Support for Arkansas Week provided by the Arkansas Democrat Gazette.

The Arkansas Times and KUARFM 89.

And hello again everyone and thanks very much for joining us COVID-19 the pandemic has killed more than 6000 Arkansans now sent three times that number to hospitals.

And not only is the end not insight experts believe the situation will get worse, perhaps much worse before it gets better hospital executives and clinic administrators are warning that the stress level has doctors, nurses, and technicians at the snapping point.

And that a shortage of staff is imperiling patient care.

Situation seems especially dire in small towns and rural Arkansas, which is the focus.

Of this edition joining us live.

Shannon Spencer, a specialist in health care delivery, particularly in smaller towns and doctor Marcia Byers, director of regional programs for the University of Arkansas for Medical Sciences.

Ladies, thank you very much for for joining us.

Doctor will let me begin with you.

How dire is the staffing situation right now?

Well, the biggest impact that we're seeing right now is is actually related to pipeline and health professions education.

The COVID pandemic has interrupted our ability to provide students face to face clinical rotations.

My role within regional programs is not specific to the clinical care of patients, but more the pipeline and addressing health professions shortage gaps in Arkansas, and it's really has significant.

Impact on our ability to recruit young people into health professions.

Yeah, I think what we find is a gap coming in the next few years.

Pandemic has made a bad situation that much worse.

Or am I misstating the situation?

No, you're absolutely right.

We train hundreds of students every year.

Regional programs is a collection of eight science that are located in role and distant areas in Arkansas.

Distant from central Pulaski County.

We provide care to over 50,000 patients.

We have approximately 200 patient visits.

Obviously, when the pandemic hit, we had to train all of our professionals.

How to provide.

Distant virtual patient care visits.

Also, as I mentioned before, it created a situation to where we are unable to adequately train our health profession.

Students, including medical students, pharmacy students, nursing students, and physician assistant students in our actual clinics and give them that patient experience that they need.

So I think that we're going to continue to see that impact as we move forward.

Especially with the very well.

Yeah, there is some assistance coming in terms of financial assistance.

I think Mr. Hutchinson is said just a couple of days ago.

The governor is that a couple of days is about a quarter of a billion dollars in health money that's made available to Arkansas now.

Can that make a difference?

Or are we just locked into a situation for the for the balance of this pandemic?

I think that will help.

I'm not sure that it will.

Provide assistance for the specific problem of having our students and face to face opportunities.

However, we have been able to transition many of those activities to virtual experiences where the clinicians in the in the exam room with the patient we actually have students that are participating electronically from home within those visits.

However, with the upcoming funding we are working on a couple of grants to specifically address.

Wellness and resiliency in our health professions populations right now and the stress that COVID has placed on all of them.

Yeah, Shannon Spencer.

This is not a surprise to hear.

This is not news to you.

No, it's not news and let me just think Doctor Byers and her team at UA Mass and the other two medical schools.

They've done a very good job of really adapting rather quickly and when I say adapting rather quickly to ensure that the medical school students continue to get the education.

But just from not, you know, not a Tele health, but just a net electronic format right now, because they understand the critical need because of the physician shortage that so many of our rural communities actually face pre pandemic.

And so it's just going to continue.

And there is a large number of our primary providers that are due to actually retire.

So UAMS and the two DO schools have done a very good job in trying to make sure that we have a large pool of physicians that could actually go out and practice.

In rural communities, I think COVID is just that first pandemic, but we need to make sure that we have the necessary infrastructure to help and to be able to assist with future pandemics.

The keyword here maybe future pandemic, because many helped a lot of the literature that I've read said this won't be the end when this when this particular COVID pandemic ends, there will be another absolutely absolutely, but I no doubt in your mind, no doubt in my mind, but I think those institutions are looking ahead to the future, but still having to actually look at what's in front of them right now.

I just congratulate them on putting together different strategies in order to really deal with the workforce and what you know.

Doctor Baez also said just the whole Wellness.

We need to ensure that Wellness from an employee perspective clinician physicians is actually built into the fabric of the organization.

You have so many clinicians physicians that are just burnt out there seeing patients die on a regular basis, and that's actually impacting them mentally.

They love nursing, that's why they went into nursing.

But we need to make sure that they're actually seeking the necessary care to ensure that their health, their healthy and whole just as well stay with us.

More on this subject.

Coming up life in rural Arkansas has its rewards, certainly.

But also its risks and one of them is emergency medical care.

