Los Angeles to limit hospital transports
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California officials are looking to speed up the pace of COVID-19 vaccine distribution, as the state braces for another holiday-related surge of confirmed cases. (Jan. 4)
As COVID-19 continues to overwhelm California hospitals, Los Angeles County officials are trying to ration medical supplies and hospital space.
The Los Angeles Emergency Medical Services Agency issued twomemos Monday instructing emergency responders to limit the use of supplemental oxygen and not transport patients who cannot be revived in the field.
“Given the acute need to conserve oxygen, effective immediately, EMS should only administer supplemental oxygen to patients with oxygen saturation below 90%,” one memo said.Oxygen saturation at that threshold and above allows for sufficient blood flow in most patients, the memo said.
Adults experiencing cardiac arrest should not be transported to the hospital if they cannot be resuscitated in the field, according to the other memo. Patients whose hearts have stopped and, despite attempts to resuscitate, show no sign of breathing or movement, should be determined dead at the scene and should not be transported, the memo said.
Dr. Marianne Gausche-Hill, medical director of the agency, told USA TODAY that the new measures aim to optimize resources. At the beginning of the pandemic, public health officials feared they would run out of ventilators, but it’s small, portable oxygen tanks that have turned out to be in high demand, she said.
“We are giving (oxygen), we’re just trying to be cognizant that there’s some scarcity, so we want to utilize it on those patients that it can serve,” Gausche-Hill said.
The memo on resuscitation was “not a big change” from past guidance and reinforced the importance of resuscitating at the scene, she said.
“The best results are if you do compressions at the scene instead of transporting the patient in cardiac arrest to a hospital … where nothing further is going to be done. It’s pretty much futile,” Gausche-Hill said. “We’re facing a capacity crisis. We’re trying to work with all our partners to optimize hospital capacity.”
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Medical workers remove a stretcher from an ambulance near medical tents outside the emergency room at UCI Medical Center, in Irvine, Calif., on Dec. 17, 2020. (Photo: Ashley Landis, AP)
Ambulances are still having to wait many hours to offload patients to emergency rooms in Los Angeles County, Dr. Christina Ghaly, the county director of health services, said Monday. The county was encouraging people to only come to the emergency department or call 911 for medical or psychiatric emergencies, Ghaly said.
“Many hospitals have reached a point of crisis and are having to make very tough decisions about patient care,” Ghaly said. “EMS is working with all hospitals across the region to relieve the pressure on, especially, the smaller facilities.”
Cases are skyrocketing in Los Angeles County, which has now reached more than 800,000 cases, County Board of Supervisors Chair Hilda Solis said Monday.
“It took 10 months to hit 400,000 cases, but we have reached another 400,000 within the last month alone. That is a human disaster and one that was avoidable,” Solis said. “But I need to underscore that it could be worse. The situation is already beyond our imagination, but it could become beyond comprehension if the health restrictions in place are not fully obeyed.”
Hospitals are declaring internal disasters and opening gyms to serve as health care units, Solis said. Oxygen is in high demand, and Army Corps of Engineers crews arrived in the county Saturday to update oxygen delivery systems in the area.
“We are pushing the limits of the hospital infrastructure,” Solis said. “… Care now has to be rationed.”
As of Sunday, nearly 8,000 coronavirus patients were in county hospitals, according to state data. More than 1,600 coronavirus patients were in the ICU, and just 326 ICU beds were available.
A person is dying from COVID-19 every 15 minutes in the county, which could soon be looking at weekly death tolls of 1,000 or more, County Public Health Director Barbara Ferrer said Monday.
The surge in cases is “distressing” for people who may need access to emergency care, Ferrer said. “People who have a stroke or a heart attack or experience a traumatic injury from a car crash are finding it more difficult to access care compared to months ago.”
The surge is the early result of an anticipated uptick following holiday gatherings, Ferrer said.
“We’re likely to experience the worst conditions in January that we’ve faced the entire pandemic, and that’s hard to imagine,” Ferrer said. “The increases in cases are likely to continue for weeks to come.”
Los Angeles County isn’t alone in the surge. Orange, San Bernardino and Riverside counties each have more than 1,500 hospitalized COVID-19 patients and fewer than a hundred ICU beds available, according to state data. Among the top 100 hospitals nationwide with the highest proportion of COVID-19 patients, 48 are in California, a USA TODAY analysis found.
Officials in San Bernardino and Riverside counties told USA TODAY that they did not anticipate issuing similar guidance on oxygen and transports at this time.
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