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Idaho Department Of Health And Welfare Activates Crisis Standards In North Idaho

A coronavirus patient is treated after going into cardiac arrest on Thanksgiving in the ICU at St. Luke’s in Boise.
St. Luke's ICU Nurse Kristen Connelly
/
St. Luke's Health System
A coronavirus patient is treated after going into cardiac arrest on Thanksgiving in the ICU at St. Luke’s in Boise.

The Idaho Department of Health and Welfare announced in a press release Tuesday morning that it had activated “crisis standards of care” in two public health districts in North Idaho due to a “severe shortage of staffing and available beds.”

Kootenai Health in Coeur d’Alene requested the state activate the policy, which gives health care providers guidelines for how to ration care – such as ventilators, ICU beds and staff time – in a public health emergency.

It’s the first time Idaho has ever utilized its Crisis Standards of Care Plan that it created in 2020 during the coronavirus pandemic.

“Almost all of this was avoidable, but we have made a mess of this,” Dr. David Pate told Morning Edition’s George Prentice.

Kootenai Health had 93 COVID-19 patients admitted on Sept. 3, more than a third of whom required critical care. Two weeks ago, Kootenai Health converted classrooms to make space for 22 more patient beds. The hospital said if it needed to care for patients in this makeshift space, that would trigger their request for crisis standards of care.

The state’s crisis standards activation committee met virtually Monday and recommended the state activate crisis standards of care in the Panhandle and North Central Health Districts.

“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” said Department of Health and Welfare Director Dave Jeppesen.

“This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places. Please choose to get vaccinated as soon as possible – it is your very best protection against being hospitalized from COVID-19,” he said.

Idaho has the lowest percentage of the total population with at least one vaccine dose out of all states, with 44.7% of residents having received the first dose.

Less than half – 49.3% – of eligible Idahoans, age 12 or older, are fully vaccinated, compared with 62% of those eligible across the nation.

COVID-19 hospitalizations statewide have surpassed peaks reached last winter.

Idaho hospital leaders have frequently said moving to crisis standards of care is a last resort policy that the state would enact only if all other options had been exhausted.

Last week, Gov. Brad Little reactivated the Idaho National Guard, and announced a few teams of federal medical staff were on their way to the state.

He said this was a “last-ditch” effort to deal with an unwavering surge of COVID-19 patients needing hospitalization. On the day of his announcement, only four staffed adult intensive care unit beds were available statewide – out of 400 statewide.

Before the state announced hospitals in the northern part of the state would move to crisis standards, hospitals throughout Idaho were already in what’s known as “contingency care.”

That means, even without the crisis designation, they are pushing the limits of normal staffing ratios, prioritizing patients who come into the emergency department based on how sick they are and delaying many time-sensitive medical procedures.

The Crisis Standards of Care Plan takes triaging to the next level. Health systems will follow state guidelines for prioritizing care such as oxygen therapy, ventilators, medications and hospice services.

Patients are given “priority scores” to determine if they’d be given a ventilator, weighing what options would save the most lives with the most “life-years.” If a patient is in cardiac arrest and their survival is unlikely, for example, they could be passed up for mechanical ventilation.

Hospitals under this framework are also encouraged to use alternative, or “less-trained” medical personnel, including volunteers and people who have just been trained for specific skills.

Hospitals in North Idaho affected by this decision include:

Panhandle (PHD1)

  • Benewah Community Hospital
  • Bonner General Hospital
  • Boundary Community Hospital
  • Kootenai Health
  • Shoshone Medical Center

North Central (PHD2)

  • Clearwater Valley Hospital and Clinics
  • Gritman Medical Center
  • St. Joseph Regional Medical Center
  • St. Mary’s Hospitals and Clinics
  • Syringa Hospital and Clinics

Each hospital will implement their own crisis standards of care protocols. The crisis standards of care will remain in effect until there are sufficient resources to provide the usual standard of care to all patients.
Editor's Note: This is a developing story and will be updated with additional information.