LA Paramedics Told Not To Transport Patients Unlikely To Survive

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LOS ANGELES, CA — In a week where officials announced that an escalating coronavirus surge in Los Angeles County was about to get even worse, paramedic teams were told not to transport patients who have little chance of survival.

According to a directive issued by the Los Angeles County Emergency Medical Services Agency, ambulance crews were asked to conserve oxygen and only to administer supplemental oxygen to patients whose saturation levels fall below 90 percent.

Another memo, which came down from the agency last week, was more or less specific to not transporting cardiac arrest patients who are unable to be resuscitated in the field.

Dr. Christina Ghaly, the county’s health services director, assured Tuesday that the order was not meant to mark any change in actual patient care. It simply prevents crews from transporting patients solely so they could be formally pronounced dead at a hospital, she said.

Such stringent and unprecedented measures were put in place to avoid a total collapse of the region’s hospitals, which could be seen in the coming months if cases continue to multiply out of control, health officials grimly remarked at a Monday news conference.

County Supervisor Hilda Solis called the situation in the Southland a “human disaster.”

“But I need to underscore that it could be worse, the situation is already beyond our imagination, but it could become beyond comprehension,” she said on Monday.

Over the weekend, almost all county hospitals were diverting advanced life-support ambulances due to overcrowding in the emergency department, Ghaly told the Board of Supervisors Tuesday morning.

But even as hospitalizations continued to climb in LA county this week, with the number of coronavirus patients crossing the 8,000 mark, there were no longer any hospitals experiencing “internal disaster” status as of Tuesday, which did occur at some locations over the weekend, effectively shutting some facilities off to all levels of ambulance traffic.

In addition to the flood of new patients, hospitals were saddled with various other problems, including the well-documented issue with oxygen supplies and delivery systems, according to Ghaly.

The availability of oxygen has become a statewide issue for hospitals, particularly in hard-hit Los Angeles County, where a surge in coronavirus patients has vastly increased the oxygen demand. Some hospitals have even experienced difficulty maintaining their pressurized systems.

To combat this situation, the U.S. Army Corps of Engineers sent experts to help with the oxygen delivery systems at six of the county’s older hospitals.

“By working to upgrade challenged oxygen delivery systems at these older hospitals, we can improve the ability to deliver life-sustaining medical care to those who need it,” said Mark Ghilarducci, director of the Governor’s Office of Emergency Services.

On the issue of overcrowding, hospitals and skilled nursing facilities faced multiple challenges this week.

Some facilities experienced difficulties discharging patients who no longer require hospital-level care. Ghaly said the four county-operated hospitals have struggled to move such patients to lower-level care facilities, with some skilled nursing facilities refusing to accept some patients’ transfers. The county Department of Public Health issued a directive to the facilities on Friday ordering them to stop blocking such transfers.

“Sometimes the patients themselves don’t want to be moved to a lower level of care, and state law prohibits us moving a patient unless the patient agrees to the placement,” Ghaly said. “Skilled nursing facilities, as well as other lower level of care areas, are facing staffing shortages, and that’s limiting the number of patients they can take as well.”

Dialysis centers were also exacerbating the problem by sending patients to emergency departments for dialysis or COVID testing “rather than doing it on-site,” Ghaly said. Dialysis patients in hospitals also can’t always be immediately discharged due to lack of outpatient space.

And as case numbers have continued to rise, consequentially, hospitals were also dealing with increased absences of staff who were exposed getting sick with coronavirus, Ghaly said.

“Just as transmission increases within the community, health care workers get sick too,” she said.

But the problem extends far past hospital workers getting sick.

“We are still facing critical call-outs from staff that aren’t eligible for the vaccine right now, and that includes supply chain (personnel), power plant, people fixing the oxygen system, and other areas,” she said.

“Countywide, for all hospitals, the issues are really the same,” Ghaly told the Board of Supervisors. “All hospitals are working through staffing issues. Many are working through infrastructure and oxygen-supply issues, which are complicated and numerous.”

According to numbers released by the state Tuesday morning, Los Angeles County had 8,023 COVID patients in hospitals, including 1,642 in intensive-care units. The county’s 70 “911-receiving” hospitals with emergency rooms have a total licensed capacity of about 2,500 ICU beds. However, in recent weeks, they have implemented surge plans and staffed a daily average of about 3,000 ICU beds.

Health officials painted a gloomy outlook for January and beyond on Monday with the announcement that 1 in 5 Angelenos testing for coronavirus received a positive result.

Ghaly warned Monday that despite beginning a new year, the virus remains, and “The worst is almost certainly still ahead” in terms of virus cases, hospitalizations, and deaths.

The county reported another staggering 9,142 cases Monday, while Long Beach health officials announced 1,865 new cases, and Pasadena added 186.

But the new cases recorded by the county Monday are still believed to be an undercount, thanks to holiday weekend reporting lags and some testing sites’ closure. As of Monday, the countywide total since the pandemic began was 829,549.

The county also reported 77 more deaths due to COVID-19 on Monday, while Pasadena and Long Beach each reported one, lifting the countywide death toll to 10,852 since the start of the pandemic.

“We’re likely to experience the worst conditions in January that we’ve faced the entire pandemic,” County Public Health Director Barbara Ferrer said on Monday. “And that’s hard to imagine. In slightly more than one month, we doubled the number of people who have tested positive for COVID-19, going from 400,000 cases on Nov. 30 to 800,000 on Jan. 2. It took us nine and a half months to get to the first 400,000 cases.”

She noted that the current average of people testing positive for the virus within Los Angeles County is now 21 percent. The cumulative positivity rate from throughout the pandemic is 16 percent.

As of Monday, the county reported a total of 577 available and staffed hospital beds, including only 20 adult intensive-care unit beds. As of late December, county hospitals were operating a total of about 3,000 ICU beds, averaging only 29 available and staffed beds daily. Hospitals in the county-operated an average of about 10,000 non-ICU beds.

“Assume that this deadly, invisible virus is everywhere,” Ferrer warned Monday. “It’s better to be lonely than to be sick.”

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