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How L.A.'s Hospitals Were Able To Avoid 'Last Resort' Medicine

Health care workers prepare a Mobile Isolation Unit for operation outside of the VA Hospital in Westwood. (Chava Sanchez/LAist)
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At the beginning of January COVID-19 hospitalizations hovered around 8,000 patients. A lot of hospitals considered implementing crisis care, which refers to battlefield-type medicine, where care is concentrated on the patients who are more likely to survive.

But thankfully, that hasn't happened so far.

"No hospital in L.A. has gotten there," said Cathy Chidester, director of the L.A. County Emergency Management Services Agency.

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One reason is that there's been a slight decline in the number of people in area hospitals. Another reason: direct coordination with the state health department.

"In December, we were so taken off guard by the sheer number of patients that were coming in, I think the mindset was that the hospitals would be able to handle this on their own," Chidester said.

But it soon became clear the surge of COVID-19 patients was growing. Hospital administrators were asking the county for help as they began shifting overflow patients into operating recovery rooms and emergency rooms, and in at least one case a gift shop.

Chidester said on Christmas Eve, a team from the state health department toured some of the hospitals in L.A., and saw how dire the situation had become.That struck a chord, and a state team was quickly embedded with L.A. county's team.


"We don't have the authority to make certain changes happen, but the state does," Chidester said.

The state team brought in additional medical staff like nurses, and waived some regulatory rules to speed up the discharge process for patients who were well enough to go to nursing homes, she said.

The increased coordination has also helped ease equipment supply issues, from oxygen to gloves, Chidester said.

"We call hospital emergency managers and then we ask them, what are you short on, what do you need? We try to anticipate based on what the hospitals are telling us," she said.

The embedded state team will likely stay in L.A. until nurse staffing ratios are back to normal, Chidester said.

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"I think some of it is going to just depend on the numbers," she said. "Probably when we have about 3,000 COVID-19 patients [hospitalized]," she said.


Currently there are more than 7,000 coronavirus patients in L.A. County hospitals, which is actually an improvement over early January.

The recent dip in hospitalizations has given embattled Los Angeles hospitals a little hope after weeks of patient overcrowding that led to hours long ambulance delays and oxygen rationing.

Lower patient numbers are bringing "much needed relief" in terms of serious overcrowding, but L.A. County Public Health Director Barbara Ferrer stressed that "it's nowhere near the number that we need to get down to."

"Having 7,200 patients [hospitalized] ... is far more than the hospital system can actually manage over the long term," she said.


The state is also adding additional hospital beds -- including ICU beds -- at Pacifica Hospital of the Valley in Sun Valley, and it's reopening Pacific Gardens Medical Center in Hawaiian Gardens, which had closed four years ago. Those moves will add 263 beds to the region's supply.

The additional beds will act like a pressure valve, allowing overburdened hospitals to transfer more patients.

"We're really excited about it," said Chidester. "They can be a regional resource to transfer some of these patients to offload hospitals that are very, very stressed right now," she said.

The hospitals will admit COVID-19 patients and those who don't have the virus.