'Things Are Worse Than People Think': LA County Official On New Directives For EMS

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Los Angeles County paramedics examine a potential COVID-19 patient sitting on the sidewalk before transporting him to a hospital in Hawthorne, Calif., on Dec. 29, 2020. Apu Gomes/AFP via Getty Images

Apu Gomes/AFP via Getty Images

In Los Angeles, ambulances are waiting for hours — up to eight, in some cases — to admit new patients at overwhelmed hospitals. The number of coronavirus patients in ICUs has more than quadrupled since the beginning of November.

On Monday, LA County’s Emergency Medical Services Agency directed EMTs not to bring people who have little chance of survival in to hospitals and to conserve oxygen out in the field.

And with the holidays just behind us, public health officials warn that the situation could get worse for emergency services.

“A lot of what’s happening right now, even though people are talking about it, people are reporting about it, people aren’t really seeing it. And the reality is, things are worse than people think,” says Dr. Nichole Bosson, assistant medical director at the Los Angeles County Emergency Medical Services Agency. “And I say that because I see how people are still congregating in groups and making decisions to have family gatherings or New Year’s parties. And these decisions are what continues to impact our health care system.”

In an interview with All Things Considered, Bosson explains what Monday’s orders mean and what is being done to address the problems. Here are excerpts.

I want to start with some of these new directives that we’ve been hearing about, like not bringing in patients who have little likelihood of survival. Can you put that in context for us? How extraordinary is that measure?

Well, actually, it is best practice to resuscitate patients in cardiac arrest in the field where they are found. That is our normal protocol in LA County. So the shift towards not transporting patients who do not have restoration of pulse is a relatively small change. These patients have very limited chance of survival. And so these are the patients that we’re asking the paramedics to call in to our base hospitals, discuss with the base physician and determine if further resuscitation is futile and therefore terminate resuscitation on scene. We are continuing to resuscitate patients in cardiac arrest, and we continue to transport all patients in whom our paramedics are able to resuscitate in the field.

How concerned should Angelenos be about the availability of oxygen right now? We are hearing from people like [LA County Public Health Director] Barbara Ferrer that January will likely be the worst month on record for LA. So I imagine oxygen supplies will only get stretched even more in the weeks to come.

We have made this move because of a limited supply of portable oxygen tanks. … Because the paramedics and EMTs are spending more time in the field with patients. They are transporting longer distances because of hospital closures. They are spending more time waiting to offload patients at hospitals. And these patients need oxygen. And so they’re using a lot of oxygen in these small portable tanks. And if we cannot get additional tanks and cannot fill the tanks, we risk to run out of oxygen for patients who need it. So this directive is meant to conserve oxygen in order to make sure that we continue to have enough oxygen to treat patients who really, really need the oxygen.

The waits for ambulances to offload patients at hospitals are getting longer. What is being done to address that situation?

We are implementing a surge response to develop ambulance receiving spaces at these hospitals. These are intended to be climate-controlled spaces where EMS can offload patients. And instead of having each individual unit, usually two paramedics or two EMTs, monitoring a single patient, they will be able to offload the patients and have a paramedic or EMT as appropriate, staffing the area and monitoring several patients at a time. … And we have a medical officer on duty 24/7 to help consult in terms of identifying the most critical patients and getting them into the hospital as quickly as possible and determining which patients may be stable, say, to go to the waiting room and be triaged in through the walk-in process. And by this way, we’re trying to get more ambulances back into the field to respond to the critical emergencies and reduce the burden on the hospitals as well, because we know they don’t have the staff to monitor these patients.

Ailsa Chang
Author: Ailsa Chang

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