As hospitals overflow, ambulances told not to bring in patients they can’t revive in the field
As hospitals scramble to find enough staff and supplies to treat COVID-19 patients, county officials have told ambulance crews to limit their use of oxygen and stop bringing in certain patients with little to no chance of survival.
The Los Angeles County Emergency Medical Services agency has instructed ambulance crews not to bring in most patients without a pulse if they can’t be resuscitated in the field or terminally ill patients with do-not-resuscitate orders if the hospital treatment would be related to end-of-life care.
Some hospitals around LA County have also had trouble finding enough portable oxygen containers and getting them refilled, according to county officials, prompting the instructions sent today to conserve it unless a patient falls below a certain oxygen saturation threshold.
The directives apply to Long Beach, but most of the changes were already considered best practices in the city, according to Andy Reno, the Long Beach Fire Department’s emergency medical services education coordinator.
“If COVID wasn’t here, would we be treating people differently than we are now? That’s a hard one,” he said. “It’s affecting things because of the quantity and how sick everyone is.”
Experts generally agree that it’s more beneficial for emergency medical personnel to do everything to try to restart a cardiac arrest patient’s heart at the scene than to rush the person to the hospital while performing CPR, which can be delayed or interrupted by moving the patient.
Nevertheless, the new directives spell out a stark reminder of how thin emergency crews and medical workers have been stretched by the pandemic.
“Everyone says they’ve never seen anything like this before in their career,” Reno said.
Just like local medical centers, paramedic crews have been inundated with more critically ill patients than at any point during the pandemic, he explained.
And in practice, the new instructions can end in taxing situations for EMS crews and families who may expect that their loved ones will be transported to the hospital even if there’s only a marginal chance of survival.
Reno said he recently spoke with a paramedic who had to explain to a nursing home administrator that the new criteria meant their ambulance couldn’t take a patient from the facility to a hospital.
That decision aligned with the patient’s end-of-life instructions, Reno explained, but it’s still a difficult decision. Ambulance crews always have access to an on-call doctor to help them in making those choices, he added.
Hospitals around Long Beach are treating more COVID-19 patients than ever before. Reno said that means it’s taking longer for crews to offload patients as they wait for available beds.
It’s become common recently for all of the local hospitals to be so overwhelmed that they ask ambulances to take patients elsewhere, according to Reno. When that happens crews simply try to spread them out among facilities as best as possible.
“I’ve been on the phone with nurses that are crying,” Reno said. “It’s just so hard.”
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