‘Human disaster’ unfolding in LA will get worse, experts say

Imagine having cardiac arrest and getting picked up by an ambulance that won’t take you to a hospital.

Or having a medical emergency and languishing outside an emergency room for hours.

This is what Los Angeles County faces as the onslaught of Covid-19 devastates the community – including those without coronavirus.

“Hospitals are declaring internal disasters and having to open church gyms to serve as hospital units,” County Supervisor Hilda Solis said. “Our health care workers are physically and mentally exhausted and sick.”Solis called the situation a “human disaster.”

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Almost 7,900 people are hospitalized with Covid-19 in just Los Angeles County. And 21% of them are in intensive care units, officials said Tuesday. The number of hospital patients grew by more than 200 from Monday.

On Tuesday, another 224 deaths were announced, bringing the total in the county to more than 11,000.

Now, ambulance crews in LA County have been told not to take patients with little chance of survival to hospitals.

“This order that was issued by the county emergency medical services really is very specific to patients who suffered from a cardiac arrest and are unable to be revived in the field,” said Dr. Jeffrey Smith, chief operating officer of Cedars-Sinai Medical Center.

“Those patients have a very low rate of survival each if they are transported to the hospital. So at this time, it is deemed to likely be futile.”

Who gets taken to a hospital, and who doesn’t

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

ER tech Brenda de la Cruz (R) and RN Janet Hays works outside St Mary Medical Center in the triage tents as they handle the overflow at its 200 bed hospital during the outbreak of the coronavirus disease (COVID-19) in Apple Valley, California, U.S., December 8, 2020. REUTERS/Mike Blake

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“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.

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

If the patient is stabilized during that time, they would then be taken to a hospital.

But if the patient is declared dead at the scene or no pulse can be restored, paramedics will not take the patient to the hospital.

Patients may or may not get oxygen help

The Covid-19 surge has also led to a shortage of supplemental oxygen, meaning some patients treated by EMS will go without.

APPLE VALLEY, CALIFORNIA - DECEMBER 23: (EDITORIAL USE ONLY) A patient lies on a stretcher in the hallway of the overloaded Emergency Room at Providence St. Mary Medical Center amid a surge in COVID-19 patients in Southern California on December 23, 2020 in Apple Valley, California. The 213 bed capacity hospital in San Bernardino County is currently treating at least 140 COVID 19-positive inpatients while operating at approximately 250 percent of ICU capacity. Southern California remains at zero percent of its ICU (Intensive Care Unit) bed capacity amid the spike in coronavirus cases and hospitalizations. (Photo by Mario Tama/Getty Images)

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

The oxygen shortage in the county and San Joaquin Valley prompted the formation of a “task force on oxygen” last week, Gov. Gavin Newsom said.

The task force has been working with local and state partners to try to refill oxygen tanks and get them to the hospitals and facilities most in need.

Holiday gatherings and essential work fuel spread

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

But it’s the magnitude of hospitalized patients and the staggering rate of increase that are causing major problems.

Victorville, CA - December 17: ER uncharge-nurse Jennifer Caspary, left, and emergency department medical director Dr. Leroy Pascal attend to a COVID-19 patient at Desert Valley Hospital on Thursday, Dec. 17, 2020 in Victorville, CA. (Irfan Khan/Los Angeles Times/Getty Images)

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As of Tuesday, more than 22,000 Covid-19 patients were hospitalized statewide, according to the California Department of Public Health. More than 27,000 people have died from Covid-19, including 368 new deaths reported just Tuesday.

“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,” Los Angeles County Public Health Director Barbara 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.”

Experts say other reasons also contribute – including pandemic fatigue, resistance to stay-at-home regulations, the huge number of essential workers and socioeconomic factors affecting poorer and minority households.

Ambulances wait for hours outside hospitals

Even when patients are lucky enough to get to a hospital, they might languish outside for hours if there’s no more room.

“The Emergency Medical Services are working very hard to divert ambulances or send them to hospitals that do have potential capacity to receive those patients,” said Smith, COO of Cedars-Sinai Medical Center.

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

For EMT Jimmy Webb, the wait can last several hours.

TOPSHOT - A patient rests in a corridor waiting for a room at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California on January 3, 2021. - Approximately four weeks ago, the hospital had a very manageable census, and very small amounts of patients in the ICU, but since Thanksgiving it seems like the census has been doubling every 10 days and they've gotten to a point where 80% of the hospital is filled with patients with Covid-19, and ?90% of the ICU is now filled with Covid-19. According to doctor Yadegar, it's not just a matter of room, but it's also the staffing to have nurses, as well as doctors to be able to take care of those patients. It's very difficult to get critical care nurses and doctors. So, it's hard to expand, even if we can expand with the number of beds in the rooms it's impossible to expand in terms of nurses and doctors because there's limited resources. The situation is very dire. The hospital systems are at a breaking point unless we were able to get this infection under control. It's not sustainable. Unfortunately, the emergency room is having to close and not be able to take patients that are coming in with ambulances because we don't have room for them, and at this point this is impacting not just what happens in the hospital but it affects everyone in the community. (Photo by Apu GOMES / AFP) (Photo by APU GOMES/AFP via Getty Images)

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“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,” Webb told CNN affiliate KCAL.

Local officials have urged the public not to call 911 unless “they really need to,” Dr. Marc Eckstein, head 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,” he said.

“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 more ambulances waiting at hospitals means there are fewer ambulances to respond to other 911 calls – leading to even more delays.

The situation may get worse, Eckstein said.

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

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