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The situation in LA County hospitals is so critical that ambulance crews have been urged to try to reduce their oxygen consumption and not bring patients to the hospital who have virtually no chance of survival. . Officials now say they need to focus on patients with a greater chance of survival.
The measures came as circumstances were expected to worsen further in the coming weeks, when sick patients over the Christmas holidays will need treatment, leaving authorities desperate to find ways to increase capacity and care. triage to focus on the sickest patients.
Hospitals are moving to quickly release sick patients who, in less crowded situations, would normally be allowed to stay for continued observation. It has helped, but officials fear the influx of new patients – many with COVID-19 – will exceed their ability to discharge less critical patients.
In a sign of the strain the push is putting on essential medical supplies needed for critically ill patients, the LA County Emergency Medical Services Agency on Monday issued a directive that ambulance crews should retain l oxygen by only administering it to patients who had oxygen saturation levels below 90%.
To reduce demand on overwhelmed hospitals, EMS also released memos last week urging paramedics not to transfer most of the patients who had virtually no chance of survival to hospitals.
In pre-pandemic times, even those with a low chance of survival were rushed to hospital, as there was the ability to adapt to the most unlikely recovery scenarios.
Patients who should not be taken to hospital include those whose hearts have stopped and, despite efforts at resuscitation, show no signs of breathing, movement, pulse or blood pressure and would be declared dead on places. Paramedics and EMS should obviously continue to attempt to perform resuscitation in the field until a pulse can be restored, after which a patient could be stabilized and transported to hospital.
Emergency rooms are already so criticized that some patients have to wait up to eight hours inside ambulances for a bed to open. This backlog is blocking ambulances and preventing them from responding to other emergency calls – renewing fears that some patients, such as those who have suffered a heart attack or stroke, may not be discharged quickly enough.
To deal with the shortage, officials devised an emergency plan to create temporary ‘ambulance reception spaces’ – set up just outside the emergency entrance and often covered by tents or awnings – to accommodate patients.
A paramedic or emergency medical technician can be used to help monitor up to four patients in these areas, a change from the conventional practice of having a patient monitored by a member of the ambulance staff. Officials say the plan allows more ambulances to leave the hospital and return to circulation.
An ambulance reception area can only be set up with permission from the LA County EMS Agency Medical Alert Center. The threshold is only reached when all available patient treatment areas in the emergency room – including hallways – are fully occupied and when at least three ambulances or at least three patients managed by paramedics or paramedics have to wait more than an hour.
The additional measurements illustrate how hospitals in California’s most populous county will cope with the crash of COVID-19 patients.
On Sunday, the most recent day for which full data is available, 7,898 coronavirus-positive patients were hospitalized across the county, including 1,627 in intensive care.
Officials remain concerned that these numbers – already at unprecedented levels – will rise even further by the end of this week or early next week, although case reports may be lower over the next few years. days because fewer people were tested during the holidays.
“Let’s say we see the cases increasing to 17,000, 18,000, 19,000 per day, which means that seven to 10 days later, hospitals are going to see an upsurge, and a week later, deaths will also increase,” said Dr. Jeffrey Gunzenhauser, Chief Medical Officer of Los Angeles County.
Gunzenhauser said the county had worked with hospital officials, its emergency services agency and the state to prepare for the possibility.
“We are collectively exploring all possible ways to reduce the burden on hospitals,” he said. “Many steps have been taken to improve the coordination of identifying patients in serious need of hospitalization and linking them to where there is a bed available rather than stacking ambulances outside. an emergency service.
He said the state has relaxed some administrative requirements on hospitals, such as the amount of graphics needed, to free up staff so they can take care of more patients.
They also work to identify and remove barriers to discharging patients to lower levels of care.
“For example, there are beds available at some skilled nursing facilities,” Gunzenhauser said, “and we are doing everything we can to remove the restrictions so that patients who are healthy enough to be discharged from hospitals can be discharged. move to these skilled nursing facilities.
Qualified nursing facilities have been the site of coronavirus outbreaks, but Guzenhauser said officials “were trying to put it in place so that it is as safe as possible from COVID transmission.
Patients who could be moved could include those who have had a heart attack or stroke and who don’t need to stay in the hospital but have to go somewhere to receive intense nursing support, he said. declared.
Such arrangements make more sense than setting up a field hospital or medical ship, as was done at the start of the pandemic, as the medical infrastructure and staff are already in place, has he declared.
“If you put up a tent or have a boat, you have to build everything around it.”
The goal, Gunzenhauser said, is to prevent LA County hospitals from going into “crisis care” mode, in which medical rationing would occur.
“But if there is an increase in cases, there could be an additional 1,000 or more beds needed for COVID patients, which would be difficult to accommodate here in Los Angeles,” he said. “It’s hard to speculate, but we are doing everything we can to prepare for the worst.”
LA County’s intensive care units are booming. COVID-19 patients in intensive care units nearly tripled in December, even as hospitals cut the number of coronavirus non-positive intensive care patients in half. 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 intensive care beds.
Of more than 2,000 occupied intensive care beds in LA County as of Wednesday, 77% were filled with COVID-19 patients. This is a marked increase from December 1, when 37% of intensive care beds were used by patients with COVID-19.
The situation is particularly precarious when looking at specific regions.
Many hospitals are already claiming that their intensive care units are indeed full and they have been forced to treat dying patients in emergency rooms and even in hallways. As of Wednesday, only 25 of the county’s intensive care beds were available, or 1% of the total number of beds available.
On the same day, there were no intensive care beds available in the San Gabriel Valley or in southeast Los Angeles County. There were only three beds in southern LA County, which is less than 1% of all staffed intensive care beds in an area that includes Long Beach and South Bay.
Between Christmas and December 28, there were no intensive care beds available in downtown Los Angeles, which includes Cedars-Sinai Medical Center near Beverly Hills and LA-USC County Medical Center on the ‘Eastside. As of December 26, there was only one ICU bed available on the West Side, an area that includes Ronald Reagan UCLA Medical Center in Westwood and Providence Saint John Health Center in Santa Monica.
An additional 11,513 new coronavirus cases were reported in the county on Sunday, according to a Times tally from local health jurisdictions. Over the past three days, LA County has reported an average of around 16,000 new cases of coronavirus per day, among the highest numbers in the entire pandemic.
Additionally, 85 additional COVID-19-related deaths were reported on Sunday, the latest in a grim holiday season that saw the highest number of single-day deaths in the past week, including 242 on Tuesday, 262 on Wednesday, 291 on New Years Eve and 193. on New Year’s Day.
Together, 184 deaths have been reported on average every day over the past week, the highest number on record – the equivalent of one death every eight minutes.
January will be “the darkest month we’ll have,” Los Angeles Mayor Eric Garcetti said on Sunday.
In another disturbing trend, Garcetti said, more people who do not have underlying health conditions are dying from COVID-19. At the start of the pandemic, about 92% of those who died had pre-existing health problems; that number has now fallen to around 86%, officials said.
“So my message to everyone is this isn’t just going to come for someone you love,” Garcetti said Sunday on CBS “Face the Nation.” “It might come for you. And so all we do is either save lives or save lives at this point.
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