Many overwhelmed hospitals, with no beds to offer, are putting critically ill COVID-19 patients on planes, helicopters and ambulances and sending them hundreds of miles to far-flung states for treatment.

The surge in the delta variant of the virus, combined with low vaccination rates, has pushed hospitals to the brink in many states and resulted in a desperate scramble to find beds for patients.

The issue is that large hospitals in urban areas already were running short of space and staff with non-COVID procedures like cancer biopsies and hip replacements when the summer surge started. That means they have very few free beds to offer to patients from small rural hospitals without ICUs or from medical centers in virus hotspots.

“Just imagine not having the support of your family near, to have that kind of anxiety if you have someone grow acutely ill,” said Steve Edwards, CEO of CoxHealth, whose hospital in Springfield, Missouri, is treating patients from as far away as Alabama.

Hospitals across the U.S. had more than 75,000 coronavirus patients as of last week, a dramatic increase from a few weeks ago but still well below the winter surge records. However, Florida, Arkansas, Oregon, Hawaii, Louisiana and Mississippi all have set pandemic records for COVID hospitalizations in recent weeks.

Unlike the winter surge, hospitals this summer were already strained because emergency room volumes are back to pre-pandemic levels and patients are catching up on care they put off.

“We are seeing COVID patients and we are seeing car accidents and we are seeing kids come in with normal seasonal viral infections. And we are seeing normal life come into the emergency department along with the extra surge of COVID patients so it is causing that crisis,” said Dr. Mark Rosenberg, president of the American College of Emergency Physicians.

In Arizona, a special COVID-19 hotline is getting desperate calls from hospitals in Wyoming, Arkansas, Texas and California who are in search of bed space.

Often, there are no takers.

“We just can’t get them out,” lamented Dennis Shelby, CEO of the 15-bed Wilson Medical Center in Neodesha, Kansas. Officials at the small hospital recently called 40 other facilities in multiple states seeking a bed for a COVID-19 patient, before finally finding one more than a day later about 220 miles (354.06 kilometers) away. Six of its seven patients have COVID-19, a pandemic high.

In Kansas, sick COVID-19 patients at small rural hospitals are waiting an average of nearly 10 hours to be flown somewhere else, according to Motient, a company contracting with the state to help manage transfers.

Dr. Richard Watson, founder of Motient, said Kansas patients are being sent as far away as Wisconsin Illinois, Colorado and Texas. Often, though, the rural hospitals just muddle through.

“That is just the worst day that you can have in the emergency room as a provider to be taking care of a patient that you are totally helpless to give them what you know they need,” he said.

He said the delayed transfers can have dire consequences for patients, especially those who urgently need to see specialists, often available only in bigger hospitals, for issues such as strokes or heart attacks.

“Imagine being with your grandma in the ER who is having a heart attack in western Kansas and you are saying, ’Why can’t we find a bed for her?′ We are watching this happen right in front of us. ‘This is America. Why don’t we have hospital bed for her.’ Well here we are.”

In Washington state, the 25-bed Prosser Memorial Hospital doesn’t have an intensive care unit, so it often sends critically ill patients elsewhere in the state. Hospital spokeswoman Shannon Hitchcock said Washington state hospitals are full, so Prosser patients are being sent as far away as eastern Idaho — 600 miles (965.61 kilometers) away.

Luke Smith, director of the Arizona Surge Line, which coordinates COVID-19 patient transfers for Arizona patients and offers advice to out-of-state hospitals, said people arriving at emergency rooms “are more acutely ill than we have seen historically.”

Finding a hospital to take them is made more difficult by staffing shortages, after pandemic-fatigued doctors and nurses walked away.

“Most of them are saying it isn’t that they don’t have an open bed, it is that they don’t have nursing staff to care for them,” said Robin Allaman, chief nursing officer at the 25-bed Kearny County Hospital in tiny Lakin, Kansas. Officials there called hospitals in Nebraska, Oklahoma and New Mexico before one in Colorado Springs, Colorado, 200 miles (321.87 kilometers) away, agreed to take a recent patient.

Allaman has no idea how many calls they made. “I think we quit counting,” she said.

High vaccination rates among the 65-plus age group group that filled beds early in the pandemic were supposed to protect hospitals from becoming overwhelmed again. But Justin Lessler, a professor of epidemiology at John Hopkins, said there hasn’t been the kind of reduction in hospitalizations that officials had hoped for because the delta variant seems to be more severe, particularly in younger age groups, whose vaccination rates are lower.

University of Iowa Healthcare in Iowa City has been getting calls from out-of-state hospitals seeking transfers, said Dr. Theresa Brennan, the hospital’s chief medical officer. They turn down most of them “because we have beds full of our Iowans.”

Des Moines emergency medicine specialist Dr. Clint Hawthorne, like many doctors in Iowa, is concerned the situation could get worse after the Iowa State Fair, which is expected to draw 1 million people.

“How are we going to be able to handle that?” Hawthorne said. “There’s not a good answer to that.”

(AP)