Do Not Transport Orders

Los Angeles County Emergency Medical Services Agency (EMS) has issued do not transport orders for patients requiring intensive care as area ICUs are full with COVID19 patients. EMS providers are also bring told to ration oxygen.

Southern California has one of the country’s worst outbreaks of COVID19. ICU bed availability plunged to zero in Southern California last month as more and more people were admitted to hospital seeking treatment for the novel coronavirus.

Medical facilities do not have the space or providers to take in patients who do not have a chance of survival, according to the Los Angeles County Emergency Medical Services Agency. The Do Not Transport orders are not necessarily out of the norm for military style triage.

As of Monday evening, there were 7,544 people hospitalized in Los Angeles due to Covid-19 and just 17 available adult ICU beds, according to county health data. Due to the shortage of beds, the county EMS said patients whose hearts have stopped, despite efforts of resuscitation, should no longer be transported to hospitals.

If there are no signs of breathing or a pulse, EMS will continue to perform resuscitation for at least 20 minutes, the EMS memo said. If the patient is stabilized after the period of resuscitation, the patient would then be transported to a hospital. If the patient is declared dead at the scene or if no pulse can be restored, paramedics will no longer transport the patient to the hospital.

Do Not Transport Orders

There is also an acute shortage of oxygen in Los Angeles and the nearby San Joaquin Valley, due to COVID19. It is putting pressure on the entire emergency medicine system and forcing EMS responders to conserve the supply.

In order to maintain normal circulation of the blood to organs and tissue needed for the body to function, EMS said an oxygen saturation of at least 90% will be sufficient. This does follow American Heart Association standards on resuscitation training.

California Gov. Gavin Newsom formed a task force to address the issue last week. It is working with local and state partners to help refill oxygen tanks and mobilize them to hospitals and facilities most in need, but he has faced mounting criticism after telling Californians to quarantine at home and he was seen dining with health industry executives at the opulent French Laundry.

These new orders are likely to increase the toll on EMS responders which was described this summer as more dangerous than 9-11. Smaller population states and communities have not been immune to the issues faced by EMS and compounding problems are healthcare providers attacking the ongoing immunization process.