How would crisis care standards be enacted in Washington – and when?
The COVID unit at Harborview Medical Center. (File photo by Karen Ducey / Getty Images)
As Washington hospitals are strained, we are not yet at the point of having to adopt crisis care standards like northern Idaho has.
Idaho’s medical crisis ‘becomes our problem’ in Washington
However, health officials warn that we are getting dangerously close.
“Crisis care standards” is a medical designation primarily used in the context of a disaster, such as an earthquake, volcano, or pandemic such as COVID-19. This means that a disaster has caused so many medical problems and overwhelmed the healthcare infrastructure to such an extent that difficult triage decisions will have to be made by healthcare professionals in order to make the best use of the limited resources available. to save lives.
“It’s a term that’s really meant to be a last resort, when life-saving drugs, therapy, or ventilators, you just don’t have enough, and you get to the point where you have to ration care.” Washington State Secretary of Health Dr. Umair Shah told the Washington State Department of Health Wednesday briefing.
While some Washington hospitals have seen people with serious illnesses like stroke and appendicitis having to wait for care, we’re not quite about to officially declare crisis standards.
“Today in our system we see care that is provided in a crisis… but that does not promulgate what this specific term of crisis care standards would mean,” Shah said.
It is the state’s Disaster Medical Advisory Committee that would meet and decide if and when to designate crisis standards. Shah explained that they would look at two main factors when making their decision.
“One is the saturation within the current health care system,” he said. “The other is the inability to move resources back and forth, or patients being moved back and forth… if you can’t transfer patients across the state anymore, or if you can’t get more patients. of resources in a severely stressed hospital. “
If the committee felt it was necessary to make this decision, it would make the recommendation to the Department of Health. The department, along with other health partners and Governor Inslee, would make the final decision.
Shah said if that were to happen, it would likely be as a state, rather than a region as Idaho has implemented.
So how close is Washington really to crisis care standards?
Shah likened it to stretching a rubber band to its breaking point over and over again.
“I’m really worried that we’ve stretched that rubber band, and at some point this rubber band is going to break if we don’t continue to do what we can to keep people out of this health care system,” he said. -he declares. . “In addition, we have a problem of staff shortages. “
He said the state had asked for 1,200 people to help fill those gaps.
Earlier this week, the Washington State Hospital Association announced in its briefing that it had requested personnel assistance from the National Guard and other Federal resources, but did not expect to get much help due to the nationwide demand for COVID-19 and hurricanes.
“In addition to providing assistance for the COVID-19 response, civil unrest last summer and again in January, wildfire seasons last summer and currently, we have over 1,000 men and women deployed. abroad, “the National Guard told KIRO radio in a statement. declaration.
Meanwhile, medical centers rely on the state’s emergency volunteer database, as well as community volunteers at individual hospitals.
And as the elastic continues to stretch, Dr Steve Mitchell, medical director of the Harborview Emergency Department, said they particularly had issues with the second factor in the Disaster Medical Advisory Board’s decision. . Mitchell founded the Washington Medical Coordination Center, which helps hospitals move patients statewide for care, for example, from small rural facilities to larger and more urban ones where they can access a greater variety of procedures.
There are 39 designated critical access hospitals in rural Washington, which are hospitals of 25 beds or less who usually take care of a patient in an emergency and then send them to a larger regional facility for further treatment. Lately, however, hospitals have struggled to find other facilities to accommodate their patients.
State hospitals warn of stroke, patients with appendicitis see delayed care
“Since July 1, my team at the Washington Medical Coordination Center has processed more than 1,000 requests from hospitals that have been unable to place their patients from these small, critically-accessible rural hospitals, where they can stabilize patients, to places that can actually step in and care for these patients, ”he said.
These resource hospitals are taking spectacular measures to integrate these patients.
“They do things like turn areas that aren’t supposed to care for intensive care patients into intensive care units,” Mitchell said. “They’re also taking staff who don’t normally work in intensive care units and expand the staff who normally work in intensive care units, trying to increase their reach so they can care for even more patients, putting a increasing pressure on all of our staff.
Even though new cases appear to be starting to flatten statewide, that doesn’t mean stress will immediately start to increase for our hospitals, which are still at record levels. Shah said hospitalization trends typically take a few weeks to track case rates, so hospitals will always be inundated for some time. He likened it to taking your foot off the accelerator when driving at high speed on the highway.
“It doesn’t mean the car will stop immediately,” he said. “Your car will continue at a certain speed for a while, and it will be a real problem that we will have in our health system, is that we will continue to see any contribution, regardless of the patients who arrive. . this will continue to test this system for some time in the future. “
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