The situation in LA County hospitals is so critical that ambulance teams have been advised to try to reduce oxygen use and not bring patients to hospitals that have virtually no chance of survival. Authorities now say they need to focus on the patients most likely to survive.
The measures were taken because circumstances are expected to get even worse in the coming weeks, when patients sick during the Christmas holiday will need treatment, leaving authorities desperate for ways to increase capacity and screen for care to focus on patients. sickest patients.
Hospitals are moving to quickly discharge patients who, in less crowded situations, would normally be allowed to stay for continuous observation. This helped, but officials fear the flood of new patients – many with COVID-19 – is outpacing their ability to remove less critical patients.
In a sign of the strain that the surge is putting on essential medical supplies for critically ill patients, the LA County Emergency Medical Services Agency issued a directive on Monday that ambulance teams should conserve oxygen by administering it only to patients who had oxygen saturation levels below 90%.
To reduce demand in crowded hospitals, the EMS agency last week also issued memos instructing the ambulance staff not to transfer most patients to the hospitals who had virtually no chance of survival.
In pre-pandemic times, even those who had little chance of survival were transported to the hospital, as they were able to accommodate even the most unlikely recovery scenarios.
Patients who should not be transported to hospitals include those whose hearts have stopped and, despite resuscitation efforts, show no signs of breathing, movement, pulse or blood pressure and would be pronounced dead on the spot. Paramedics and emergency medical technicians, of course, must continue trying to perform resuscitation in the field until the pulse is restored, after which the patient can be stabilized and transported to the hospital.
The emergency rooms are already so full that some patients have to wait in the ambulances for up to eight hours for a bed to open. This buildup blocks ambulances and prevents them from responding to other emergency calls – renewing concerns that some patients, such as those who have suffered a heart attack or stroke, are not being discharged quickly enough.
To deal with the scarcity, the authorities drew up an emergency plan to create temporary “ambulance seats” – installed outside the emergency room entrance and usually covered by tents or awnings – to accept patients.
A paramedic or emergency medical technician can be used to assist in monitoring up to four patients in such areas, a change from the conventional practice of having a patient monitored by an ambulance staff member. Officials say the plan allows more ambulances to leave the hospital and return to circulation.
A space for receiving ambulances can only be implemented with the permission of the Medical Alert Center of the EMS Agency of LA County. The limit is reached only when all patient treatment areas available in the emergency room – including the corridors – are fully occupied and when at least three ambulances or at least three patients attended by paramedics or paramedics must wait more than an hour.
The additional measures illustrate the extent to which hospitals in California’s most populous county will face the crush of patients with COVID-19.
On Sunday, the most recent day for which complete data is available, there were 7,898 coronavirus-positive patients hospitalized across the county, with 1,627 of them in intensive care.
Officials remain concerned that these figures – already at higher levels – will increase further later this week or early next week, although case reports may be lower in the coming days because fewer people have been tested. during the holidays.
“Let’s say we see cases increase to 17,000, 18,000, 19,000 a day, which means that seven to 10 days later, hospitals will have a sudden increase, and another week after that, deaths will also increase,” said Dr. Jeffrey Gunzenhauser, Los Angeles County Chief Medical Officer.
Gunzenhauser said the county has been working with executives from the hospital, its Emergency Services Agency and the state to prepare for that possibility.
“We are collectively exploring all possible ways to reduce the burden on hospitals,” he said. “Many actions have been taken to improve coordination in identifying patients who really need hospitalization and connect them to a place where a bed is available, rather than stacking ambulances outside an emergency department.”
He said the state has eased some administrative requirements for hospitals, such as the number of maps needed, to release staff so they can care for more patients.
They are also working on identifying and removing barriers to patient discharge to lower levels of care.
“For example, there are beds available in some qualified nursing centers,” said Gunzenhauser, “and we are doing everything possible to remove restrictions so that patients who are well enough to be discharged from hospitals can move to these centers. qualified nursing staff. ”
Qualified nursing facilities have been the site of coronavirus outbreaks, but Guzenhauser said authorities are “trying to set it up to be as safe as possible with regard to COVID transmission”.
Patients who can be moved can include those who have suffered a heart attack or stroke and do not need to stay in the hospital, but have to go somewhere to receive intensive nursing support, he said.
Such arrangements make more sense than setting up a field hospital or medical ship, as was done at the beginning of the pandemic, because medical infrastructure and staff are already available, he said.
“If you pitch a tent or have a ship, you have to build everything around you.”
The goal, said Gunzenhauser, is to prevent LA county hospitals from entering the “crisis care” mode, in which medical rationing would take place.
“But if there is an increase in cases, there may be 1,000 additional or more beds needed for patients with COVID, which would be difficult to accommodate here in LA,” he said. “It is difficult to speculate, but we are doing everything we can to prepare for the worst.”
LA County ICUs are exploding. Patients with COVID-19 in intensive care units almost tripled in December, even as hospitals cut in half the number of ICU patients who were not positive for the coronavirus. But it comes at a cost. For example, a patient with a kidney transplant scheduled for mid-January at Cedars-Sinai Medical Center had his procedure postponed due to a lack of ICU beds.
On Wednesday, of the more than 2,000 ICU beds occupied in LA County, 77% were occupied with COVID-19 patients. This is a marked increase since December 1, when 37% of the ICU beds were used by COVID-19 patients.
The situation is especially precarious when looking at specific regions.
Many hospitals are already reporting their ICUs as effectively full and have been forced to treat terminally ill patients in emergency rooms and even in corridors. On Wednesday, only 25 ICU beds attended in the municipality were available, 1% of the total available beds.
That same day, there were no ICU beds available in the San Gabriel Valley or southeast Los Angeles County. There were only three beds in southern LA County, representing less than 1% of all staffed ICU beds in a region that includes Long Beach and South Bay.
Between Christmas and December 28, there were no ICU beds available in downtown Los Angeles, which includes Cedars-Sinai Medical Center near Beverly Hills and LA County-USC Medical Center at Eastside. As of December 26, there was only one ICU bed available in Westside, a region that includes the Ronald Reagan UCLA Medical Center in Westwood and Providence Saint John’s Health Center in Santa Monica.
On Sunday, 11,513 new cases of coronavirus were reported in the county, according to a Times count from local health jurisdictions. In the past three days, LA County has reported an average of about 16,000 new cases of coronavirus a day, among the highest numbers in the entire pandemic.
In addition, an additional 85 deaths from COVID-19 were reported on Sunday, the most recent in a bleak holiday season that saw the highest single-day death counts last week, including 242 on Tuesday, 262 on Wednesday 291 on New Year’s Eve and 193 on New Year’s Day.
Combined, 184 deaths were reported on average every day for the past week, the highest number ever recorded – the equivalent of one death every eight minutes.
January will be “the darkest month we will have,” said LA Mayor Eric Garcetti on Sunday.
In another worrying trend, said Garcetti, more people who have no underlying health problems are dying from COVID-19. At the beginning of the pandemic, about 92% of the people who died had pre-existing health problems; that number dropped to about 86%, officials said.
“So my message to everyone is that it won’t just come to someone you love,” said Garcetti on Sunday on CBS’s “Face the Nation” program. “This will possibly come to you. And then everything we do can save or take lives right now. “