After weeks of rising COVID-19 cases and a wave of hospitalizations that have strained state hospitals, 20 healthcare facilities in Alaska are now operating to crisis care standards.
Switching to crisis standards is often seen as the worst-case scenario. They are intended to provide both guidance and liability protection for healthcare workers who work with extremely limited resources.
The 20 hospitals that have requested crisis standards represent the majority of Alaska’s 31 health facilities (a total that includes hospitals and nursing homes), and they cover almost every region of the state – on the road network and off, from southeast to northwest Alaska. to Bristol Bay and along the Railbelt.
Heidi Hedberg, director of the state’s Public Health Division, said in an interview on Saturday that the move to crisis standards is a sign that hospitals are moving closer to making extremely difficult decisions about patient care, calling the changes in Alaskan hospitals lately. weeks “a slow progression”.
These hospitals are “really tipping further and further into the space where … they have to call on this triage team to make a clinical decision, which hasn’t happened before.”
The application of crisis care standards varies considerably from facility to facility and does not always mean that they are rationing care. In many cases, activating crisis standards is seen as a preventative measure, Hedberg said.
Some of the hospitals now under crisis standards had said, “We want to know that we have this responsibility, so at 2 a.m. if we’re going to get our triage team together and use the state document, we’ve got it. “in place, according to Hedberg.
Alaskans should know that the move doesn’t mean care is no longer available in hospitals – and they shouldn’t delay seeking important medical attention when they need it.
“The people of Alaska are going to get care, but it may not be the care they need,” she said. “The resources they need may not be there. “
“A heavy psychological burden”
Alaska hospitals have been operating under high stress levels for months. Amid the country’s strongest coronavirus wave, the state’s limited healthcare system is particularly vulnerable due to its isolation and large rural population.
“Right now we have five times the national average of cases, which is reflected in our hospitalizations, but we have one of the most limited healthcare systems,” Hedberg said.
In recent weeks, some impacts on care have included limited kidney dialysis therapy, a shortage of oxygen supply, staff shortages, and difficulties in transferring patients from rural communities as Anchorage hospitals have been particularly filled with critically ill patients in recent months.
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Triage teams in hospitals are made up of clinical ethicists, medical ethicists, and sometimes pastors. They exist to help physicians make difficult decisions.
“There is a heavy psychological burden for these doctors who treat patients at the bedside when they do not have enough resources,” Hedberg said.
“If a doctor says, ‘I have two patients and I have a resource. What do I do?’ They have to go to this triage committee, and this triage committee will look at the information and help make a decision, so it’s not on the shoulders of this bedside doctor, ”she said.
Hedberg said she has only heard of three examples so far in recent weeks of an Alaskan doctor facing a tough decision over resource allocation.
The 20 institutions involved include: Alaska Native Medical Center; Alaska Regional Hospital; Bartlett Regional Hospital; Bristol Bay Area Health Corp./Kanakanak Hospital; Central Peninsula Hospital; Cordoba Community Medical Center; Fairbanks Memorial Hospital; Maniilaq Health Center; Mat-Su Regional Medical Center; Norton Sound Health Corp .; St. Petersburg Medical Center; Providence Alaska Medical Center; Providence Kodiak Island Medical Center; Providence Seward Medical Center; Providence Valdez Medical Center; SEARHC / Mt. Edgecumbe; Southern Peninsula Hospital; Elias Specialized Hospital; Wrangell Medical Center; and Yukon Kuskokwim Health Corp.
Flexibility and search for resources
Several of these health facilities had already adopted crisis care standards specific to their facilities.
Providence Alaska Medical Center moved up to crisis standards early last month. This week, the Alaska Native Medical Center and Bethel Hospitals, Kodiak and Fairbanks also made the switch.
[Alaska reports over 1,000 COVID cases Friday as ANMC shifts care standards, gets help from Outside workers]
In Providence, “crisis care” has meant occasional rationing of treatment and the use of state guidelines and an in-house triage team to make difficult care decisions if necessary. At the Alaska Native Medical Center, the decision to switch to crisis standards was primarily made to allow more flexibility for providers.
For those 20 facilities, the crisis care standards “will remain in effect until there are sufficient resources to provide the usual standard of care to all patients,” the health department said. State in a press release.
To deal with staffing shortages at many Alaskan hospitals, the state signed a federal contract to bring in about 470 health care workers from outside. They started arriving this week.
The state also recently ordered five dialysis machines from the national stockpile as well as more oxygen, and continues to do everything possible to avoid another crisis, Hedberg said.
At the start of the pandemic, hospitals in Alaska worked together to draft crisis care standards guidelines, which break down specific topics around resources, including oxygen, personnel, nutritional support, and medication administration.
It wasn’t until last month, when the increase in COVID-19-related hospitalizations overwhelmed the state’s healthcare system, that the document came into play. The state allowed crisis standards in a Addendum to an emergency public health order.
When healthcare facilities reach a point of extreme stress, they now have the option of appealing to the Alaska Health Commissioner and the state’s Crisis Care Committee, which is made up of 15 physicians and health officials. the health of tribal and non-tribal state hospitals. The state can then approve requests from hospitals to activate crisis standards.
“This is what happened yesterday,” Hedberg said.
A “very fluid” situation and “a very serious push” in Fairbanks
Foundation Health Partners, which operates Fairbanks Memorial Hospital, said on Friday it had activated crisis care standards due to a “critical lack of resources,” including staff, available beds and options for transferring to d other establishments.
“Switching to crisis care standards is not something we take lightly,” said Dr. Angelique Ramirez, chief medical officer of Foundation Health Partners, which also operates the Tanana Valley Clinic and the Denali Center. “This is in response to a very serious wave of COVID in our community. “
Health organization Fairbanks also referred to a shortage of monoclonal antibody therapy, which health officials say is a very effective treatment for people at high risk with COVID-19 early in their illness. although they stressed that it does not replace vaccination. .
Other factors involved in the decision, according to Ramirez, include “community spread driven by low vaccination rates and low use of masks,” a high number of patients and the acuity of hospital patients.
About one in three patients hospitalized at Fairbanks Memorial Hospital on Friday tested positive for COVID.
[’Watching themselves die’: Fairbanks nurse describes panic and ‘air hunger’ among COVID patients in video encouraging vaccination]
The move to crisis standards “has an impact on all patient care, those with broken bones, trauma, heart attacks, strokes, COVID, anyone in need of medical attention could be affected,” Ramirez said. “The care that we are able to provide is very fluid and can change from day to day and even hour to hour depending on the availability of resources within our system and across the state.”
The borough of Fairbanks North Star is one of the least vaccinated areas in the state, with about 52% of residents fully vaccinated. Acting University of Alaska President Pat Pitney said in a letter Friday that University of Alaska Fairbanks Chancellor had asked him to consider approving a vaccine requirement for staff and staff. in-person students at its Fairbanks sites. An update is expected within two weeks.
Health officials continue to encourage people to wear masks in public, get vaccinated if possible, and get tested if symptoms of COVID-19 develop.