With hospitals in Los Angeles County overflowing with Covid-19 patients, a memo sent to the county’s emergency services last week sparked a public alarm and prompted health professionals on social media to explain their nursing practices.
In the memo, the slightly updated version of which was released on Monday, the county emergency agency instructed crews to move most adult patients whose hearts have stopped beating to hospital if on-site resuscitation was unsuccessful or if it failed the patients met established criteria for declaring death.
The measure was “necessary due to the serious effects of the Covid-19 pandemic on the emergency services and the 9-1-1 hospitals,” wrote Dr. Marianne Gausche-Hill, Medical Director of the agency, in the guideline.
What the memo actually reflected, however, was an effort to keep congested emergency rooms from spending time and resources on patients who were already out of their care. And instead of a terrible last resort, it was actually a relatively small change from the county’s previous policy that was already preventing emergency personnel from admitting most of the patients whose heartbeat could not be recovered where they were found in the hospital.
“Although this has already happened, paramedics have transported some of these patients to emergency rooms,” wrote Dr. Gausche-Hill in an email in response to questions about the guidelines. “We suggest it doesn’t,” she continued, “because the emergency room wouldn’t offer additional therapeutic interventions.”
She added that the guideline allowed exceptions for cases where the scene was unsafe or where emergency teams had special concerns that need to be discussed with a doctor.
Ambulances regularly took patients to a hospital without a heartbeat, a practice known as “Scoop and Run”. However, that changed about a decade ago, according to Dr. David K. Tan, President of the National Association of EMS Physicians.
Today he said, “The standard of care is to understand that cardiac arrest is an EMS problem, not a hospital problem, and that a patient’s chances of survival are better to deal with where you can find them.”
Several medical professionals across the country, like Kari Dickerson, a Kentucky medic who tweeted as @MedicTrommasher, jumped on social media in an attempt to allay fears about the policy they believed to be unfounded.
“The people I saw most angry were blacks and browns,” said Ms. Dickerson, who said she had to explain to her parents that “that’s what we’re already doing.” She said that she had read posts from people who expressed fears that “medical professionals would only leave people on the ground” and that “EMS made the decision who would live and who would die, who was worthy”.
Ms. Dickerson said she was concerned that these misunderstandings could lead to anger over the staff who had to spread the word about someone’s death. The families asked themselves, “Did you do this on purpose, did you not work as hard as you wanted? someone who looks like her? ”
She added, “People are already concerned that there is a hierarchy of who will be cared for before a pandemic, and now that we are at it, it’s even worse.”
Research shows that patients, as described in the Los Angeles guideline, are seldom alive, even when rushed to hospital after EMS tried unsuccessfully to resuscitate them, said Dr. Jeffrey M. Goodloe, director of the American College of Emergency Physicians.
“None of us ever want to withhold the chance of survival from someone who is dependent on us,” said Dr. Goodloe, who is also the chief physician for an EMS system in Oklahoma City and Tulsa.
In areas where hospital wards are overcrowded and empty beds are scarce, he said, “The best advice we can give someone is to work to keep yourself healthy so you don’t need EMS care, emergency care or hospital care . ”He added,” Prevention is more important than ever. “