EMT shares experience on the frontlines and what we can do to help them

Updated article: January 6, 2021

Health officials in Los Angeles County are looking to clear up some details from a memo sent Monday to ambulance crews.

It said EMTs should not bring patients to hospitals if they have virtually no chance to survive. 

Here is a statement from Cathy Chidester, director of the LA County Emergency Medical Services Agency:

"The Emergency Medical Services (EMS) Agency regulates and coordinates the EMS system for LA County. Following the Health and Safety Code, the EMS Agency Medical Director is responsible for and oversees the emergency care provided in the prehospital setting. The EMS Agency Medical Director develops and promulgates the medical policies and procedure that paramedics and EMTs throughout LA County are required to follow. The EMS Agency is doing all that it can to support hospitals’ needs during the surge while maintaining quality patient care."

Statement on the directive regarding ambulance transports:

"Under existing policy, paramedics are required to provide a standard set of resuscitative efforts to all individuals suffering cardiac arrest or a traumatic injury resulting in the heart stopping. Existing policy also allows for paramedics to declare death in the field if such resuscitative efforts are not successful at bringing a pulse back and after consultation with medical staff at a hospital or trauma center.   Currently, approximately three-quarters of patients without a pulse are declared dead in the field and one-quarter are transported to a hospital.  

This Directive does not make any changes in paramedics’ efforts to resuscitate patients in the field. Paramedics will continue resuscitation efforts on all patients and continue to transport all patients who are able to be resuscitated. Rather, this Directive instructs paramedics to use their existing authority to declare a patient’s death in the field if there is no pulse, rather than transporting the individual to a hospital. Before making a decision to pronounce a patient’s death in the field the paramedic will still consult with medical staff at a hospital or trauma center.

The reason for the change is that hospitals across LA County are overwhelmed at this time and transporting a patient to a hospital when that patient cannot be resuscitated is not the best use of limited resources. Transporting these patients to the emergency department is futile and further impacts the hospitals. This directive, which is based on current medical literature and best practices, provides the guidance to the paramedics and EMTs on the most appropriate use of scarce resources. It also helps ensure that paramedics, EMTs and hospital teams can continue caring for as many patients as possible."

Statement on the directive regarding oxygen:

"The Emergency Medical Services (EMS) Agency regulates and coordinates the EMS system for LA County. Following the Health and Safety Code, the EMS Agency Medical Director is responsible for and oversees the emergency care provided in the prehospital setting. The Medical Director develops and promulgates the medical policies and procedure that paramedics and EMTs throughout LA County are required to follow.

EMS Agency medical policies cover all aspects of medical conditions that are encountered in the field before patients are brought to the hospital. During this pandemic, the EMS Agency has actively reviewed the medical policies and procedures to align patient care treatment and the use of resources with current conditions and limitations. One such resource limitation is concentrated oxygen and oxygen equipment. To ensure that oxygen is available to patients as needed, the EMS Agency published a directive that provides guidance to paramedics and EMTs on the most appropriate use of oxygen given scarce resources. This directive is based on current medical literature and best practices. It instructs paramedics to determine when a patient requires additional concentrated oxygen as part of their treatment. Paramedics make that determination after a full assessment, which includes a measurement of oxygen saturation in the blood, and consideration of certain known or suspected underlying medical conditions. The directive instructs paramedics that, in the absence of a condition allowed for as an exception in the policy, an oxygen blood saturation of 90% is an indication of adequate oxygen saturation.

The EMS Agency issue this directive now because it is a safe change in our policy and care standard that also helps to conserve concentrated oxygen, which is currently in short supply. Hospitals in general are running out of oxygen sooner than under their normal conditions and some hospital facilities are having difficulty maintaining oxygen pressure delivery. There is also a high demand for oxygen for COVID-19 patients who are being discharged on home oxygen therapy."

Like many frontline workers right now, EMTs are working tirelessly at all hours to handle an increase in calls due to the pandemic. 

News Channel 3’s Caitlin Thropay spoke with a local EMT to let you know what they are experiencing on the frontlines.

“We’ve been seeing a very very big increase in calls compared to what we were seeing in October and November," Samuel Gaete an EMT covering the Coachella Valley said.

Gaete has been an EMT for two years. He said many of the calls they’ve recently gotten are minor which are contributing to a clogged system. 

“People are calling for you know headaches; we’re getting people that are calling just wanting a COVID test um and it’s uh definitely been uh taking up the system and we’ve been seeing a lot more bed delay recently," he shared.

He said EMT crews find long delays at the hospitals. 

“Crews just the other day well yesterday were sitting on bed delay for five plus hours," Gaete said.

“If you don’t know what bed delay is, it essentially is the ambulance crew brings in a patient to the hospital and we are sitting with the patient on our gurney essentially waiting for a bed," he said.

Those kinds of delays are happening across southern California. In Los Angeles County EMTs are being told not to take patients who have little chance of surviving to the hospitals there. Gaete said here in Riverside County that’s not what they are being told to do. 

“I do recommend that if you feel it is absolutely necessary to call 911 do not hesitate," he said. "Call immediately and we will gladly be there to help," he added.

The waits at the hospitals are tying up the EMTs. 

“Sometimes we have no ambulances available anywhere,” he shared.

And he said crews are being sent all over the county to help with the increase in calls. 

“We have Riverside units coming to Palm Springs, Hemet units coming to Palm Springs, we have Palm Springs units covering Riverside, and Hemet and down to Temecula, Corona; everyone is going everywhere," he said.

If you are experiencing minor symptoms, Gaete recommends having a family member or friend take you to urgent care or the hospital.

As far as getting a COVID vaccine, Gaete said he has not received one yet but said he knows of some other EMTs starting to get vaccinated.