An alarming letter has emerged instructing some emergency workers in the US to not treat dying patients as the coronavirus scourge continues to wreak havoc across the world.
In the disturbing letter posted to Twitter, the Los Angeles County Emergency Medical Services (EMS) directs ambulance crews to not transport patients who have little chance of surviving, particularly those suffering from cardiac arrest.
“Effective immediately due to the severe impact of the Covid-19 on EMS and 911 Receiving Hospitals, adult patients (18 years of age or older) in blunt traumatic and non-traumatic out-of-hospital cardiac arrest shall not be transported if return of spontaneous circulation is not achieved on field,” the blunt letter states.
It also adds patients in traumatic full arrest who meet the current criteria for the determination of death shall not be resuscitated and be “determined dead on scene and not transported”.
A registered nurse who shared the letter on Twitter said mortuaries had been filling up and were refusing new bodies.
“A directive from the EMS ... announced that if EMS are unable to revive an adult in cardiac arrest, they are to be pronounced dead on scene, not transported to ER,” she said.
In another letter, ambulance crews are also advised to only administer oxygen to some patients.
“Given the acute need to conserve oxygen, effective immediately, EMS should only administer supplemental oxygen to patients with oxygen saturation below 90 per cent,” the letter says.
Chief operating officer of Cedars-Sinai Medical Centre, Dr Jeffrey Smith, told CNN the order from the EMS was specific to those suffering cardiac arrest who could not be resuscitated on the scene.
“Those patients have a very low rate of survival [even] if they are transported to the hospital. So at this time, it is deemed to likely be futile,” he said.
LA records infection every six seconds
Los Angeles mayor Eric Garcetti revealed a grim statistic highlighting the devastation coronavirus is wreaking on the area as the US nears to a tally of 350,000 Covid-19 deaths.
In LA alone, there have been more than 820,000 cases and more than 10,000 deaths, while John Hopkins University data shows more than 20 million across the US have been infected.
Mr Garcetti told CBS News program Face the Nation on Sunday that a person was contracting the coronavirus in LA every six seconds as it becomes a major hotspot.
“One [reason] is just simple density,” he said.
“We’re the densest metro area in the US.
“But we’re also seeing the household spread now. One person is coming home, an essential worker, there might be five, seven, 10 people in that household.
“This is a worrying trend that the fatalities now are not just people with pre-existing conditions.
“Ninety-two per cent of previous deaths were people who had an underlying condition. That is rapidly falling.”
Mr Garcetti added there was a shortage of medical personnel while he believed the virus was spreading and mutating.
“This is a virus that preys off of our weakness, preys off our exhaustion. Ninety-five per cent of people can be doing the right thing. It’s still dangerous. If 80 per cent are doing the right thing, it is disastrous,” he said.
Bodies pile up at funeral homes
As communities across the US feel the pain of a surge in coronavirus cases, funeral homes in the hotspot of Southern California say they must turn away grieving families as they run out of space for the bodies piling up.
The head of the state funeral directors association says mortuaries are being inundated.
"I've been in the funeral industry for 40 years and never in my life did I think that this could happen, that I'd have to tell a family, ‘No, we can't take your family member’,”owner of Continental Funeral Home in Los Angeles, Magda Maldonado, said.
Continental is averaging about 30 body removals a day - six times its normal rate.
Mortuary owners are calling one another to see whether anyone can handle overflow, and the answer is always the same: They're full, too.
In order to keep up with the flood of bodies, Ms Maldonado has rented extra 15-metre refrigerators for two of the four facilities she runs in LA and surrounding counties.
Continental has also been delaying pickups at hospitals for a day or two while they deal with residential clients.
Bob Achermann, executive director of the California Funeral Directors Association, said that the whole process of burying and cremating bodies has slowed down, including embalming bodies and obtaining death certificates.
During normal times, cremation might happen within a day or two; now it takes at least a week or longer.
Mr Achermann said that in the southern part of the state, "every funeral home I talk to says: ‘We're paddling as fast as we can’."
"The volume is just incredible and they fear that they won't be able to keep up," he said.
"And the worst of the surge could still be ahead of us."
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