Crisis care and military help in Fresno. ‘Things are going to get worse before they get better.’
Fresno County’s top doctor says he saw two signs early this week that “things are going to get worse before they get better.”
The signs: San Joaquin Valley hospitals are working with the local health department to prepare for crisis operations due to the coronavirus pandemic; and military teams arrived to alleviate staffing constraints during the latest surge in hospitalizations.
The California Department of Public Health on Monday issued letters to all general acute care hospitals throughout the state to develop and implement crisis guidelines. The hospitals themselves determine their status and then can use ethical standards of fairness to decide who will be treated.
Fresno County Interim Health Officer Dr. Rais Vohra said Tuesday those letters indicate situations at the hospitals are “not normal.”
Meanwhile, a team with the Air Force and Department of Defense arrived in town Tuesday to help staff Community Regional Medical Center’s intensive care units as the hospital faces staffing constraints due to the volume of patients and hospital workers being out of work due to COVID-19 exposure and infection.
Similar teams were sent to Fresno in July and August.
Crisis care guidelines
The letter from CDPH on Monday requires hospitals to have a crisis care plan ready.
Currently, Fresno’s hospitals are operating in contingency care, which means “standard care” still is delivered even though it might be delivered differently, Vohra said.
Under crisis care, that might not be the case, he said.
“We’re at a point where the hospitals are really having to make some tough choices about exactly what services they can or can’t deliver,” Vohra said.
“Besides the spacing issues, there may be other kinds of changes and adaptations that hospitals need to make in order to just make sure that they’re serving the most people and trying to do the most good – even if that means that at the individual level, they’re not able to do things in a normal, or even a contingency style,” he said.
A crisis care plan ensures hospital staff follow ethical principles and civil rights laws to deliver care in an equitable way.
Fresno’s hospitals currently have enough ventilators for the patients who need them, but the crisis plan will create a model to follow when there aren’t enough. Medical staff can follow a guide instead of picking and choosing on their own which patients receive a ventilator.
“If you’re expecting things to look normal when you visit the emergency department in the next few weeks, then you’re going to be surprised because that’s really not where things are,” Vohra said.
Military team arrives in Fresno
At the request of FEMA, 15 U.S. Air Force and five U.S. Army military medical personnel began orientation Tuesday at CRMC in downtown Fresno. The team includes doctors, nurses and respiratory technicians.
The help is part of a Department of Defense medical team deployed earlier this week into four California hospitals in response to the pandemic.
The extra support will help the hospital add additional ICU beds, said Dan Lynch, Fresno County’s director of emergency services.
The San Joaquin Valley had 0% ICU availability on Tuesday.
Already, hospital workers are treating about 20 patients at an alternate care site set up at CRMC. County officials still haven’t opened up the field hospital at the Fresno Convention Center, and even if it did, there wouldn’t be enough people to staff it, Lynch said.
“The issue will always be staffing,” he said. “We will have to deal with the staffing anywhere else we go, whether it be to another hospital or to the Convention Center.”