In expectation of more coronavirus patients, hospitals in LA County are preparing for what they call “crisis standards of care.”
“Crisis care generally means that you could offer beneficial life saving care to someone, except that you don't have enough of that care to offer, so they're not going to get it. That's where none of us want to be,” says Dr. Brad Spellberg, the chief medical officer at County/USC Medical Center.
His hospital is not yet at that point, but planning for it. He says although hospitalizations have seemed to plateaued in the past month, they’ve plateaued at a dangerously high level.
“It's like running at max speed on a treadmill for four weeks and you can't get off,” he says. “The hope is that we don't see a post-December additional surge. Because if we do, we will tip into crisis care. The entire county will.”
Methodist Hospital in Arcadia declared it was in crisis mode on December 29. According to Chief Medical Officer Dr. Bala Chandrasekhar, it’s mainly a staffing issue.
“We are paying about $190 an hour for ICU nurses, and we still are unable to get extra,” he says. “We had patients waiting in the [emergency department] for days on end, and we just didn't have the capacity. Even today, we have 14 patients, 11 of them intubated on a ventilator, waiting to go upstairs to the ICU.”
The hospital has convened a triage team of doctors, community members, a bioethicist, and spiritual care providers to review the severity of critically ill patients and make decisions about allocating limited resources. They have not had to ration care yet.