Los Angeles County ambulance teams are advised not to transport Covid-19 patients with little chance of survival

Los Angeles County ambulance teams are advised not to transport Covid-19 patients with little chance of survival

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Or having a medical emergency and languishing outside an emergency room for hours.

That’s what Los Angeles County is facing as the Covid-19 attack devastates the community – including those without coronavirus.

“Hospitals are declaring internal disasters and having to open church academies to serve as hospital units,” said county supervisor Hilda Solis. “Our healthcare professionals are physically and mentally exhausted and sick.”

And every 15 minutes, a person dies from Covid-19, said Los Angeles County Public Health Director Barbara Ferrer.

Now, ambulance teams in Los Angeles County have been told not to take patients with little chance of survival to hospitals.

“This order issued by the county emergency medical services is actually very specific for patients who have suffered cardiac arrest and cannot be revived in the field,” said Dr. Jeffrey Smith, director of operations at Cedars-Sinai Medical Center.

“Each of these patients has a very low survival rate if they are transported to the hospital. Therefore, at this moment, it is considered futile ”.

Who is taken to a hospital and who is not

The Los Angeles County Emergency Medical Services Agency (EMS) issued a memo last week to ambulance workers.

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“With immediate effect, due to the severe impact of the Covid-19 pandemic on EMS and recipient hospitals 9-1-1, adult patients (18 years of age or older) in traumatic and blunt non-traumatic cardiac arrest (OHCA) must not be transported [if] the return of spontaneous circulation (ROSC) is not achieved in the field, “said the agency.

If the patient shows no signs of breathing or pulse, the EMS will try to resuscitate him for at least 20 minutes, says the memo.

If the patient is stabilized during this time, he will be taken to the hospital.

But if the patient is pronounced dead on the spot or if the pulse cannot be restored, paramedics will not take the patient to the hospital.

Patients may or may not receive oxygen assistance

The Covid-19 peak also led to a shortage of supplemental oxygen, which means that some patients treated with EMS will be left without.

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“Given the acute need to conserve oxygen, with immediate effect, the EMS should only administer supplemental oxygen to patients with oxygen saturation below 90%,” said the Los Angeles County EMS in its memo.

The EMS said an oxygen saturation of at least 90% is sufficient to maintain normal blood circulation to organs and tissues.

The lack of oxygen in the county and the San Joaquin valley led to the formation of an “oxygen task force” last week, said Governor Gavin Newsom.

The task force has been working with local and state partners to try to replenish the oxygen tanks and take them to the hospitals and facilities most in need.

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Because it is the most populous state in the country and home to about 1 in 9 Americans, it would make sense for California to have the largest number of Covid-19 cases.

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But it is the magnitude of hospitalized patients and the impressive rate of increase that are causing the biggest problems.

“The increases in cases are expected to continue for weeks as a result of holidays and New Year’s Eve and return of travelers,” said Ferrer.

“We are likely to experience the worst conditions in January, since we faced the entire pandemic. And that is hard to imagine.”

Experts say other reasons also contribute – including pandemic fatigue, resistance to regulations for staying at home, the sheer number of essential workers and socioeconomic factors that affect the poorest and minority families.

Ambulances wait hours outside hospitals

Even when patients are lucky enough to get to the hospital, they can languish outside for hours if there is no more space.

“Emergency Medical Services are working hard to divert ambulances or send them to hospitals that have the potential to receive these patients,” said Smith, COO of Cedars-Sinai Medical Center.

“There are situations in which patients are forced to wait in ambulances under the care of paramedics. We want to ensure that the time is as short as possible so that they can receive the necessary care ”.

For EMT Jimmy Webb, the wait can last for several hours.

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“We are waiting at least two to four hours to a hospital, and now we have to drive even more … then wait three more hours,” Webb told CNN affiliate KCAL.
Local officials asked the public not to call 911 unless “they really needed it,” said Dr. Marc Eckstein, head of the Los Angeles Fire Department’s emergency department, to CNN’s KABC affiliate.

“One of our biggest challenges now is to get our ambulances out of the emergency department,” he said.

“When our paramedics and paramedics transport a patient to an emergency department, there is a transfer of care that must occur. Patients who are unstable or cannot be safely transferred to the waiting room or to a chair need a bed in the emergency department to be transferred. And those beds are missing now. “

And more ambulances waiting in hospitals means that there are fewer ambulances to answer other calls to 911 – leading to even more delays.

The situation could get worse, said Eckstein.

“I think the next four to six weeks will be critical for our system to be taxed,” he said.

CNN’s Jenn Selva and Travis Caldwell contributed to this report.

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