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Special Year End Message

Happy New Year’s Eve,

It’s only a matter of hours before this unsettling and chaotic year concludes. However, 2020’s pandemic crisis is not receding quietly into the history books. The strain and stress experienced by the health care community is beyond severe as our members continue to care for their communities during a full-blown emergency. Beds, staff, and supplies are extremely scarce, and our workforce is fatigued – having been stretched to the limit for nearly a year.

We at HASC understand there are immediate and urgent challenges, and we remain committed to supporting you and your teams as we navigate this treacherous terrain together.

In recognition of these challenges, HASC is providing support in the following ways:

Region-wide:

HASC leadership hosted a call with the RVPs and county EMS directors from across the HASC region to discuss issues in each of HASC’s six counties, and to promote collaboration and communication among all agencies and organizations.

Takeaways and next steps coming out of this call: 

  • APOT/APOD times are up significantly in all counties. The lack of ability for hospitals to discharge patients, due to a long list of reasons, and the increase in the acuity of patients needing hospitalization are primary reasons for the delays on the front end. San Bernardino and Riverside counties are the hardest hit so far. Each has issued directives similar to the one issued by LAC yesterday (but they did so in consultation with HASC and hospitals). They have also issued field triage protocols. San Bernardino has set up an alternative holding area for 911 units with patients they can’t offload in the parking lot at Victor Valley Global Medical Center. There have been instances in both counties when all 911 response units were at hospitals offloading or waiting to offload patients. One county was temporarily unable to respond to 911 calls. 
  • The situation in Orange, Ventura and Santa Barbara counties are bad compared to normal, but they’re in better shape than other counties. However, they expect to be in a much worse situation in the days and weeks to come. 
  • LAC EMS provided a report that was similar to what was shared on the call with CEOs last week. Unfortunately, our call with the EMS directors occurred shortly before the CEO call so we were unable to have the county pull back on directive 4. 
  • The EMS directors agreed to provide hospitals in cross-county jurisdictions with a safety release to prevent situations similar to what has occurred recently with units stacking up at Los Alamitos, Pomona Valley and San Antonio facilities. ReddiNet has initiated a programming change to enable hospitals and first responders to see the status of hospitals in border counties. 
  • The group anticipates we will be in large-scale disaster mode within a few weeks, if not days in some areas. Crisis care standards are likely to be implemented on a widespread basis. 
  • The next call with the EMS directors and the HASC RVPs/leadership team will take place in early January – of course changing dynamics may necessitate a need for this call to take place sooner. 

Other Region-wide Developments:

  • HASC is preparing to launch the Association’s fourth COVID-19 Pay Practices & Policies Pulse Survey in the first week in January to capture current information on pay practices, policies and strategies that have been affected by the current pandemic and what organizations are doing to address any new concerns that may be arising as a direct result.
  • Working with the state to communicate the Non-Congregate Sheltering for California Healthcare Workers Program that provides hotel rooms to frontline health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. The cost is covered by the federal or state government. 
  • Meeting with local colleges and universities to determine ways that hospitals and schools can partner to provide staffing support to hospitals.
  • Reaching out to counties for updates on child care funding or program changes to be shared with members. 
  • Hospitals are required to post their crisis care guidelines policy. CDPH has removed the requirement to notify the community if they are implementing contingency or crisis care. Now, the “local jurisdiction” is to develop a communications plan to notify the public that impacted facilities are operating under crisis standards of care.
  • Twenty West Coast University students assisted with vaccine delivery in the Ontario area last week. The volunteers are offering their time to other organizations in need. Contact James Scheu at (909) 467-6045 to learn more.

County-specific actions include:

Los Angeles County:

  • Identifying sites on hospital property that enable EMS to take inventory of what is needed to submit requests to the state. This is inclusive of staffing, equipment and funding.
  • Urging DMH to execute a surge plan to expand inpatient beds for 5150 COVID-19 patients. HASC provided DMH contact at DHCS to facilitate and expedite approval. DMH announced on Dec. 30 it will bring on new beds in early January 2021 to meet this need.
  • Briefed Board of Supervisors staff on hospital challenges related to the placement of COVID-19 5150 patients and the need to execute DMH’s plan to assist with ED decompression. The board office weighed in with DMH, requesting an update.
  • Urged the Mayor of Los Angeles and Los Angeles Homeless Services Authority to provide additional homeless shelter capacity.
  • Assisting select hospitals with resolving logistical issues and/or access to the vaccine.
  • EMS:
    • Intervened on behalf of hospitals seeking temporary diversion relief on both ALS and BLS runs.
    • Convened EMS and hospitals to discuss implementation of patient load balancing.
    • Partnering with LA EMS to connect hospitals to EMTs who are interested and available for employment.
    • Supported Policy 845 related to field triage to decompress EDs of non-emergent cases.
    • Partnered with EMS to share a pilot program that deploys first responder EMTs outside hospital EDs to monitor patients with a goal of decreasing APOD while supporting hospital staff.
  • Advocated to DPH and DHS to expand interim housing capacity for COVID-19 individuals who need assistance with isolation and quarantining. Provided key barriers encountered by hospitals, including the need to reduce turnaround times. The program goal was to bring an additional 200 beds online by the end of the month.