And the pandemic has underscored that vulnerability, the time it may take for an emergency medical team to reach an accident victim or a COVID patient and then get them to a hospital and what to do about that issue.

That's the subject of this month's good roots.

Here's Logan Duvall.

Dispatch radio when you show us in Groundhog, sometimes one if you live in a rural area and require immediate medical attention, how long will it take for you to receive help?

And with the recent strain on hospital space and staff, where will the emergency crews even take you?

The answer to those questions and what's being done to help with response times and patient care?

Is this episode of good groups.

The vast majority of Arkansas can be considered rural with populations heavily consolidated in only a few areas.

For most Arkansans, medical care means travel, and for some a considerable distance, whether that's for a traumatic event and Iraq or even to get a vaccine.

I'm Robert Thurlby retired from general internal medicine practice and Russellville Andover, Arkansas.

If someone is moving to a rural area they need to do research the ambulance practice number of specialists, what's available in their town that they're going to be dependent upon, particularly if they've got an ongoing medical problem that that requires some sophistication.

The ambulance program has improved.

They've moved out into some of the boroughs.

And they were reaching people earlier.

Also 911 can get you a helicopter in quickly.

In many instances, emergency medicine starts with lights and sirens, ambulances and fire trucks for Arkansans living in more rural areas.

It can take up to an hour or more for an ambulance to reach the seem.

Much of that depends on staffing locations, access and equipment.

I have first hand experience in rural EMS responding to all kinds of emergencies, from traumas in car wrecks, diabetic cardiac emergencies after spending 8.

Years on an ambulance.

What is Med tech and what do y'all do?

Med Tech EMS of Conway County we provide a paramedic level service or all of Conway County.

We have two primary trucks that are paramount, little trucks that we staffed 24/7 365 days a year all the time all the time.

And then we have a reserve unit that we can staff fairly quickly if needed.

If all of the trucks are out, it doesn't happen.

Yes, so y'all covered the entire county.

So how long would it take to get?

To the outskirts of the county, probably at the Max.

Running Code 3, which is lots of sirens and pending traffic, gets out of our way about 30 minutes, about 30 minutes.

OK on the on the long side.

So what has COVID done for EMS?

It's been a big challenge, so with COVID it slowed our response on every other call.

Basically because when we have a COVID transport we have guidelines we have to follow the protocols once they have transported patients, they come back, they have to completely decontaminate the unit and then they have to be contented themselves, which means shower.

Change of uniform everything it's been tough and our guys.

It's real.

You know when you think about the long extended transports that they have.

Sometimes with COVID it's there in either an in 95 masks or half face respirator masks.

They have full, you know, gown suit, you know topic suit on so it's it's definitely wears on them.

They see the effects of COVID and what it's doing to their patients and it's it's definitely definitely wears on.

What biggest challenges have you seen at the hospitals in dealing with at the hospital that's been wait time?

Everybody is doing their best.

Let me start with that.

Everybody is doing their best.

It's just this is a territory we've never seen before.

All of the COVID beds are taken, just the other day we made a transport all the way to Mina.

That's a 5 hour turn around time for a transport to Mina, so there's no specialty necessarily that our hospital doesn't have.

It's just they have COVID units, a COVID unit.

So, and that was the only COVID bed available in the whole state at that time.

EMS typically take patience to the closest emergency department.

However many times in rural areas they are.

Inadequately equipped and staffed to deal with the most severe cases and the patient is better suited at a higher level of care.

For example, a larger hospital in Little Rock.

Pediatric surgeon Doctor Todd Maxon is the chief of the trauma system at Arkansas Children's Hospital in which he helped to create.

And unfortunately, the beds in our trauma centers are at or near capacity.

The impact that I've seen from COVID on the trauma system is pretty significant.

I mean, we really have.

Two goals now we must continue to provide outstanding care, but we've got to protect ourselves because if we're infected or we spread this, then we just simply don't have the personnel to continue to perform.

It's almost a daily analysis of whether we're going to have enough space to continue to do this, so everything we can do in this state to curb the spread of COVID has such important downstream effects for us.

The Arkansas Department of Health, along with several other private health care providers.

Had begun to focus on establishing COVID-19 vaccination clinics in more rural areas across the state in an effort to provide all that would like to receive the vaccine and opportunity.

You can find that list on healthy Arkansas Gov.

I feel that rural Arkansans definitely have access to vaccine and people will call me and ask me should I take this vaccine.

