ROCHESTER, N.Y. — Violence is just one of the factors turning emergency departments into places so crowded, that some are afraid to go there.

Stretchers stretched down hallways and staffing levels struggling to keep up. It was common at the height of the pandemic, but things are still that way.

"Well, violence, in general, has almost become its own epidemic," said Dr. Keith Grams, the leader of Rochester Regional Health's emergency services. "You’re dealing with the COVID pandemic issues as well as all the downstream in the community from a health care standpoint. We’re having challenges with hospital capacity, which basically generally backs up into the emergency departments causing some challenges on the ground floor, as it were.

"Any time you have a victim of violence coming in like that, you’re using those same team members that are busy taking care of other patients that kind of have to drop what they’re doing and go take care of their patient. Exactly what they should do, but that means other challenges for patients that are already in the waiting room, or in the ED, and even potentially, in the waiting room as people are basically shifting attention and taking care of the patients."

Grams said the pandemic itself has caused a lot of challenges.

"Any time you were working in an environment where it’s tough to even turn and take care of something and do something and you were continually trying to figure out ways to take care of patients, in very non-traditional spots, it’s very wearisome and challenging for the staff," he said.

Victims of violence are arriving at the ED in their own vehicles. They’re not even getting there in traditional ambulatory methods.

Grams says that's the most challenging part.

"Generally, when patients come in via EMS or ambulance or other mechanisms, we at least get a heads-up," he said, "and if they come in by private vehicle, you’re basically scrambling to get them inside with all things just basically everyone has to drop and run and take care of it. There’s no preparation. The good news is the team actually has equipment and places that we try to keep open to try and take care of these patients. And we have a spot to kind of shift them in. Sometimes there’s even some patient shuffling that can make it happen too."

Grams says his staff is continuing to communicate ongoing capacity constraints throughout the system.

"In general, we still see patients seeking emergency care that should be ... seeking emergency care that don't have access to other places," he continued. "We are dealing with patients that are sick and very sick that either are getting the full work-up in the emergency department setting or have been admitted to the hospital and still working to find a bed in the hospital setting. That’s really our most challenging piece. And what our staff continually tries to deal with under those hospital inpatients that have not been able to get a bed in the hospital."

The major factor keeping health systems like Rochester Regional from answering this crisis most directly, according to local health leaders, are state regulations on expansion. New York, they say, doesn't allow hospital rooms to be built easily. That has a lot to do with who will pay for the needed care.