More than 20 years ago, a study looked at the rate of heart attacks in the United States, and found that Acute Myocardial Infarctions (AMIs) run as much 53% higher during the winter months than than during the summer.
Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction.While cold weather combined with strenuous physical activity (like clearing snow from sidewalks) has often been blamed for this spike, even in balmy Southern California, studies have shown a 33% increase in heart attacks over the holidays (see below).
Spencer FA, Goldberg RJ, Becker RC, Gore JM.
When Throughout the Year Is Coronary Death Most Likely to Occur?
A 12-Year Population-Based Analysis of More Than 220 000 Cases
Robert A. Kloner, MD, PhD; W. Kenneth Poole, PhD; Rebecca L. Perritt, MS
In many places we've seen hospitals, EMS, and sometimes entire state health delivery systems forced to invoke a `Crisis Standard of Care' when medical resources are no longer able to cope.
A month ago, in More U.S. Hospitals Inch Towards Invoking Crisis Standards of Care, we looked at the rising number of hospitals adopting emergency protocols to deal with overwhelmed ERs, increasing admissions, and growing staff shortages.
We've explored the impact of these protocols often over the past few months (see The Realities Of Crisis Standards Of Care), but in short it can mean hospitals are allowed - under certain dire circumstances - to ration care (including access to ventilators, ICU beds, etc.), invoke DNR (Do Not Resuscitate) protocols (see Standards Of Care During A Pandemic: CPR & Cardiac Arrest), and even turn some patients away.
With a high demand for EMS responses, and many of their EMTs out sick with COVID, the State of Colorado has decided to invoke a Crisis Standards of Care (CSC) protocol for their Emergency Medical Services statewide.
Colorado reactivates Crisis Standards of Care for Emergency Medical Services
STATEWIDE (Jan. 7, 2022) — The Chief Medical Officer at the Colorado Department of Health and Environment reactivated Crisis Standards of Care for Emergency Medical Services (EMS). With many EMS staff out ill and with high demands for patient transports, guidance to the EMS providers on how to best use their services is needed at this time. The last time the state activated Crisis Standards of Care for Emergency Medical Services was April 2020.
Emergency Medical Services are an essential part of the continuum of health care that often starts with a call to emergency dispatch (e.g., 9-1-1). The crisis standards for Emergency Medical Services provide guidance for call centers, dispatch centers, and emergency medical service agencies, and responders regarding how to:
Interact with potentially infectious patients.At this time, the state has not activated crisis standards of care for hospital and acute care facilities, crisis standards of care for out of hospital care providers, crisis standards of care for specialty patient populations, or crisis standards of care for personal protective equipment.
- Maximize care for multiple patients with limited staff and emergency vehicles.
- Determine what kind of treatment to provide, such as whether and where a patient should be transported for further care, if deemed necessary.
“If you are sick and think you need emergency care, please continue to use 9-1-1 or seek emergency care as you would normally. Your health in an emergency is always a priority. The dispatchers and emergency medical service experts will help you determine if you need immediate care. They may also advise you to seek care through a normal doctor’s appointment, if your case can wait,” said Dr. Eric France, Chief Medical Officer. “With increasing demands on hospitals and EMS, we need to make sure we can provide care to anyone who needs it immediately. Crisis standards of care help us to do that. We also need every Coloradan over the age of 5+ to get vaccinated so we can lessen the strain on our healthcare system and protect everyone.”
In November, the state of Colorado reactivated crisis standards of care for staffing of health care systems. Crisis standards of care for staffing of health care systems allows hospitals to implement staffing solutions to meet the increasing medical needs of their communities.
Crisis Standards of Care are protocols that help health care providers and systems decide how to deliver the best care possible under the extraordinary circumstances of a disaster or public health emergency. These protocols may be used when there are not enough 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.
Continue to stay up to date by visiting covid19.colorado.gov.
While this order only covers the State of Colorado, a number of other states and jurisdictions are also operating under various versions of CSC, and more are likely to follow.
For most people this will mean delays in EMS response times, but for those with out-of-hospital cardiac arrests, it can mean a radically different approach to resuscitation efforts.
The details are outlined in Colorado's 12-page Crisis Standards of Care – Emergency Medical Services protocol, but essentially EMTs are less likely to perform aggressive (and often futile) lifesaving measures in the field on some patients.
A reminder that you don't have to catch COVID to have your health negatively impacted by this pandemic. This is a bad time to have a heart attack, get in an accident, or need emergency or elective procedures of any kind.
Making anything you can do to stay healthy - particularly when healthcare delivery systems are stretched to their limits - very much worth doing.
