Los Angeles County urges ambulance crews not to bring to hospitals patients they cannot resuscitate.


With hospitals in Los Angeles County swamped with Covid-19 sufferers, a memo that went out to the county’s ambulance crews final week prompted public alarm and prompted explanations from medics on social media about their care practices.

Within the memo, a slightly updated version of which was released on Monday, the county Emergency Medical Providers Company instructed the crews to not transport most grownup sufferers whose hearts had stopped beating to a hospital if resuscitation within the area was unsuccessful or if the sufferers met established standards for declaring loss of life.

The measure was wanted “as a result of extreme impression of the Covid-19 pandemic on E.M.S. and 9-1-1 receiving hospitals,” Dr. Marianne Gausche-Hill, the company’s medical director, wrote within the directive.

What the memo truly mirrored, although, was an effort to spare overburdened emergency rooms from having to spend time and sources on sufferers who had been already past their assist. And relatively than a dire final resort, it was truly a comparatively small change from the county’s previous policy, which already discouraged emergency personnel from taking most sufferers whose heartbeats couldn’t be restored the place they had been discovered to the hospital.

“Though this has been in place, paramedics have been transporting a few of these sufferers to emergency departments,” Dr. Gausche-Hill wrote in an e mail in response to questions in regards to the insurance policies. “We advise that they don’t,” she continued, as a result of “the emergency division wouldn’t supply any extra therapeutic interventions.”

She added that the coverage allowed exceptions for instances the place the scene was unsafe or when emergency crews had explicit issues that have to be mentioned with a doctor.

Ambulances used to usually rush sufferers with no heartbeat to a hospital, a follow often called “scoop and run,” however that modified a few decade in the past, in response to Dr. David Ok. Tan, president of the Nationwide Affiliation of E.M.S. Physicians.

Today, he stated, “the usual of care is to grasp that cardiac arrest is an E.M.S. drawback, it’s not a hospital drawback, and {that a} affected person’s probabilities of survival are higher to work them the place you discover them.”

A number of medics across the nation, like Kari Dickerson, a paramedic in Kentucky who tweets as @MedicTrommasher, jumped into social media to attempt to quell anxieties in regards to the directive they believed had been unfounded.

“The folks I noticed most upset had been Black and brown folks,” stated Ms. Dickerson, who stated that she needed to clarify to her dad and mom that “that is stuff we already do.” She stated that she learn posts by folks expressing fears that “medics had been simply going to go away folks on the ground” and that “E.M.S. was the one deciding who would stay and who would die, who was worthy.”

Ms. Dickerson stated she was involved that these misunderstandings might result in anger at personnel who needed to break the information that somebody had died, with households questioning, “Did they do that on function, did they not work as laborious as they’d have for any person that appears like them?”

She added, “Individuals are already frightened that there’s some hierarchy of who will get care even previous to a pandemic, and now that we’re in it, it’s even worse.”

Analysis reveals that when E.M.S. had tried with out success to resuscitate them, sufferers like these described within the Los Angeles directive hardly ever stay, even when transported to a hospital, stated Dr. Jeffrey M. Goodloe, a director of the American School of Emergency Physicians.

“None of us, ever, wish to withhold the prospect of survival from somebody that’s relying upon us,” stated Dr. Goodloe, who can also be chief medical officer for an E.M.S. system protecting Oklahoma Metropolis and Tulsa.

So for areas the place hospital wards are overflowing and empty beds are scarce, he stated, “one of the best recommendation we can provide any person is figure to maintain your self effectively so that you don’t want E.M.S. care, or emergency division care, or hospital based mostly care.” He added, “Prevention is extra essential than ever.”



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