POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”

……as Los Angeles County grapples with a new wave of COVID-19 patients that is expected to get worse in the coming days….

In a separate memo from the county’s EMS Agency, paramedic crews have been told not to transfer patients who experience cardiac arrest unless spontaneous circulation can be restored on the scene.

Both measures announced Monday, which were issued by the agency’s medical director, Dr. Marianne Gausche-Hill, were taken in an attempt to get ahead of an expected surge to come following the winter holidays.

Many hospitals in the region “have reached a point of crisis and are having to make very tough decisions about patient care,” Dr. Christina Ghaly, the LA County director of health services, said at a briefing Monday…

Speaking to the CBS affiliate in Los Angeles, Gausche-Hill said personnel would continue to do everything possible to save the lives of patients, both at the scene and in the hospital.

“We are not abandoning resuscitation,” she said. “We are absolutely doing best practice resuscitation and that is do it in the field, do it right away.”

“[We] are emphasizing the fact that transporting these patients arrested leads to very poor outcomes. We knew that already and we just don’t want to impact our hospitals,” she added.” (A)

“Officials in California have painted an increasingly catastrophic picture of the state’s Covid-19 crisis over the past several days, precisely what they had warned was coming, as the state faces an oxygen shortage.

California has deployed the U.S. Army Corps of Engineers and the California Emergency Medical Services Authority to deliver and refill oxygen tanks.

In Los Angeles County, emergency workers have been told to conserve oxygen and administer the minimum amount of oxygen to keep patients’ oxygen saturation level at or just above 90 percent. (A level in the low 90s or below is a concern for people with Covid-19.)…

In some cases, there will be nowhere for the victims of that surge to go.

Health authorities in Los Angeles County have directed ambulance crews not to transport some cardiac arrest patients whose survival is unlikely. At some hospitals, patients are being lined up outside while workers try to find bed space.” (B)

“California is so swamped by coronavirus cases that the state has ordered those with room to accept patients from others that have maxed out on intensive care beds.

The public health order issued late Tuesday is the latest attempt by authorities in the nation’s most populous state to confront a surge in coronavirus infections and hospitalizations, a deteriorating situation that could worsen before it gets better, as gatherings during the recent holidays possibly accelerate cases.

The order, which will last three weeks, could result in patients being shipped to Northern California from Southern California and the agricultural San Joaquin Valley, where 14 counties were ordered to delay nonessential “and non-life threatening” surgeries in order to provide beds. The directive also applies to any county where ICU capacity to treat COVID-19 patients is bottoming out.

“If we continue to see an alarming increase of COVID-19 patient admissions at hospitals statewide, some facilities may not be able to provide the critical and necessary care Californians need, whether those patients have COVID-19 or another medical condition,” said Dr. Tomás J. Aragón, the state’s public health officer…

Martin Luther King Jr. Community Hospital in Los Angeles, where patients are being housed in its former gift shop, a chapel, tents and hallways, had more COVID-19 patients on Tuesday than its total capacity. The hospital, which serves a largely Black and Latino population in the south part of the city, has a capacity of 131 patients but was treating 215 patients, 135 with COVID-19, said Jeff Stout, interim chief nursing and operating officer…

Some hospitals have had to close their doors at times because they’ve become so overwhelmed, leaving ambulances waiting up to eight hours and diverting others to different emergency rooms.

Stout said Martin Luther King hospital was finalizing its crisis standards of care, which are guidelines for rationing treatment when staff, medicine and equipment are in short supply.

“We’re not there yet,” Stout said. “Every day, every hour we’re trying to avoid going into crisis care. The ultimate goal with crisis care is never to get there.”

The state on Tuesday formally requested that 500 federal medical personnel be deployed in California to help staff hospitals and skilled nursing homes after learning that the USNS Mercy Hospital ship, which docked off Los Angeles earlier in the year for overflow patients, was in dry dock and would not be returning.” (C)

“Los Angeles County Department of Health Services Director Dr. Christina Ghaly described the medical facility situation as on the “brink of catastrophe.”

Some health department primary care clinics have had to close or reduce their hours because the county’s hospitals are “so incredibly taxed,” Ghaly said.

More than 700 nurses have been reassigned to fulfill duties within the inpatient units, the emergency department, as well as the quarantine and isolation beds provided by the health department. All types of health care staff are being used and the county is requesting additional help.

Teams from the US military with 75 doctors, nurses and staff are being deployed to the state.

While no hospitals in the L.A. County have formally declared they are operating under “crisis care,” health officials have said that some Southern California hospitals have put in place practices that would be a part of crisis care, including redirecting ambulances when facilities are overwhelmed.” (D)

“A COVID-19 outbreak at Oakland, Calif.-based Kaiser Permanente’s San Jose hospital is linked to confirmed cases for 60 emergency department staff members, according to a statement shared with Becker’s Hospital Review.

San Jose (Calif.) Medical Center previously reported that 44 emergency department staff members tested positive between Dec. 27 and Jan. 1, and one of those workers has died. As of Jan. 5, 60 staff members who worked in the emergency department on Dec. 25 have tested positive.” (E)

“When the coronavirus began spreading through New York, Gov. Andrew M. Cuomo ordered state-run hospitals to stop suing patients over unpaid medical bills, and almost all of the major private hospitals in the state voluntarily followed suit by suspending their claims.

But one chain of hospitals plowed ahead with thousands of lawsuits: Northwell Health, which is the state’s largest health system and is run by one of Mr. Cuomo’s closest allies.

The nonprofit Northwell sued more than 2,500 patients last year, records show, a flood of litigation even as the pandemic has led to widespread job losses and economic uncertainty.

The Northwell lawsuits each sought an average of $1,700 in unpaid bills, plus large interest payments. They hit teachers, construction workers, grocery store employees and others, including some who had lost work in the pandemic or gotten sick themselves.

After this article was published Tuesday morning, Northwell abruptly announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.” (F)

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