Crisis Care Standards Activated in 10 Northern Idaho Hospitals

Idaho has one of the lowest vaccination rates in the country.

EDITOR’S NOTE:b The total U.S. coronavirus death this morning, Thursday, Sept. 9, 652,675. RACmonitor will continue to monitor this developing story in Idaho.

After being part of the local healthcare community for more than 40 years, it is hard to believe what has just occurred in my own state. The Idaho Department of Health and Welfare has activated crisis standards of care for 10 hospitals in Northern Idaho. Two are regional referral centers (with Kootenai Health warning for weeks that the hospital was overwhelmed by a wave of desperately sick COVID-19 patients, having requested the Department to make the designation) and eight small critical access hospitals that cannot care for many critically ill patients and have nowhere to transfer them.

Idaho has one of the lowest vaccination rates in the country, which has fueled the overwhelmed ICUs and left all of Idaho at the brink of disaster. To better understand what a crisis care standard actually means, it is important to understand that two things have been occurring: there are too few hospital beds, and too few hospital personnel to care for all the sick. More than 95 percent of COVID-19 patients in Idaho hospitals are unvaccinated. The hospitals in the southern part of the state are also repeatedly warning that they are close to being in the same situation as northern Idaho.

What does this really mean? Essentially, it starts with the initial screening of patients who present. Historically, patients most at risk are triaged first. Now, a new “level black” is being used, and will be assigned to patients who do not have a high probability of surviving. They will be the fourth level, not the first. Once in the hospital, the same type of screening, under crisis standards, like hospital beds, medicine, equipment, and use of ICU beds, may be allocated to those deemed most likely to survive, with the goal of saving as many lives as possible under extraordinary circumstances.

Kootenai Health in Coeur d’Alene, Idaho has converted a conference room to COVID beds for non-ICU patients. Hallways are being used for treatments; entire wings are being used for purposes not initially intended. In an interview with KTVB/Boise, the CMO indicated that he does not see any change in the near future due to their high positivity rate. According to Department Director Dave Jeppesen, the declaration can change from day to day, being evaluated and discussed, with each facility determining if they have sufficient resources to provide the usual standard of care to all patients.

Examples under the crisis care standard could be someone struggling to breathe who may no longer get a ventilator, or someone badly hurt in a car wreck or accident who may no longer get a bed in the hospital. Someone near death from illness may receive only “comfort care,” as hospital staff use limited medicine and lifesaving equipment on patients likelier to pull through.

“We have exhausted our resources. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect. 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,” Director Jeppesen said. Yet county fairs were held this past week; large local events are still occurring and masks are rare. Multiple schools are closed due to massive numbers of positive cases or quarantines, and they have only been in session for one week. Governor Brad Little said “more Idahoans need to choose to receive the vaccine so we can minimize the spread and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable.” The National Guard was activated to help with support care, with some active military doctors and nurses coming to Kootenai. Many hospitals across the country have felt they “were close” to these circumstances – but now Northern Idaho is there.