A petition dated Monday and signed by more than 1,000 Arizona medical providers is asking state leaders to allow for "crisis care standards" and to reinstate a stay-at-home order that expired in May.
Crisis care is "something that most of us, when choosing our career, thought we would never be doing," the letter says.
The petition comes as the state may be considering officially activating crisis care standards due to COVID-19, the disease caused by the new coronavirus. Cases and hospitalizations of COVID-19 patients in Arizona have been spiking in recent weeks.
Activating crisis standards of care would, among other things, protect hospitals from legal liability for triaging patients, according to a set of guidelines that take into account a person's likelihood of survival, the extent of their sickness and other factors.
Decisions on who to treat or not treat happen when there are not sufficient resources to take care of all patients. A scenario of overrunning hospital capacity is what many feared could happen if places did not successfully slow the spread of COVID-19.
Several hospitals have reported in recent days that they were activating surge plans as hospitalizations for COVID-19 grew. They reported converting floors and bringing in nurses from other places.
The Arizona Department of Health Services is "currently reviewing the recommendation" to activate crisis care by the State Disaster Medical Advisory Committee, a group of health care experts that comes together to make plans for care and use of scarce medical resources during public health emergencies, according to spokesperson Holly Poynter. This recommendation was separate from the petition by health care workers.
"This request was taken as a proactive step to ensure clear and consistent guidance to healthcare partners throughout the COVID-19 response. If the request is accepted, ADHS will post this update along with other guidance and recommendations made by the SDMAC on the SDMAC webpage," Poynter wrote in an email to The Arizona Republic.
Phoenix family physician Dr. Christine Severance, who authored the petition, collected 1,064 signatures from physicians, nurses, physician assistants and pharmacists in less than 24 hours, she told The Arizona Republic on Monday.
"Historically, our use of crisis care standards in the United States has been limited to terrorist attacks, mass shootings, battlegrounds, and aviation accidents," it says. "What pains us most is that this was avoidable."
The letter, addressed to Arizona Gov. Doug Ducey and Arizona Department of Health Services Director Dr. Cara Christ, says that when Ducey lifted the executive stay-at-home order he did it without a "staged re-opening," which meant people "returned to crowded bars and restaurants, had large social gatherings, and did not wear masks."
The letter says that health providers are now "forced to operate in crisis mode, placing a huge strain on an already stressed hospital system. ... Families will lose loved ones. Difficult choices will be made, and there will be untold emotional and mental consequences for every healthcare worker on the front lines."
The letter asks that Arizona leaders:
- Reinstate the stay-at-home order and enforce it.
- Close bars and nightclubs.
- Limit restaurants to take-out only and require transparency regarding employees testing positive for COVID-19.
- Mandate masks statewide and communicate concrete consequences for those refusing to wear masks in public.
- Increase testing capacity.
- Expand contact tracing.
- Enforce quarantine for those with suspected or confirmed COVID-19.
What does crisis care look like?
For crisis care to take place in hospitals statewide, the state health department would have to activate a plan it developed for this scenario back in mid-April. The plan was created by medical representatives from hospitals statewide as part of the health department's broader preexisting crisis care guidelines.
A document provides a plan for how hospitals will allocate scare resources for treating COVID-19 patients if that becomes necessary.
The April COVID-19-specific plan was an addendum to a broader plan regarding crisis standards of care in general.
Hospital systems across the state intended to collaborate so that no hospital would reach crisis care unless all do. If all hospitals face scare resources or a lack of time to collaborate, ADHS would coordinate and call for statewide crisis care.
The plan outlines "statewide triage protocols for acute care facilities." If there are not enough resources, patients will be individually assessed to decide how to divvy up treatment.
The plan says no one will be denied care based on "stereotypes, assumptions about any person’s quality of life, or judgement about a person’s 'worth' based on the presence or absence of disabilities. All patients, regardless of resource availability, will be treated with respect, care, and compassion.
"Triage decisions will be made without regard to basis of race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity, quality of life, or any other ethically irrelevant criteria."
Patients would be given scores based on a range of criteria and ranked for highest, intermediate and lowest priority for critical care resources. Those initial scores would be based on years the individual may live after treatment and underlying conditions.
Then, if two or more patients need one resource, these additional factors may be considered as priorities, in the following order:
- Pediatric patients under the age of 18.
- First responders or frontline health care workers.
- Single caretakers for minors or dependent adults.
- Pregnant women.
- Younger individuals.
Triage scores would be recalculated daily for hospitalized patients based on their condition, according to the plan.
State could consider crisis standards
An update sent Friday to members of the Arizona Hospital and Healthcare Association said the State Disaster Medical Advisory Committee met to discuss activating contingency and crisis standards of care. When the committee is activated for a disaster response, it serves as the statewide policy group for the Health Emergency Operating Center, which is managed by the state health department.
“After much discussion, the committee agreed that most, if not all, hospitals are currently operating under crisis standards of care and recommended that the Arizona Department of Health Services declare this to be the case,” the association’s update said.
“Moving to crisis standards of care will allow consideration of regulatory waivers as well as additional liability protections. A decision on activation is expected to be made within the next few days.”
Will Humble, the executive director of the Arizona Public Health Association and a former director of the state health department, said officially activating these standards would protect hospitals from liability while acknowledging that the state’s hospitals are at this point of needing such protection because they need to triage patients.
“It's the only time that this has happened in my lifetime. I mean they used it in Vietnam, and they use it in war. But for civilian purposes, I can't think of a time when this has been implemented,” Humble said.
Most doctors and health care providers don’t expect that this is how they will have to treat patients at any time, unless perhaps they are front-line military providers, he said.
Humble recalled times, such as during H1N1, when hospitals were given some regulatory reliefs or waivers of parts of the administrative code.
“I think it's really important for everybody to know about this," Humble said. "It's the reality. It's what's coming. And it's a result of the decisions that have been made. This isn't bad luck.”
Dr. Marjorie Bessel, chief clinical officer for Banner Health, which is the state's largest health system, said it's up to the state to make a declaration of crisis care standards.
Some of the indicators for crisis care are already happening inside Banner Health in Arizona, including having two patients per room instead of one, pausing elective surgeries and bringing in outside labor to help with increased patient capacity.
In light of the additional patients, Banner Health has started to "really focus on maximizing our space," Bessel said.
"The (Arizona) Crisis Standards of Care is a plan that was written years ago, way before the pandemic, to be available for use at the state level, for those of us in health care delivery if needed."
"This is something that the state would declare. So I'm hopeful that when that happens, that information and declaration will come from them. ... I'm hopeful that the state will inform and educate on this."
Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.
Reach reporter Rachel Leingang by email at rachel.leingang@gannett.com or by phone at 602-444-8157, or find her on Twitter and Facebook.
Reach the reporter at Alison.Steinbach@arizonarepublic.com or at 602-444-4282. Follow her on Twitter @alisteinbach.
Support local journalism. Subscribe to azcentral.com today.
"care" - Google News
June 30, 2020 at 04:51AM
https://ift.tt/2BUOXEP
Doctors urge Arizona leaders to declare 'crisis care standards' because of COVID-19 surge - AZCentral
"care" - Google News
https://ift.tt/2N6arSB
Shoes Man Tutorial
Pos News Update
Meme Update
Korean Entertainment News
Japan News Update
Bagikan Berita Ini
0 Response to "Doctors urge Arizona leaders to declare 'crisis care standards' because of COVID-19 surge - AZCentral"
Post a Comment