Los Angeles County ambulance workers are told not to transport Covid-19 patients with low survival rate

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Or have a medical emergency and languish for hours outside an emergency room.

This is what Los Angeles County stands for when the Covid-19 attack devastates the community – including those without the coronavirus.

“Hospitals are reporting internal disasters and must open church gymnasiums to serve as hospital units,” said County Supervisor Hilda Solis. “Our health workers are physically and mentally exhausted and sick.”

And every 15 minutes, one person dies from Covid-19, said Barbara Ferrer, Los Angeles County’s director of health.

Now LA County emergency personnel have been told not to take patients with low survival rates to hospitals.

“This warrant, issued by the county emergency medical services, is really very specific for patients in cardiac arrest who cannot be revived in the field,” said Dr. Jeffrey Smith, Chief Operating Officer of Cedars-Sinai Medical Center.

“Those patients each have a very low survival rate if they are taken to the hospital. So at this point it is probably considered useless.”

Who is taken to a hospital and who is not

The Los Angeles County Emergency Medical Services Agency (EMS) issued a memo to ambulance workers last week.

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“Immediately effective, 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) with blunt traumatic and non-traumatic cardiac arrest out of hospital (OHCA) not transported [if] return of spontaneous circulation (ROSC) is not achieved in the field, ”the agency said.

If the patient has no signs of breathing or a pulse, EMS will attempt to resuscitate the patient for at least 20 minutes, the memo said.

If the patient has stabilized during that time, he is taken to a hospital.

But if the patient is pronounced dead on the spot or if no pulse can be restored, paramedics will not take the patient to the hospital.

Patients may or may not receive oxygen assistance

The Covid-19 spike has also led to a lack of supplemental oxygen, meaning some patients treated by EMS will do without it.

Problems with oxygen supply forced five hospitals in the Los Angeles area into an 'internal disaster'

“Given the acute need to conserve oxygen, effective immediately, EMS should only administer supplemental oxygen to patients with oxygen saturation below 90%,” Los Angeles County EMS said in its memo.

EMS said that an oxygen saturation of at least 90% is sufficient to maintain normal blood circulation to organs and tissues.

Oxygen deficiency in the province and the San Joaquin Valley led to the formation of a “task force for oxygen” last week, Gavin Newsom said.

The working group is working with local and national partners to try to refill oxygen tanks and get them to the most needy hospitals and facilities.

Holiday gatherings and essential work fuel the spread of Covid-19

As the most populous state in the country and home to about 1 in 9 Americans, it would make sense that California would have the most Covid-19 cases.

But it is the size of the number of hospitalized patients and the staggering increase that are causing major problems.

“The increase in cases is likely to continue for weeks as a result of holiday and New Year’s Eve celebrations and repeat travelers,” Ferrer said.

“We will probably experience the worst conditions in which we have experienced the entire pandemic in January. And that is hard to imagine.”

Experts say other reasons contribute as well – including pandemic fatigue, resistance to home housing rules, the sheer number of essential workers, and socioeconomic factors affecting poorer and minority households.

Ambulances wait for hours outside the hospitals

Even if patients are lucky enough to get into a hospital, they can languish outside for hours when there is no room left.

“The emergency medical services are working very hard to divert ambulances or send them to hospitals that have the capacity to receive those patients,” said Smith, COO of Cedars-Sinai Medical Center.

“There are situations where patients have to wait in ambulances under the care of paramedics. We want to make sure that the time is as short as possible so that they can receive the necessary care.”

For EMT Jimmy Webb the wait can take several hours.

Hospitals are feeling the impact of holiday gatherings
“We wait at least two to four hours to get to a hospital, and now we have to drive even further … and then wait another three hours,” Webb told CNN subsidiary KCAL.
Local officials have urged the public not to call 911 unless “really necessary,” Dr. Marc Eckstein, chief of the EMS office of the Los Angeles Fire Department, to CNN subsidiary KABC.

“One of our biggest challenges right now is getting our ambulances out of the emergency room,” he said.

“When our paramedics and paramedics transport a patient to an emergency department, care must be transferred. Patients who are unstable or cannot be transferred safely to the waiting room or to a chair need a bed in the emergency department to transfer to to be transferred. And those beds are missing at the moment. “

And more ambulances waiting at hospitals means fewer ambulances to respond to other 911 calls, leading to even more delays.

The situation could get worse, Eckstein said.

“I think the next four to six weeks will be critical as our system is under strain,” he said.

CNN’s Jenn Selva and Travis Caldwell contributed to this report.

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