And my answer is yes, both my lovely wife and I've have both had COVID-19 the disease and we both had dual shots.

Our case incidence is going up and we're leading the United States in two areas.

They're both of which are bad.

Let's do something about it.

We have so many health care workers that are that have been out from COVID or or continuing to be out from COVID.

So we've got to get ahead of this.

It is absolutely changing what we do.

Living in rural Arkansas offers many joys, but health care is an aspect of life we all must face for good roots.

I'm Logan Duvall.

Major funding for good roots is provided by Arkansas Farm Bureau, Arkansas Farm Bureau advocating the interests of Arkansas's largest industry for more than 80 years.

Arkansas counts on agriculture, agriculture counts on Farm Bureau.

Then we're back and I want to go straight to Doctor Byers, doctor, the Ozark foothills.

Our vets, your native turf Searcy County, that area up there, boy.

What's the situation on the ground?

This has a special resonance for you.

Yes, so I do live in a very rural area and I can absolutely appreciate the challenges and stressors that our health care workforce are facing.

And I think just with the the information that's been shared in this program, you can see the stress of COVID and the impact that it has on our existing health care workers in many circumstances which are already shortages in rural areas of nurses.

In positions in pharmacist so when you add on to that, the impact of COVID, whether it's a direct impact with our health care professionals being ill or having the burnout and the stress based on all of the traumatic situations that they're seeing, it really is culminating into a significant issue.

And I think in addition to that, these are all direct impacts that you're seeing right now.

We really have to focus on and think about the long term impacts on our health care work.

Course my team is responsible for pipeline programs and introducing students to health professions from as early as middle school all the way.

Programs that help these students all the way through the finished product, which in our case is a trained health professional that's placed in a rural area, taking care of underserved populations.

And so we're transitioning all of our programs to make sure that we can continue our recruitment efforts and continue this.

Obviously very important pipeline and make sure that we don't have additional future strains on health care workforce as a result of coding.

Just a couple of nights ago Doctor I had Clinton and a pharmacist.

There told me that there has been and appreciate a real spike in the immunization vaccination rate in, say, in Van Buren County and a bit north of there.

Are you seeing that in Searcy County as well?

Well, absolutely I don't have the specific statistics for Searcy County and our vaccination rate, but just from my personal group of friends and family, I I do believe that the importance of it is is being shared and is obvious and is being understood now more than ever.

So I I think that I think that trend is probably consistent across the state.

We'll be right back with more.

And we are back joining us now.

Doctor Dewey McAfee of Unity Health's Medical Center White County Medical Center at Searcy doctor we thank you very much for coming aboard.

Yours is a vibrant and a thriving city Searcy, but it's not the biggest in Arkansas.

Can you give us the situation as you see it on the ground there?

And here in Searcy that, uh, we have actually surpassed the surge about what it was back in the winter of last year, when we actually thought the surge was happening, that we are approaching those numbers and exceeding them, and we're making plans that it is going to continue to worsen.

We are anticipating up to as much as doubling the number of COVID patients that we will have in our facility.

Within the coming 60 days.

What does that mean?

Doctor for the delivery of patient care.

What kind of stresses does that put on a the staff and and be the facility itself?

What are you having to do or anticipate having to do?

Stress is trying to find enough staff to be able to handle all of that patient load.

We're already taxing our nurses up to the maximum ratios that are comfortable for the nurses and safe for the patients and.

So we either are going to have to limit the other number of patients that we can admit to the hospital, or we're going to have to find staff that can help take care of the patients.

Uhm, nursing shortage is one of the biggest things that we have and having enough nurses to staff.

The patient load.

Uhm, is it's very very real.

It was real before COVID hit, but COVID has made it even more apparent and we feel the effects of it much worse.

We have empty beds on the floors, but we don't have staff that could cover those beds, so you can't put patients in them if it's not safe for the patient to be there so.

Uh, we we're, we're shuffling where we can and doing what we can to provide the care for those necessary patient cover.

Correct me if I'm wrong doctor, but it sounds like the entire hospital there and I'm White County.

Probably not alone.

Your facility, not alone, but it sounds like the entire facility is being is is now an ER.

It's a triage center and my correct.

Am I overstating it there?

Not too much.

Our emergency room is, UM, pretty well maxed out up.

We can't discharge patients fast enough to take care of the patients that need to be admitted.

Uhm, some of the COVID patients, and because of the nature of the disease.

UM, whereas a regular pneumonia, you could figure that they probably are going to be in the hospital.

