Idaho hospitals are so overwhelmed by the rise in coronavirus cases that doctors and nurses have to contact dozens of regional hospitals across the West in hopes of finding places to transport individual critically ill patients.
Kootenai Health, a hospital in Coeur d’Alene, Idaho, has already turned a conference room into a Covid overflow unit, started paying street nurses $ 250 an hour, brought a military medical unit and received the state permission to attend the ration. This is all in response to the rise in Covid, which in recent weeks has taken over much of Idaho, a state with one of the lowest vaccination rates in the country.
“It’s just trying uninterruptedly to find the location of these patients and the care they need,” said Brian Whitlock, president and CEO of the Idaho Hospital Association, who noted that hospitals across the state they struggle with the same problem. “There’s really a minute-by-minute assessment of where the beds are open and hospitals say we don’t know where we’re going to put the next one.”
The need for space for beds in the ICU is affecting several patients: those suffering from Covid, as well as people who have had heart attacks or strokes or have been involved in accidents, for example.
Prior to the pandemic, experts said the borders between states in the region were blurred when it comes to caring for patients. While many of the states are known for their beautiful scenery and open terrain, access to critical medical care can be difficult for small rural towns that fill their landscape. Easier access to medical treatment may be across a border, rather than within the confines of a state.
These state limits, however, have become a little stronger as hospitals struggle to keep beds open for patients within their own state.
Washington state health leaders said they were trying to help their neighboring states, but were closely monitoring their bed.
“We’ve had to start patient placement committees with doctors from our various hospitals to really evaluate and prioritize, in conversation with these facilities they want to transfer, to really identify who is most at risk for care and what can be has managed where they are and what can’t be managed where they are, ”said Peg Currie, head of operations at Providence Health Care in Spokane, Washington, which is a 40-minute drive from Coeur d’Alene and Kootenai Health.
It has become an ethical challenge as Washington has been aggressive in its Covid security measures, while Idaho state leaders have done little to address the latest increase.
It doesn’t matter what you think of Covid right now – the important thing is that our healthcare system is tailored to you.
dr. David Pate said of Idaho
Dr. Doug White, director of the University of Pittsburgh’s Critical Illness Ethics and Decision Making Program, said that while Washington’s health services may feel a moral obligation to help, the need for acting falls to the Idaho state government.
“Medical practice is regulated at the state level, public health interventions reach the state level, and therefore in an emergency like this, I think state lines become very important because what we are seeing are such strong differences between how Washington state has responded to the pandemic and how Idaho has responded to the pandemic, ”he said, noting that Washington’s aggressive security measures came at a cost to the state.
But the relationships between these hospitals are deep.
Dr. David Pate, a member of the Idaho Coronavirus Working Group and former chairman and CEO of the St. Louis Health System. Luke in Boise said that because of the distance to Idaho cities from metropolitan areas, it was common for doctors before the pandemic to send their patients to cities like Spokane, Salt Lake City, Seattle, Portland, Oregon. and other cities in the region. It often required patients to be transported by plane or helicopter and close coordination between medical facilities.
Now, he said, doctors are forced to call 30 or more hospitals in several states to find a single-patient bed in hospitals with which they have little or no relationship. Some Idaho doctors have called south to Texas and east to Georgia.
“You spend seven to eight hours calling a group of hospitals to see if you can catch the patient who may be facing a time-sensitive emergency,” Pate said. “Seven to eight hours may mean the patient will not survive.”
The challenge of transfers has also put pressure on Idaho to allow its hospitals to set standards of care in crisis, meaning doctors can choose patients depending on the availability of bed space and health care workers without specific training can join the ICU.
For Idaho health leaders, the number of hospital transfers that Kootenai Health had to decrease due to the Covid increase crystallized the need to change care standards.
A regional transfer center for patients in urgent need of critical care (usually car accidents, heart attacks and strokes), Kootenai Health has had to reject 392 patient transfer requests during the month of August due to the number of Covid patients. From July to the end of September last year, they rejected 18 patient transfers.
Kootenai Health is not the only hospital to set these new standards of care and northern Idaho is not the only part of the state that can enforce them.
When Idaho declared the ration of care in the northern region last week, the state’s director of health and welfare, Dave Jeppesen, defined it as a “last resort.”
He said crisis care standards are “imminent” for hospitals in the rest of the state as Idaho continues to set new hospital and patient records in the intensive care unit and ventilators due to Covid.
“The numbers are rising at an alarming rate and we don’t see any spikes in sight,” he said in a briefing on Tuesday.
Under critical standards of care, the state allows health care providers to make difficult decisions about how to allocate and use scarce medical resources, allowing them to choose patients if necessary.
Idaho isn’t the only one looking for that kind of attention.
The Billings Clinic, a 300-bed hospital in Montana, is considering adopting standards of care in times of crisis, as its ICU reaches 150% of its capacity. Alaska’s largest hospital, Providence Alaska Medical Center in Anchorage, said Tuesday that, based on the number of patients, they had been “forced into our hospital to apply crisis care standards.”
Meanwhile, Wyoming hospitals are not normally equipped with pediatric beds.
Eric Boley, the president of the state hospital association, said they usually depend on neighboring states to accommodate critical children.
“We don’t really have pediatric beds in our state, so we rely on the surrounding states to help us,” he said. “And we’re seeing a big increase in pediatric cases right now.”
It is a frustration for Western health leaders as they struggle to control this latest increase.
With few indications that it will stop working soon, the region’s health systems could spread to the breaking point in a region of the country that remains highly skeptical of vaccines and Covid mask mandates.
“It doesn’t matter what you think of Covid right now. The important thing is that our health care system is in good condition,” said Pate of the Idaho Coronavirus Working Group. “I just ask people, who work with us for a month, six weeks. Give us humor. Be careful, don’t get into big people, wear a mask, and please consider getting vaccinated.”