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COVID Nightmare in L.A. As Emergency System Falters

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 cannot be resuscitated within the subject and to preserve the area’s dwindling provide of oxygen provides.

The Emergency Medical Providers Company of Los Angeles County issued the brand new steerage 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 Hearth 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 dwell and die and who will get care.”

Relatively, beneath the brand new directive involving cardiac arrest sufferers, “our EMTs and paramedics will try resuscitation the best way they’ve all the time completed. 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 beneath the brand new directive are well-defined, Eckstein says.

Lately, he says, analysis has proven that cardiac sufferers who don’t have any pulse after they arrive on the hospital are not possible 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 have to preserve oxygen, efficient instantly, EMS ought to solely administer supplemental oxygen to sufferers with oxygen saturation under 90%.” And when the oxygen degree is under 90%, the minimal quantity of oxygen wanted to take care of the saturation at or simply above 90% ought to be given, the directive says.

A saturation of 90% is deemed sufficient to take care of tissues usually. The directive has some exceptions, comparable to using oxygen for steady constructive airway strain (CPAP), carbon monoxide poisoning, and different situations.

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

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