Idaho DOH Activates Crisis Standards Of Care In Northern Districts Due To COVID-19

 

#16,178

Although we are barely 1/3rd the way through September, the summer wave of Delta is already crushing some healthcare delivery systems, and winter - and the possible return of influenza - is still months away.  

As I recounted nearly a month ago, in Through A Scanner Darkly, hospitals and EMS crews where I live (central Florida) are already overwhelmed, with delayed response times for emergency crews, hospitals constantly on and off `Divert' status, and long waits for beds. 

Ambulances (and hospital rooms) have to be decontaminated after caring for a confirmed or suspected COVID patient (see Interim Guidance for Emergency Medical Services (EMS)Systems for COVID-19 in the United States), which can make a unit 10-7 (Out of Service) for prolonged periods of time.

And as we saw last year during the height of the COVID wave, if you are unlucky enough to have an unwitnessed out-of-hospital cardiac arrest, emergency responders are less inclined to attempt prolonged resuscitation due to a lack of resources and concerns over spreading `aerosolized' virus to HCWs or nearby patients (see Standards Of Care During A Pandemic: CPR & Cardiac Arrest). 

Officially declared, or not, today - if you are in need of emergency or elective healthcare procedures - the COVID pandemic will greatly impact how (and sometimes even `if') it will be delivered.  And that goes for everyone, not just COVID cases. 

When things get really bad, an official declaration is generally made, such as we have below this week from the Iowa Department of Health and Welfare. 

First their statement, after which I'll return with more. 

Idaho activates Crisis Standards of Care in North Idaho due to of surge in COVID-19 patients requiring hospitalization

September 7, 2021

The Idaho Department of Health and Welfare (DHW) has activated Crisis Standards of Care (CSC) in accordance with IDAPA 16.02.09 – Crisis Standards of Care For Healthcare Entities. CSC is activated in the Panhandle Health District and the North Central Health District (Public Health Districts 1 and 2) because of a severe shortage of staffing and available beds in the northern area of the state caused by a massive increase in patients with COVID-19 who require hospitalization.

Kootenai Health in Coeur d’Alene requested that CSC be activated. The CSC Activation Advisory Committee convened virtually on Sept. 6 and recommended that CSC be activated in the Panhandle and North Central Health Districts. Although DHW has activated CSC in North Idaho, hospitals will implement as needed and according to their own CSC policies.

Hospitals and healthcare systems impacted are:

• Panhandle (PHD1)
• Benewah Community Hospital
• Bonner General Hospital
• Boundary Community Hospital
• Kootenai Health
• Shoshone Medical Center
• North Central (PHD2)
• Clearwater Valley Hospital and Clinics
• Gritman Medical Center
• St. Joseph Regional Medical Center
• St. Mary’s Hospitals & Clinics
• Syringa Hospital & Clinics

Crisis standards of care are guidelines that help healthcare providers and systems decide how to deliver the best care possible under the extraordinary circumstances of an overwhelming disaster or public health emergency. The guidelines may be used when there are not enough healthcare resources to provide the usual standard of care to people who need it. The goal of crisis standards of care is to extend care to as many patients as possible and save as many lives as possible.

“We have reached an unprecedented and unwanted point in the history of our state. We have taken so many steps to avoid getting here, but yet again we need to ask more Idahoans to choose to receive the COVID-19 vaccine. More Idahoans need to choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable with safe and effective vaccines,” Governor Brad Little said.

When crisis standards of care are in effect, people who need medical care may experience care that is different from what they expect. For example, patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (such as a conference room) or that needed equipment is not available.

“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” said DHW Director Dave Jeppesen. “This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places. Please choose to get vaccinated as soon as possible – it is your very best protection against being hospitalized from COVID-19.”

The process to initiate crisis standards of care began when resources were limited to the point of affecting medical care. The director of DHW convened the Crisis Standards of Care Activation Advisory Committee on Sept. 6, 2021, to review all the measures that were taken to address the staffing and bed shortages. The committee determined that the ability of northern Idaho hospitals and healthcare systems to deliver the usual standard of care has been severely affected by the staffing shortages, and all contingency measures to address these shortages had been exhausted. The committee recommended to the director that crisis standards of care be activated. Director Jeppesen issued his decision on Sept. 6, 2021, under the authority vested in him through the temporary rule.

Efforts will continue with earnest to alleviate the staffing and any other resource constraints in North Idaho. The crisis standards of care will remain in effect until there are sufficient resources to provide the usual standard of care to all patients.

Learn more about crisis standards of care and see an FAQ at https://coronavirus.idaho.gov/idaho-resources/

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.

Defining precisely what the `crisis standards of care' are has been a hot potato for years, but some general guidance is available (see HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources).  

On the HHS Topic Collection: COVID-19 Crisis Standards of Care Resources, you'll find a variety of opinions by leading public health entities, including:

American Medical Association. (2020). Crisis Standards of Care: Guidance from the AMA Code of Medical Ethics.

This document highlights guidance from the AMA Code of Medical Ethics relevant to physicians making decisions about the allocation of scarce resources during the COVID-19 pandemic.

American Nurses Association. (2020). Crisis Standards of Care: COVID-19 Pandemic.

This document provides guidance to registered nurses and institutions about the provision of patient care during extreme circumstances such as the COVID-19 pandemic.

American Public Health Association and National Academy of Medicine. (2020). Crisis Standards of Care During COVID-19.

This webinar was the fourth in a series of COVID-19 Conversations. Presenters offered an overview of crisis standards of care, discussed adapting them during the COVID-19 pandemic, and highlighted practical and ethical considerations of enacting crisis standards of care. The webinar recording, transcript, and presenter slides are available for review.

Before COVID, most Americans could  usually summoned an ambulance in under 10 minutes, true emergencies were treated promptly and aggressively in hospital Emergency rooms, and only rarely (usually during the height of flu season) might hospital beds be hard to come by. 

Triage - and the allocation of scarce lifesaving resources - was something that only happened on the battlefield or at the scene of major accident or disaster.

But during a severe pandemic wave it can also occur in hospital emergency rooms and ICUs simultaneously across the nation.  And the grim reality is that hospitals and EMS services around the country are flirting with that prospect right now, and many - like the hospitals in Northern Idaho - are already at their limit. 

While we are arguable better prepared to deal with patient surge this winter than last, Delta is hospitalizing more people than the wild type (or Alpha), and we've already seen RSV return this summer, and influenza may not be far behind. 

Meaning that barring some kind miracle, a lot of other health districts around the country are going to find themselves in the same - or worse - predicament as Northern Idaho in the months ahead.