
Jackson TN 0

There is no where to put sick patients in Middle TN.

OR /

Working in a rural 21 bed emergency department. Our volumes are up 15% in two months. We have a 40% nurse shortage in all acute areas (ED, medical floor, ICU). 30% of our inpatient beds have long term patients that nursing homes won’t take and all our regional referral centers (larger hospitals in the area) are full. 30% of our emergency department beds are occupied with admitted patients.

Average wait times to see a doctor have gone from 20 minutes to 2 hours in two months. We are trying, please be patient and kind to the staff!

FL /

It’s a mess. We had 3 deaths in the ED that I am aware of in the last 24 hours of non-vaccinated people. One 30 yo, a 40 yo and a 55 yo. We are having serious problems off loading EMS patients (finding room for ambulance patients). Stroke and STEMI (heart attack) alerts have been delayed in their care because of the system overload. Our ICUs are nearly full and the CCM(Critical Care Medicine) staff is really stretched thin.  One of our biggest problems is the lack of nursing staff in the ED, ICU and ORs. In the first wave when volumes were down many were furloughed or incentivized to retire to avoid the labor costs while revenues were down. Now they are gone and not available to rehire. Staff continue to leave either from burnout or more commonly to go to a higher paying job elsewhere.The inane conversations we have with unvaccinated patients are mind numbing. We offer free on the spot vaccinations to all our ED patients and whomever is with them. Despite the obvious carnage in front of them they mostly don’t want it for a variety of nonsensical reasons.

FL /

Florida is in crisis.  Emergency Medicine physicians are coming together to ask if they are alone as they are seeing makeshift ICUs emerging across multiple health systems and regions of Florida.  Coolers (mobile mortuaries) can be found in parking lots across the state.  This is what we prepared for when New York was in crisis but it didn’t come in 2020.  It is here now but not being acknowledged.  The media and political reality that is being portrayed is unfortunate and not accurate.

FL /

The hospital is full. We are holding boarders (admitted patients waiting for hospital room) who are now taking up more than 1/2 of our ER space. Anyone who is not critical is being sent home with oxygen. Multiple nurses out sick and no room to see patients but the waiting room. We cannot accept transfers from smaller, less capable centers because we have no room left. And then…the news that we had a pediatric death from COVID. In 16 years of practice, this the worst thing I have ever seen. Almost all are unvaccinated.

AZ /

I haven’t seen a patient in an ER room for more 2 months. Even hall beds are full. All beds are used up by boarders (admitted patients waiting for a hospital room). Average admitted patient stays several days in the ER. That includes staying in a hall bed by the way. Also patients not in an actual room don’t get assigned a nurse so basically nothing gets done

Unknown /

Every ICU bed is full, every telemetry bed, every floor bed. When I left, my last admission was sitting in a hallway chair. By night shift we had three nurses for our whole ED with one managing three admitted patients (one a sick covid patient getting remdesivir), our results pending area, and triage. I had a cancer patient we couldn’t transfer out with us 27 hrs when I left.

FL /

It’s getting worse daily. Our ICU is full. We are coding (CPR) patients daily and the morgue is full so we have to find places to put the bodies until pick up. Our 45 bed ER is packed. (Patients on) BiPAP/CPAP and ventilators everywhere. 98% unvaccinated.

I’m back in an N95 with a surgical mask now for weeks.

TX /

I’m seeing quite a few unvaccinated people in their 30s and 40s being admitted with this variant (delta). These were previously healthy people with no co-morbidities. This demographic was not as sick with last years variant.

NC /

I’m at a rural critical access hospital in the mountains. While our daily census/capacity varies wildly on the inpatient side we have absolutely no where to send people. We have MI’s (heart attacks) waiting for days in the ER. We don’t generally manage ventilated patients and have been trying to transfer a covid patient on a ventilator for 8 days. I admit multiple covid patients daily. Yesterday I saw 28 patients in an 8 hour shift. We are totally overrun and the only solace I have is that the surrounding counties are in even worse shape.

TX /

San Antonio here. Boarded (admitted patients waiting for a hospital room) 3 covid patients for 40+ hours last weekend. All 3 were ICU status. They were still there when I signed out on my last shift. They might even be still there now.

WA /

Immunization rate higher than many areas, but “Blue Collar suburb” hit hard right now. Boarding (admitted patients waiting for a hospital room) 75% of our ED rooms right now.

Treated CHF & NSTEMI’s (critically ill) in the waiting room last shift.

“Beds” are only part of the issue.  Available staff a bigger issue.  As those that now fill in with overtime get burned out, the horizon looks even worse.

Almost no CoVid patients being seen who are vaccinated.  Like most spots, the sick admits are universally unvaccinated.  Most, regrettably, once they are sick…and they are surrounded by contacts also unvaccinated.

And those admitted have extraordinarily long lengths of stay (hospital stay).  Surprised to know no one wants to take them at discharge (home, shelters, nursing homes)?

As the system backs up, we aren’t as bad as many other areas I hear about.  But not good. The vaccine is still the only way out of this I foresee.

Prayers with everyone.

AL /

Working 28 Bed ED Community Hospital in North Alabama. As of today 18 in house Covid patients, 6 in ICU, 1 on a ventilator.

Our county has roughly a 50% vaccination rate.

On nearly all shifts we have moved our providers (doctors, nurse practitioners and PAs) to the front (waiting room) to initiate care, with little nurse support due to staffing.

Critically ill people being diagnosed in waiting room chairs.

All COVID admissions to date have been unvaccinated patients

Nursing staff being pushed to the limits, I can only buy so many lunches/dinners to let them know they are appreciated for what they do.

FL /

Situation is dire here as well, as you already know. Most of our hospital is COVID. No ICU capacity. About half the ED is boarding (admitted patients without a bed in the hospital). Can’t get transfers out unless pregnancy related or children.

GA /

We are understaffed. Long waits and Covid is back. Mostly younger, average 50 years old, but that being said, we had a pediatric death suspected of being covid-related.

TN /

I’m in TN. This week we have had 80-95 patients in a 43 bed ED with ALL care in the waiting room and some patients on oxygen (tanks) in the waiting room for 12 hrs +.

ICU overbooked, no in-patient beds and resident physicians so overwhelmed they were not able to stay on shift.

ANYONE not critically ill gets sent home.