The situation in hospitals in LA County is so critical that ambulance personnel are advised to reduce their oxygen consumption and not bring patients who have virtually no chance of survival to hospitals. Officials now say they should focus on patients with a greater chance of surviving.
The measures were taken because conditions are expected to worsen in the coming weeks, when patients who are ill during the Christmas holidays will need treatment, and officials will be desperate for ways to increase capacity and triage care on the focus on sickest patients.
Hospitals are rapidly discharging sick patients who would normally be allowed to continue in less stressful situations. It has helped, but officials fear the flood of new patients – many with COVID-19 – surpasses their ability to evict less critical patients.
In the wake of the strain that the surge places on critical medical supplies needed for seriously ill patients, the LA County Emergency Medical Services Agency on Monday issued an order that ambulance personnel save oxygen by administering it only to patients who have oxygen saturation levels under 90 it. %.
To reduce the demand for overwhelming hospitals, the EMS agency also issued memoranda last week in which ambulance personnel had to transfer most patients who had virtually no chance of survival to hospitals.
In the times of pre-pandemic, even those who did not have the chance to move through were transported to the hospital as there was the ability to recover even the most unlikely scenarios.
Patients who should not be transported to hospitals include those whose hearts have stopped and, despite attempts at resuscitation, have no signs of breathing, movement, pulse or blood pressure and would be pronounced dead at the scene. Paramedics and emergency medical technicians should, of course, try to do resuscitation in the field until a pulse can be restored, after which a patient can be stabilized and transported to the hospital.
The emergencies are already so entrenched that some patients have to wait eight hours in ambulances until the bed opens. That backlog connects ambulances and prevents them from being able to respond to other emergency calls, reminding the concern that some patients, such as those who have had a heart attack or stroke, are not being discharged fast enough.
To address the shortage, officials drew up an emergency plan to create temporary “ambulance reception spaces” – just outside the emergency room entrance and often covered by tents or canopies – to accept patients.
An emergency paramedic or medical technician can be used to assist in monitoring up to four patients in such areas, a change in the usual practice of having one patient monitored by one ambulance staff. Officials say according to the plan, more ambulances could leave the hospital and go back into circulation.
An ambulance reception space can only be implemented with the permission of the LA County EMS Agency’s Medical Alert Center. The threshold is only reached when all available patient treatment areas in the emergency – including the corridors – are fully occupied and when at least three ambulances or at least three patients managed by EMTs or paramedics have to wait more than an hour.
The additional measures illustrate how long hospitals in the most populous province of California will have to fight COVID-19 patients.
As of Sunday, the most recent day for which full data is available, there were 7898 coronavirus-positive patients hospitalized nationwide, with 1,627 in intensive care.
Officials are still worried that the numbers – albeit a peak – will be even higher by the end of this week or early next week, although reports may be lower over the next few days as fewer people were tested during the holidays.
“Suppose we see cases rise to 17,000, 18,000, 19,000 a day, which means that seven to ten days later there will be a resurgence in hospitals, and another week later deaths will also increase,” said Dr Jeffrey Gunzenhauser. Los Angeles County Chief Medical Officer.
Gunzenhauser said the province has partnered with hospital managers, its emergency services agency and the state to pursue the possibility.
“We are jointly investigating every possible way to reduce the burden on hospitals,” he said. “Many actions have been taken to improve coordination to identify and connect patients in need of hospitalization to the place where a bed is available, rather than stacking ambulances outside an emergency department.”
He said the state has eased administrative requirements on hospitals, such as the amount of card needed to free up staff, so they can care for more patients.
They are also working to identify and remove barriers to the discharge of patients to lower levels of care.
“For example, there are beds available in some competent nursing homes,” Gunzenhauser said, “and we are doing everything possible to lift restrictions so that patients who are good enough to be discharged from hospitals can go to the skilled nursing homes.”
Skilled nursing homes were the site of coronavirus outbreaks, but Guzenhauser said officials are trying to set them up so they can be safe from COVID transmission.
Patients who can be relocated may include those who have had a heart attack or stroke and do not have to stay in the hospital but have to go somewhere to receive intense nursing support, he said.
Such arrangements make more sense than setting up a field hospital or medical ship, as was done earlier in the pandemic, because the medical infrastructure and staff are already in place, he said.
“If you set up a tent or have a ship, you must build everything else on it.”
The goal, according to Gunzenhauser, is to prevent LA County hospitals from entering the “crisis care” mode, in which medical rationing takes place.
“But if there is an increase in cases, 1,000 extra beds or more may be needed for COVID patients, which will be difficult in this home in LA,” he said. “It’s hard to speculate, but we do everything in our power to prepare for the worst.”
The ICUs of LA County are bursting at the seams. COVID-19 patients in intensive care units nearly tripled in December, even though hospitals reduced half the number of ICU patients who were not coronavirus-positive. But it has a cost. For example, one 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 occupied ICU beds in LA County, 77% were filled with COVID-19 patients. This is a clear increase from December 1, when 37% of the ICU beds were used by COVID-19 patients.
The situation is especially difficult when looking at specific regions.
Many hospitals are already reporting that their ICUs are effectively full, and they have been forced to treat dying patients in emergency rooms and even in the hallways. On Wednesday, only 25 of the staff’s ICU beds were available, 1% of the total number of available beds.
On the same day, there were no available ICU beds in the San Gabriel Valley or in southeastern Los Angeles County. There were only three beds in southern LA County, representing less than 1% of all ICU beds in a region that includes Long Beach and the South Bay.
Between Christmas and Dec. 28, there were no ICU beds available in central LA, which includes the Cedars-Sinai Medical Center near Beverly Hills and the LA County-USC Medical Center on the east side. On December 26, there was only one ICU bed available on the Westside, a region that includes the Ronald Reagan UCLA Medical Center in Westwood and the Providence Saint John’s Health Center in Santa Monica.
On Sunday, an additional 11,513 new cases of coronavirus were reported in the country, according to a Times Census of local health areas. Over the past three days, LA County has reported an average of about 16,000 new cases of coronavirus per day, among the highest number in any pandemic.
An additional 85 COVID-19 deaths were also reported on Sunday, the youngest in a gloomy holiday season to achieve the highest deaths from one-day deaths in the past week, including 242 on Tuesday, 262 on Wednesday, 291 on New Year’s Eve and 193 on New Year’s Day. .
In total, an average of 184 deaths were reported in the past week, the highest number recorded – the equivalent of one death every eight minutes.
January will be “the darkest month we will have,” LA Mayor Eric Garcetti said Sunday.
In another worrying trend, Garcetti said, more people who do not have underlying health conditions die from COVID-19. Earlier in the pandemic, about 92% of those who died had pre-existing health conditions; the number has now dropped to about 86%, officials said.
“So, my message to everyone is that it’s not just going to be for someone you love,” Garcetti told CBS ‘Face the Nation on Sunday. ‘It’s going to happen to you. And everything we do is life-saving or life-threatening at this point. ”