Inland Area:

  • Facilitating situational awareness calls twice a week in San Bernardino County with public health, EMS, and hospitals to discuss capacity, treatment, supplies, equipment, staffing and pre-hospital issues.
  • Facilitating as-needed calls in Riverside County with public health, EMS, and hospitals to discuss capacity, treatment, supplies, equipment, staffing and pre-hospital issues.
  • Continuing to assist in the coordination of interfacility transfers on behalf of hospitals with EMS.
  • Working with Emergency Management Departments in both counties to explore options for ATS.
  • Working with counties to coordinate care for mental health and homeless patients.
  • Coordinating with San Bernardino EMS to develop an alternate destination program for lower-acuity patients.
  • Working with CDPH, CHA, public health, and member facilities to lessen the onerous burden of CDPH surveys during the surge.
  • Coordinating separate regional calls with hospital leaders to address critical issues impacting them, such as surge, equipment, oxygen, morgue capacity, interfacility transfers, etc.
  • Participated in a media event at Arrowhead Regional Medical Center announcing the arrival of the new vaccine in San Bernardino County.
  • Worked with San Bernardino Department of Public Health to assess the willingness of hospitals to enact a hub for vaccinating community providers.
  • Working with CHA to address member concerns regarding CDPH surveys, how to limit potential legal complications post-COVID-19 for members related to waivers, labor issues, ratios and space utilization.

Santa Barbara and Ventura Area:

  • Maintaining frequent contact with EMS in Santa Barbara and Ventura counties regarding alternate care sites, staffing, COVID-19 testing, surge, PPE and vaccination distribution.
  • Working with CHA to answer member inquiries about vaccinations, COVID-19 testing, discharges and admissions to SNFs, and other issues.
  • Secured $10 million for non-profit hospitals in Ventura County. The funds were delivered Dec. 24, 2020.
  • Participating in weekly calls with hospital CEOs to touch base on needs, challenges and best practices.
  • Provided public comment to the Ventura County Board of Supervisors on the issue of a possible labor strike at Los Robles Regional Medical Center.
  • Working with Santa Barbara and Ventura counties on policies for treating COVID-19 mentally ill (5150 and voluntary) patients.
  • Engaging with the Santa Barbara County CEO’s office to address the increased mental health populations in emergency departments, which impacts bed availability.

Orange County:

  • EMS issued 159 free ventilators to the following hospitals: Anaheim Regional, Orange Coast Medical Center, Mission Hospital Laguna Beach, Mission Hospital Mission Viejo, St. Jude, West Anaheim Medical Center, La Palma Intercommunity Hospital, Garden Grove Medical Center, Huntington Beach Hospital, Saddleback Medical Center, and Fountain Valley Regional. EMS has 349 ventilators available from the $10 million allocation approved by the Board of Supervisors in September.
  • The county purchased 200 mobile field hospitals in the spring. The procurement allows hospitals to use the beds in increments of 25 each, for combination up to 100. While the county is providing the structure and beds at no charge, hospitals still face the challenge of staffing the beds. Four additional hospitals are in discussion with EMS. The following hospitals are in-process of MFH deployment: UCI – 50 beds, Fountain Valley – 25 beds, Los Alamitos – 25 beds. The criteria for hospitals to receive the equipment are (1) activate surge plans and (2) validate cancellation of elective procedures.
  • Public Health and EMS are regularly surveying SNFs for available care space as of Friday morning. EMS will be contacting hospital case managers to offer connection for SNF transfers based on hospital volume, catchment area, and eligibility. For updates to the contact list, please email Sharon Richards at srichards@hasc.org.
  • For additional information on MHOAC, APOT, and Diversion Reports, please access the O.C. EMS website.
  • In response to CDPH mandating hospital employee testing, O.C. Public Health Director Dr. Margaret Bredehoft, is offering free partnership opportunities with county-contracted labs. She may be reached at (714) 336-4289 (mobile).
  • If your hospital is willing to accept volunteer time from the County of Orange BHS clinical staff (unlicensed), please contact Rachael Ferraiolo, LCSW Service Chief 1, BHS Disaster Response & Supporting Survivors at (714) 483-1764 (County cell number).

For situational awareness, I’ve included a report that contains relevant hospitalization and bed availability data in each of the counties that HASC serves. It will come as no surprise that the data trajectories are unfavorable – and unfortunately are likely to continue to worsen as we enter 2021.

Despite the darkness we find ourselves in, there is light to guide us and there are shoulders to place our hands on when we lose our footing. Not only is there hope on the horizon with the arrival of vaccines – we also have resilient and committed partners to stand beside us when our fight seems too daunting. We can, and will, get through the dark times together. 

Happy New Year’s to all, to your teams, families, partners and friends.

Take care and stay safe. Also feel free to reach out directly to me with your specific issues.

George G.

Contact:
George W. Greene, Esq.
(213) 538-0706
ggreene@hasc.org