• Wed. Sep 14th, 2022

Colorado reactivates crisis standards for emergency medical services, signaling worsening situation


Colorado’s COVID-19 situation is worsening. The last sign, much like flashing red lights and sirens from an ambulance, arrived late Friday afternoon when the state reactivated its emergency standards, called crisis care standards, for emergency medical services. This is the first time the state has done this for EMS since the pandemic began in April 2020.

Still, the state’s top medical official is urging those who are ill or in need of emergency care to use 911 or seek emergency care as usual.

The state health department said it has released advice on how best to use EMS services because many staff are sick and “high demand for patient transport.”

The state’s standard EMS crisis plan allows agencies to bypass normal operating procedures to primarily prioritize and sort care, based on resources – such as paramedics and ambulances – available.

For patients, this means that transport can take place in “only the most serious cases”, and where an ambulance will pick up a patient for care could include clinics, surgery centers, emergency care centers or other alternative sites besides hospitals. Or that crews might consider not transporting patients under the age of 60.

For EMS agencies, this means allowing them options such as changing the staff and crew configuration, “ie EMS certified or approved supplier and non-medical driver”.

For dispatch centers, this may mean not sending an ambulance if there are “no life-threatening symptoms (chest pain, difficulty breathing, altered mental status)” to reduce the risk of a first responder is exposed to COVID-19. They could also save resources for “critically ill or injured patients” and other patients would be referred to “nursing advice lines, telehealth or mobile integrated health services”.

“Since there are fewer paramedics on the streets, because there just aren’t enough people to work because they’ve been out with COVID, if someone calls 9-1-1, trained medical dispatchers have the opportunity to ask a number of questions and determine if an ambulance needs to be dispatched, ”said Scott Bookman, state COVID-19 incident commander, himself a former chief paramedic in Denver. “It really is a tool to ensure that our EMS providers are able to provide care to those who need it most during times of labor shortages. ”

Bookman said if they determine that the ambulance should be dispatched when the crew arrive, the EMS medical team can assess the patient and if he is of low acuity, “maybe qu ” they give them instructions to follow up with their doctor, go to an emergency care department or transport themselves to the emergency room.

He said it would help “keep those 9-1-1 ambulances on duty for the most acute calls, heart attacks, strokes, which require this level of care.”

“It’s about staffing,” Bookman said. The change “allows us to be sure that these limited healthcare workers that we have are able to do the most important work they can do.”

The Polis administration has so far ruled out some other statewide measures, including a statewide indoor mask warrant. Gov. Jared Polis told CPR’s Colorado Matters last month he would leave mask warrants to local officials, saying the state should not “tell people what to wear.” The comments came after groups of nurses and doctors, hospitals and public health officials, among others, urged the step as a way to limit transmission.

The reactivation of EMS crisis standards comes as the omicron variant fuels an unprecedented wave of coronavirus cases, in Colorado and nationwide, and hospitalizations continue to rise. Public health officials called on residents to stay on top of COVID-19 vaccines to ease pressure on the already heavily taxed healthcare system

The state health department reported 1,374 people hospitalized with confirmed cases on Friday. That’s almost 400 in two weeks since Christmas Day.

And the numbers are dangerously thin. Fifty-three percent of hospitals say they expect a staff shortage next week. A third says he anticipates a shortage of intensive care beds.

“Things are very busy at all levels from the emergency department to the intensive care unit,” said Dr. Anuj Mehta, pulmonary intensive care physician at Denver Health. He said the increase came from a combination of an increase in the number of patients arriving at the emergency room, more patients admitted to hospital and a much more severe staff shortage.

The seven-day average of tests that come back positive is nearly 27%, the highest level documented throughout the pandemic. Just three weeks ago it was around 6%.

“Your health in an emergency is always a priority. Dispatchers and emergency medical services experts will help you determine if you need immediate care, ”Chief Medical Officer Dr Eric France said in a statement. He said they can also advise a patient to seek treatment through a normal doctor’s appointment if it can wait.

“With the increasing demands of hospitals and EMS, we need to make sure that we can provide care to anyone who needs it immediately. The Crisis Care Standards help us do that, ”he said. He also urged all Coloradians over the age of 5 to get vaccinated so that we can “reduce the pressure on our health system and protect everyone”.

According to the Ministry of Health, crisis standards for emergency medical services providing advice to call centers, dispatch centers, emergency medical services agencies and responders on how to interact with potentially infectious patients and maximize care for multiple patients with staff and vehicles limited emergencies. The guidelines also help determine the type of treatment to be provided, for example if and where a patient should be transported for additional care, if necessary.

Colorado State Reactivated crisis care standards for staffing health care systems in November. These standards allow hospitals to implement staffing solutions to meet the growing medical needs of their communities.

“We are seeing more and more healthcare workers testing positive for COVID-19 with the omicron wave,” Mehta said. “Fortunately, the vast majority of them are relatively either mild asymptomatic or asymptomatic. It’s a saving grace, is that they always go back to work after five days, but things are very busy.

The state has not currently activated some of its crisis care standards, such as those for hospitals and acute care facilities, hospital care providers, specialist patient populations, or personal protective equipment ( EAR).

Standards of Care in Crisis are protocols that help providers and health systems determine how to provide the best possible care under extraordinary circumstances resulting from a disaster or public health emergency. They can be used when there are not enough resources to provide usual care to those who need it. The goal is to treat as many patients as possible and save as many lives as possible, according to the state’s health department.