Los Angeles County ambulance crews told not to transport patients with little chance of survival

Los Angeles County has been fighting a brutal battle against COVID-19 for weeks now.

New infections have soared with about one in five residents who get tested for COVID-19 receiving positive results.

In a little more than a month, the county doubled its number of infections, climbing from about 400,000 cases on November 30 to more than 800,000 cases on January 2, health officials said Monday.

The case deluge has translated to a surge of COVID-19 patients, overwhelming hospitals and plunging intensive care unit capacity across the region to zero. There are now more than 7,600 people hospitalized with COVID-19 in in the county, 21% of whom are in the ICU, officials said

With no hospital beds available, ambulance crews in the county were given guidance not to transport patients with little chance of survival. And the patients who are transported often have to wait hours before a bed is available.

“Hospitals are declaring internal disasters and having to open church gyms to serve as hospital units,” Supervisor Hilda Solis said, calling the situation a “human disaster.”

And a person is dying of the virus every 15 minutes, Los Angeles County Director of Public Health Barbara Ferrer said.

But it will get worse. Officials say they’re headed into the feared surge stemming from holiday gatherings.

“The increases in cases are likely to continue for weeks to come as a result of holiday and New Year’s Eve parties and returning travelers,” 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.”

Here’s just how bad things already are.

 

AMBULANCE CREWS GIVEN GRIM INSTRUCTIONS

 

As hospitalizations climb, the Los Angeles County Emergency Medical Services Agency (EMS) directed ambulance crews not to transport patients with little chance of survival to hospitals and to conserve the use of oxygen.

Before the pandemic, when healthcare workers and resources were more readily available, patients who were unlikely to recover could be transported by ambulance to the hospital for treatment.

But Los Angeles hospitals are now at capacity and many medical facilities don’t have the space to take in patients who do not have a chance of survival, the agency said. Patients whose hearts have stopped despite efforts of resuscitation, the county EMS said, should no longer be transported to hospitals.

“Effective immediately, due to the severe impact of the COVID-19 pandemic on EMS and 9-1-1 Receiving Hospitals, adult patients (18 years of age or older) in blunt traumatic and nontraumatic out-of-hospital cardiac arrest (OHCA) shall not be transported [if]return of spontaneous circulation (ROSC) is not achieved in the field,” the agency said in a memo issued to ambulance workers last week.

If there are no signs of breathing or a pulse, EMS will continue to perform resuscitation for at least 20 minutes, the memo said. If the patient is stabilized after the period of resuscitation, they would then be taken to a hospital. If the patient is declared dead at the scene or no pulse can be restored, paramedics will no longer transport the body to the hospital.

And the shortage of oxygen, given the high number of COVID-19 patients, has also pressured the system to conserve supply.

“Given the acute need to conserve oxygen, effective immediately, EMS should only administer supplemental oxygen to patients with oxygen saturation below 90%,” EMS said in a memo to ambulance crews Monday.

 

AMBULANCES WAIT FOR HOURS OUTSIDE HOSPITALS

 

And even after they arrive at hospitals, some EMTs have to wait outside for hours, as hospitals often don’t have enough beds to take the patients in.

“We are waiting two to four hours minimum to a hospital and now we are having to drive even further… then wait another three hours,” EMT Jimmy Webb told CNN affiliate KCAL.

Local officials have tried to encourage the public not to call 911 unless “they really need to,” Dr. Marc Eckstein, the commander of the Los Angeles Fire Department EMS bureau, told CNN affiliate KABC.

“One of our biggest challenges right now is getting our ambulances out of the emergency department,” Eckstein told the affiliate. “When our paramedics and EMTs transport a patient to an emergency department, there’s a transfer of care that has to take place. Patients who are unstable or unable to be safely transferred to the waiting room or to a chair, need a bed in the emergency department to be transferred to. And those beds are lacking right now.”

And while ambulances are waiting at hospitals, there are fewer of them to respond to other 911 calls that are coming in, leading to delayed responses.

“I think this next four-to-six week period is going to be critical with our system being taxed,” Eckstein added.

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