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County doesn't expect limited ambulance service similar to Los Angeles

Posted at 6:16 PM, Jan 05, 2021
and last updated 2021-01-06 09:49:46-05

SAN DIEGO (KGTV) -- Paramedics in Los Angeles County are being told patients with little chance of survival should not be transported to local hospitals.

According to KABC, "Dr. Marc Eckstein, medical director and commander of the LA City Fire Department EMS Bureau, says a new directive now orders first responders in the field to stop bringing patients to the hospital if their heart stops beating, like in the event of a cardiac arrest. Ambulances are being told not to transport trauma patients - victims of heart attacks, gunshot wounds, car crashes - to the hospital if they can't be resuscitated in the field."

On Monday, Eckstein said they are trying to encourage people not to call 911 unless they really need to.

Along with the ambulance directive, Los Angeles County is also struggling with ambulances waiting for hours to offload patients or be diverted elsewhere. Starting next week, LAFD paramedics and EMTs will be staging in cots outside of hospitals so that ambulances can get back into service, KABC reported.

Monday, The Los Angeles County Department of Public Health confirmed 77 new deaths and 9,142 new cases of COVID-19.

ABC 10News asked healthcare providers across San Diego County about Los Angeles County's new ambulance directive, local ambulance diversion, and zero capacity situations.

A spokesperson for Kaiser Permanente said, "Kaiser Permanente, like all major health care systems and hospitals in the area, is working hard and thoughtfully to be well prepared for a potentially overwhelming surge of patients caused by the coronavirus pandemic. We are staying well connected and working closely with local, state, and federal public health and other officials who are leading response planning to face this challenge."

That spokesperson, along with officials from other local health providers who responded, said to contact the county's Emergency Medical Services agency.

A spokesperson for the county tells ABC 10News, "The County of San Diego is aware of a Los Angeles County EMS memo directing ambulance crews to not transport individuals who could not be resuscitated and stabilized. While the emergency transport system and emergency department capacity in San Diego County remain severely strained, San Diego County EMS has not issued a similar memo and one is not anticipated at this time. More information about the steps being taken in San Diego County can be found at the Emergency Medical Services website."

In December, San Diego County allowed hospitals to divert ambulances if their emergency rooms are already too full.

According to the county, "Hospitals on County Ambulance Diversion only accept patients who are so critical that they cannot survive transport to another facility (e.g., cardiac arrest, breathing problems that cannot be managed in the ambulance); thus, nearly all basic and advanced life support (BLS and ALS) ambulances must bypass a hospital on County Ambulance Diversion."

The county reports that a hospital can only implement the diversion in 4-hour blocks, which must be approved or initiated by the county. The county also directed ABC 10News to the state's crisis care guidance.

The California Department of Public Health tells ABC 10News, "As COVID-19 cases continue to surge, California wishes to make health facilities across the state aware about its Crisis Care guidance. This guidance, with an emphasis on hospitals, is being issued as resources and bed availability ranging from general care to Intensive Care Units continue to decrease statewide. Additionally, staffing levels are being stretched thin, and it is critical that facilities be aware of these guidelines should they be implemented as they are designed to save countless lives.

This decision to shift into the implementation of crisis care, should it happen at a facility, will not be an easy decision to make. During normal operations, routine services can be provided. However, as resources have become more and more scarce, and as hospitals are pushed to their limit, this guidance will become critical to ensure the best care is delivered to patient populations.

If strategies are not planned for ahead of time, they might not be considered and could be difficult to implement. So, it is strongly recommended by CDPH that all health facilities, particularly hospitals, review this guidance and prepare for its potential implementation.

We also expect facilities to post their crisis care plans and policies on their websites. The guidance, first created and circulated in June 2020, provides a key look into how hospitals can adapt and react to surging cases and crisis situations, covering specific categories such as health care delivery, staffing issues, triage, and elective surgeries.

Should facilities shift to delivering this level of care, it is expected to be done in a coordinated manner, keeping in mind the best decisions to help protect the health of all Californians. You can view Crisis Care guidance at this link.

Should the guidance be implemented at county, state, or regional levels, affected areas and facilities will be expected to follow the guidelines that best fit their needs in order to ensure resources and critical care are secured."