Medicare has it calculated at about 3.5 days.

This is what you're going to be allowed for a regular pneumonia.

A COVID patient may be in the hospital anywhere from two to four weeks and trying to get over the disease well enough to be able to be discharged home.

Uhm, a lot of times these patients have to be transferred to a long term care facility to continue their care and so that more acute illnesses can be admitted to the hospital.

La Shannon Spencer again, let's go to your doctor standby.

Please let Shannon Spencer this is again, you're not startled by anything, but I'm so he's talking about Searcy County.

So when you really started looking at the White County, but seriously, are Searcy, AR White County.

But when you start thinking about the demographics, you have families that actually moved into that because of the great school districts.

So prior to now, you saw that age range of 60 and above.

That's actually occupying a bed.

Now you're seeing.

40 and under that's now occupying beds, and so you're thinking about that patient population that's actually occupying those beds.

But no one's thinking about the financial wealth and the financial strain that is actually putting on that hospital.

So when you're talking about adding additional staff nursing that cost.

You start adding up some of those patients may be uninsured.

The reimbursement rate for Medicare and Medicaid, and so it just really has a domino effect of the overall operations of many of our rural hospitals.

Doctor Michael feedback to you.

Because I and my understanding is that one of the one of the effects of this is that when your facility wants to try or one like, it wants to transfer a patient who may require care at a higher level.

The hospital to which you would ordinarily transfer that patient can't accept it.

Are you seeing that, yes, we're saying that also and then us having to take care of those things that we are borderline actually capable of taking care of?

But when the patient can't go to the higher level, we're having to take care of what we can.

And sometimes the patients do have to be transferred further away than what we're used to.

Having to transfer patients.

But La Shannon Spencer back to you.

Well, if you want to pick up on that or I haven't.

He talked about having to transfer, right?

Think about that cost of having to transfer.

We only thinking about nurses right now, but he's having to make sure that there is a case manager and that case manager is dealing actually with that particular patient's family, but also having to have that constant communication with that potential receiving hospital.

That's actually going to receive that patient.

But also, there's so many other factors that's actually impacting the.

Operations and actually taking time away from patient care when you have to deal with situations like this or to both of you.

We have school starting in just a short number of days now.

Do you want those kids mask?

I do.

I want kids mask.

I want teachers mask.

I want people to really understand the importance of wearing a mask.

Steve, I actually I think about grandparents that are having to take care of their grin.

Children.

That's under the age of 12.

We need to make sure that as soon as that vaccine becomes available, those children can actually be vaccinated.

It is the responsibility.

In my opinion of a parent, to ensure that their children vaccinated.

It's not just about that child or the parents that are actually living in that home, but it's about that teacher.

It's about other individuals and members of communities as well.

Doctor McAfee back to you.

Do you wanna be given your druthers?

Do you want to see those youngsters masked?

Yes, I do.

It's doesn't take much to look at when the mask wearing mandatory we had a certain level of infection.

Once the masks were removed and the necessity to wear them all the time, the number of cases has exponentially grown and it's putting us into the point to where we are now.

Between Arkansas's reluctance to get vaccinated and their animosity to wearing mask has caused part of the problem of why we have such a high rate of infection.

And our state.

The number of people being vaccinated is increasing.

They're finally getting the message that the vaccination can help them, at least if you're vaccinated and you get the disease, you're not going to die.

You may get sick a little bit, but you're not going to die as a physician doctor, McAfee.

How did do you think the political?

How does the political class in Arkansas responded to this pandemic?

Uhm, it's evident that the legislature did not allow the governor to mandate wearing mask again, so that pretty much sums up their attitude.

I I did, oh, I think about over in Marion when school opened and the kids were actually on mass.

The number of students that actually tested positive the impact that it had on those children just over the last 18 months our kids have been a lot of kids.

Virtual virtual learning has really has such an impact on our children's mental health and their Wellness and also the increase in suicide rate among the young people.

That's actually going to school online.

It's increased academic achievements down to academic achievement is down, but I would like to say kudos to the Little Rock School District and School district and and Fayetteville they understand and so they are making that conscious effort and making sure that mask are required within their schools gonna end up there because we're simply out of time with Shannon Spencer.

Doctor McAfee.

Thank you for your time very much.

Both of you.

Thanks and come back soon.

Both of you and you too will see you next week.

Thank you as always for watching.

Second, support for Arkansas Week provided by the Arkansas Democrat Gazette.

The Arkansas Times and KUARFM 89.