COVID Nightmare in L.A. As Emergency System Falters

January 6, 2021 – As COVID-19 cases continue to rise in Los Angeles County, first responders have been urged not to take cardiac arrest patients to hospital if they cannot be resuscitated on the ground and to preserve the region. decreased oxygen supply.

The Los Angeles County Emergency Medical Services Agency released the new guidelines on Monday. The county reported 840,611 coronavirus cases and 11,071 deaths on Tuesday. Southern California remains at 0% of its critical care capacity.

The executive order puts paramedics, firefighters and other first responders in a difficult position, but for which they are prepared, says Marc Eckstein, MD, medical director of the Los Angeles Fire Department and commander of the city’s EMS office of Los Angeles, which serves more than 4 million people.

“We’re not asking our first responders to play God over there,” Eckstein says. “We are not asking our paramedics and paramedics to determine who will live and die and who will receive care.”

On the contrary, under the new directive regarding patients in cardiac arrest, “our paramedics and paramedics will attempt to resuscitate as they always have. The only difference is, after 20 minutes and [if] not resuscitated, they will not be transported, with a few exceptions. “

Before COVID, he says, “there was a lot more discretion on the part of paramedics to transport heart patients whose on-site cardiac resuscitations were unsuccessful. And sometimes they didn’t stay on stage for 20 minutes and transported [patients while] do CPR. “

The guidelines used under the new directive are well defined, Eckstein says.

In recent years, he says, research has shown that heart patients who do not have a pulse when they arrive at the hospital are very unlikely to make a significant recovery and are likely to remain in a condition. vegetative.

The other directive released on Monday, dealing with the area’s oxygen supply, says: “Given the acute need to retain oxygen, effective immediately, EMS should only administer supplemental oxygen to patients whose oxygen saturation is less than 90%. ” And when the oxygen level is below 90%, the minimum amount of oxygen needed to maintain saturation at 90% or just above should be given, the directive says.

A saturation of 90% is considered sufficient to maintain the tissues normally. The guideline has a few exceptions, such as the use of oxygen for continuous positive airway pressure (CPAP), carbon monoxide poisoning and other conditions.

” One problem is the availability of [oxygen] reservoirs, ”says Marianne Gausche-Hill, MD, medical director of the Los Angeles County Emergency Medical Services Agency. His agency is working with suppliers and others to correct the shortage.

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Jothi Venkat

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