With Los Angeles County's hospitals overflowing with Covid-19 patients, a memo sent to the county's emergency services last week sparked a public alarm and prompted health professionals to comment on their nursing practices on social media.
In the memo, the slightly updated version of which was released Monday, the county ambulance agency instructed crews to move most adult patients whose hearts have stopped beating to hospital if on-site resuscitation was unsuccessful or if it failed the patients met established criteria for declaring death.
The measure was "due to the severe impact of the Covid-19 pandemic on E.M.S. and 9-1-1 receiving hospitals, ”wrote Dr. Marianne Gausche-Hill, the agency's medical director, in the guideline.
What the memo actually reflected, however, was an effort to keep congested emergency rooms from spending time and resources on patients who were already out of their care. And instead of a terrible last resort, it was actually a relatively small change from the county's previous policy that was already preventing emergency personnel from getting most of the patients whose heartbeat could not be recovered to where they were found in the hospital.
"Although this has already happened, paramedics have transported some of these patients to emergency rooms," wrote Dr. Gausche-Hill in an email in response to questions about the guidelines. "We suggest it doesn't," she continued, "because the emergency room wouldn't offer additional therapeutic interventions."
She added that the guideline allowed exceptions for cases where the scene was unsafe or where emergency teams had special concerns that need to be discussed with a doctor.
Ambulances regularly took patients to a hospital without a heartbeat, a practice known as "Scoop and Run". However, that changed about a decade ago, according to Dr. David K. Tan, President of the National Association of E.M.S. Doctors.
Today he said, “The standard of care is to understand that cardiac arrest is an E.M.S. Problem, it's not a hospital problem and a patient's chances of survival are better if they work where they can be found. "
Several medical professionals across the country, like Kari Dickerson, a Kentucky medic who tweeted as @MedicTrommasher, jumped on social media in an attempt to allay fears about the policy they believed to be unfounded.
"The people I saw most angry were blacks and browns," said Ms. Dickerson, who said she had to explain to her parents that "that's what we're already doing." She said she had read posts from people who expressed fears that "medical professionals will just leave people on the ground" and that "E.M.S. was the one who decided who would live and who would die, who was worthy. "
Ms. Dickerson said she was concerned that these misunderstandings could lead to anger over the staff who had to spread the word about someone's death. The families asked themselves, “Did you do this on purpose, did you not work as hard as you should have done? someone who looks like her? "
She added, "People are already concerned that there is a hierarchy of who is cared for before a pandemic, and now that we are at it, it's even worse."
Research shows that E.M.S. had tried unsuccessfully to resuscitate her, patients like those described in the Los Angeles guideline rarely live even when rushed to hospital, said Dr. Jeffrey M. Goodloe, director of the American College of Emergency Physicians.
"None of us ever want to withhold the chance of survival from someone who is dependent on us," said Dr. Goodloe, who is also the chief medical officer of an E.M.S. System for Oklahoma City and Tulsa.
In areas where hospital wards are overcrowded and empty beds are scarce, he said, "The best advice we can give anyone is to work to keep yourself healthy so you don't need EMS. Care or emergency care or hospital care. “He added," Prevention is more important than ever. "