By Sarah Gantz
The Philadelphia Inquirer
CHESTER, Pa. 鈥� When responding to a shooting in Chester, VMSC Emergency Medical Services providers begin preparing bags of blood for a transfusion.
They have an hour to get gunshot victims to an operating room for their best chance of survival. Ambulances used to race patients to Crozer-Chester Medical Center, a few minutes away.
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But after Crozer closed in May, starting a blood transfusion is one of the few options to improve the odds that patients will survive the 20- to 60-minute ride to the nearest high-level trauma center.
The technique is one of the ways healthcare providers, lawmakers, and other stakeholders are adapting new approaches to cover gaping healthcare holes left in Delaware County after the demise of its largest health system, Crozer Health.
Crozer-Chester Medical Center in Upland operated the county鈥檚 busiest emergency department, its highest-level trauma center, and its only 24-7 crisis center for mental and behavioral health. Crozer ambulances served about 60% of the county.
Delaware County was left scrambling to cobble together replacements for these services when Crozer鈥檚 bankrupt for-profit owner, Prospect Medical Holdings, shut down Crozer and its sister facility, Taylor Hospital in Ridley Park.
Nearby hospitals, including Riddle Hospital in Media and Mercy Fitzgerald Hospital in Darby, have added staff and temporary beds to accommodate a sharp increase in patients.
But lawmakers, hospital administrators, and healthcare stakeholders say the county needs a more permanent, stable solution to ensure residents have access to critical health services. Moving forward, they will need to think differently about how to serve densely populated communities that are increasingly far away from high-level care, despite their location outside one of the largest healthcare-rich cities in the country.
The county is reviewing proposals for a freestanding mental health crisis center. Several of the two dozen townships that relied on Crozer鈥檚 ambulances to respond to 911 emergencies are finalizing shared emergency-response contracts.
In addition to offering blood transfusions onboard its ambulances, VMSC is expanding its community education program, to train residents on what to do to stop bleeding and respond to an emergency.
鈥淲hen we look at healthcare deserts, mostly this affects rural communities. We鈥檙e seeing this within 20 miles of Philadelphia,鈥� said Shane Wheeler, CEO of VMSC. 鈥淲e have to look at pre-hospital care more broadly.鈥�
Rethinking ambulance services
Beginning in August, 24 townships that relied on Crozer for emergency response will need to establish their own contracts for services. The grants that supported a temporary fleet of 16 ambulances are due to expire.
Townships often make plans independently, but the experience of sharing services over the last few months proved that a joint contract could work, said Monica Taylor, chair of the Delaware County Council. A group of municipalities along Chester Pike, including Glenolden, Prospect Park, Norwood, Tinicum, Eddystone and Ridley Park, have decided to partner on an ambulance contract, she said.
鈥淭his kind of forced them to think outside the box and do things in a way they hadn鈥檛,鈥� Taylor said.
Lawmakers found that even though townships were sharing ambulances, the service was more reliable than Crozer鈥檚 fleet, which was often missing vehicles because of repairs or staffing challenges. Months before closing, Crozer had reassigned some of its ambulances to cover nonemergency transports after Prospect failed to pay another transport contractor.
New approaches to emergency care
The new ambulance contracts mean there will now be EMS vehicles to respond to emergencies, but it is still taking much longer to get patients into a hospital.
The nearest emergency departments 鈥� Riddle and Mercy Fitzgerald 鈥� are overwhelmed. Ambulances must wait outside until a bed becomes available, further delaying when the ambulance can respond to its next call.
Two new micro-hospitals with emergency departments are planned for Aston and Springfield, which Taylor hopes will help relieve the strain on other hospitals.
ChristianaCare plans to open a 10-bed hospital in Aston in 2026 and expects a Springfield location to open in 2027.
The Delaware-based health system won an auction for Crozer鈥檚 outpatient facilities and recently announced that it is exploring a merger with New Jersey鈥檚 Virtua Health.
In the meantime, EMS providers are expanding their on-the-road capabilities.
VMSC Emergency Medical Services, which began working in Chester after Crozer鈥檚 closure, has equipped its vehicles to provide blood transfusions to critical patients, such as gunshot wound victims.
The organization began its blood transfusion program earlier this year in Montgomery County, where most traumas involve car accidents.
In Chester, blood transfusions are 鈥渟ingle-handedly one of the biggest things we can do to reduce trauma-related deaths,鈥� said Wheeler, VMSC鈥檚 chief executive.
Seeking mental health services
Emergency departments at Riddle and Mercy have been strained by patients experiencing psychiatric emergencies that staff are not accustomed to handling.
Riddle used to see about 20 psychiatric patients a month. The day Crozer closed, volume quadrupled, and the hospital has seen about 140 psychiatric patients a month since then, said Deborah Cunningham, vice president of behavioral health at Main Line Health.
The hospital opened an overflow area, extending its emergency department by eight beds dedicated to behavioral and mental health, and hired some of Crozer鈥檚 crisis workers.
鈥淏ut that鈥檚 just a short-term fix,鈥� Cunningham said.
Main Line Health is working on expanding its mental health services for patients who need ongoing medication maintenance and talk therapy.
But that won鈥檛 replace Crozer鈥檚 24-7 crisis response center, which offered specialized services for people experiencing a psychiatric crisis, substance abuse issues, and other emergencies.
The county is reviewing proposals for a freestanding crisis response center and hopes to select a contractor soon, Taylor said.
The center should have eight beds, a mobile crisis unit, and a crisis response line that accepts calls around the clock, according to a request for proposals.
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