COVID Nightmare in L.A. As Emergency System Falters

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Jan. 6, 2021 — As circumstances of COVID-19 proceed to surge in Los Angeles County, first responders have been directed to not take cardiac arrest sufferers to the hospital if they can not be resuscitated within the area and to preserve the area’s dwindling provide of oxygen provides.

The Emergency Medical Companies Company of Los Angeles County issued the brand new steering Monday. As of Tuesday, the county has reported 840,611 coronavirus circumstances and 11,071 deaths. Southern California stays at 0% ICU capability.

The edict places paramedics, firefighters, and different first responders in a tough place, however one they’re ready for, says Marc Eckstein, MD, medical director of the Los Angeles Fireplace Division and commander of the EMS Bureau for the town of Los Angeles, which serves greater than 4 million residents.

“We aren’t asking our first responders to play God on the market,” Eckstein says. “We’re not asking our EMTs and paramedics to find out who will stay and die and who will get care.”

Quite, below the brand new directive involving cardiac arrest sufferers, “our EMTs and paramedics will try resuscitation the best way they’ve all the time executed. The one distinction is, after 20 minutes and [if] not resuscitated, they won’t be transported, with few exceptions.”

Earlier than COVID, he says, ”there was much more discretion on the a part of the paramedics to move cardiac sufferers whose onsite cardiac resuscitations weren’t profitable. And typically they did not keep on scene for 20 minutes, and transported [patients while] doing CPR.”

The rules used below the brand new directive are well-defined, Eckstein says.

Lately, he says, analysis has proven that cardiac sufferers who haven’t any pulse once they arrive on the hospital are impossible to have a significant restoration and are more likely to stay in a vegetative state.

The opposite directive issued Monday, coping with the area’s oxygen provide, says: ”Given the acute must preserve oxygen, efficient instantly, EMS ought to solely administer supplemental oxygen to sufferers with oxygen saturation beneath 90%.” And when the oxygen stage is beneath 90%, the minimal quantity of oxygen wanted to keep up the saturation at or simply above 90% needs to be given, the directive says.

A saturation of 90% is deemed sufficient to keep up tissues usually. The directive has some exceptions, equivalent to the usage of oxygen for continuous positive airway pressure (CPAP), carbon monoxide poisoning, and different circumstances.

”One difficulty is the provision of transportable [oxygen] tanks,” says Marianne Gausche-Hill, MD, medical director of the Emergency Medical Companies Company for Los Angeles County. Her company is working with distributors and others to right the scarcity.