#16,192
Five days ago, in Idaho DOH Activates Crisis Standards Of Care In Northern Districts Due To COVID-19 we looked at a September 7th declaration of a healthcare delivery crisis in the the Panhandle and North Central Health Districts of Idaho and their authorization of `Crisis Standards of Care'.
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.
Today, almost anywhere in the country - if you are in need of emergency or elective healthcare procedures - the demands of COVID pandemic will likely impact how (and sometimes even `if') it will be delivered.
For some, it means some elective procedures may be postponed, or longer waits at the Emergency Room or your doctor's office. For others, the impacts could be more severe, as described in the the Idaho State DOH FAQ on their Crisis Standard of Care:And that goes for everyone, not just COVID cases.
(Excerpt)During a disaster, such as an earthquake or a pandemic, healthcare systems may be so overwhelmed by patients, or resources may be so scarce, that it may not be possible to provide all patients the level of care they would receive under normal circumstances. In those situations, crisis standards of care would guide decisions about how to allocate scarce resources, such as hospital beds, medications, or breathing machines.(Snip)How would crisis standards of care affect me and my care?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, emergency medical services may need to triage (prioritize) which 9-1-1 calls they respond to. Patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (e.g. a conference room) or that laboratory or radiology services are limited or unavailable.
In rare cases, ventilator (breathing machines) or intensive care unit (ICU) beds may need to be used for those who are most likely to survive, while patients who are not likely to survive may not be able to receive one. The goal in all cases is to provide the best medical care possible with the resources that are available and to save the greatest number of lives.
If crisis standards of care are implemented during the COVID-19 pandemic, will all medical care be affected, or just COVID-19-related care?
If crisis standards of care are implemented during the COVID-19 pandemic, all types of medical care may be affected. If, for example, a patient needs ICU level care for the treatment of a severe infection or a traumatic accident, and there are not enough ICU beds available to treat all the patients who need one, that patient would enter a triage algorithm just like patients with COVID-19 who need an ICU bed.
Today - with the pressures of increased COVID hospitalization continuing to grow - the Idaho Department of Health and Welfare has extended that declaration to include the entire state.
Idaho expands Crisis Standards of Care statewide due to surge in COVID-19 patients requiring hospitalizationSeptember 16, 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 statewide because the massive increase of COVID-19 patients requiring hospitalization in all areas of the state has exhausted existing resources. CSC was activated on Sept. 6 in North Idaho. This activation, declared today, expands the declaration to the rest of the state.
This action was taken after St. Luke’s Health System requested that CSC be activated. DHW Director Dave Jeppesen convened the CSC Activation Advisory Committee virtually on Sept. 15. The committee recommended that CSC be activated statewide.
“Our hospitals and healthcare systems need our help. The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19. In addition, please wear a mask indoors in public and outdoors when it’s crowded to help slow the spread” said DHW Director Jeppesen. “The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident.”
Although DHW has activated CSC, hospitals will implement as needed and according to their own CSC policies. However, not all hospitals will move to that standard of care. If they are managing under their current circumstances, they can continue to do so.
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.
When crisis standards of care are in effect, people who need medical care may get 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. They may have to wait for a bed to open, or be moved to another hospital in or out of state that has the resources they need. Or they might not be prioritized for the limited resources that are available. In other words, someone who is otherwise healthy and would recover more rapidly may get treated or have access to a ventilator before someone who is not likely to recover.
The process to initiate crisis standards of care began when resources were limited to the point of affecting medical care. DHW Director Jeppesen convened the Crisis Standards of Care Activation Advisory Committee on Sept. 15, 2021, to review all the measures that were taken to provide care for the increased number of COVID-19 patients requiring hospitalization. The committee determined that the ability of all Idaho hospitals and healthcare systems to deliver the usual standard of care has been severely affected by the extraordinary influx of patients, and all contingency measures have been exhausted. The committee recommended to the director that crisis standards of care be activated statewide. Director Jeppesen issued his decision on Sept. 16, 2021, under the authority vested in him through the temporary rule.
Efforts will continue with earnest to alleviate the resource constraints in the state caused by the massive increase in the number of COVID-19 patients needing hospitalization. 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.
Contact: Niki Forbing-Orr
Public Information Manager
208-334-0668
We've looked at the thorny issues of triage, and the allocation of scarce medical resources, previously in HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources and Contemplating A Different `Standard of Care'.
How bad things will get this winter is unknown, and a lot will depend upon whether we see a `twindemic' of influenza and COVID. But Idaho probably won't be the only state to declare a medical crisis in the months ahead.
All good reasons, if you still need one, to get your COVID vaccine, to get the seasonal flu vaccine, and avoid any `risky' behavior puts you at risk of infection this fall and winter.
