Doctors Explain Utah’s Plan If Hospitals Get Overwhelmed

SALT LAKE CITY, Utah – Hospitalizations for COVID-19 patients heading into flu season was front and center during the Gov. Gary Herbert’s weekly press conference, prompting state epidemiologist Dr. Angela Dunn to wonder aloud whether the state may “eventually move to crisis standards of care.”

“Utah Crisis Standards for Care Guidelines” is the state’s plan for how to continue to treat patients in the event hospitals are overwhelmed and there aren’t enough resources to treat all of the sick. Or, taken from the document itself, the purpose is “to guide the allocation of scarce patient care resources during an overwhelming public health emergency when the demand for services dramatically exceeds the supply of the resources needed.”

The state reported a new record for single-day COVID-19 cases today, with 1,501 positive tests. 5 new deaths were reported, and current hospitalizations continue to climb. 73% of the state's ICU beds are now occupied. https://t.co/vebQy4rWwO #COVID19 pic.twitter.com/6H6Tn84Onq

— KSL 5 TV (@KSL5TV) October 8, 2020

“It was an acknowledgment that disasters happen and at times existing health care becomes overwhelmed,” said Dr. Mark Shah, an emergency physician with expertise in disaster medicine.

The document has been in place for a decade in case of a natural disaster or other public health emergencies. In August, it was replaced with revised guidelines that take into account what health officials have learned from the current COVID-19 pandemic.

Shah, who is also a consultant with the Utah Hospital Association, chaired the committee that was behind drafting the guidelines.

“By thinking about the worst-case scenario, if you will, of not having enough care, it allows us to more deeply consider how to avoid that situation in the first place by optimizing the resources that we do have to really try to take care of all the patients that need care in the first place,” Shah said.

The prioritized health care outlined in the plan aims to meet the goal of “the greatest good for the greatest number.”

“Meaning that resources are increasingly targeted to those most likely to benefit based on short term outcome. Which means short-term likelihood of recovering from the acute illness,” Shah said.

Utah is not to that point. But it remains a concern. So we spoke to the man who chaired the committee that wrote up the state’s “Crisis Standards of Care Guidelines.” That’s our story on #ksltv at 10.

— Matt Rascon (@MattRasconNews) October 9, 2020

The document states the guidelines do not discriminate based on things like race, disability or gender. But under crisis standards of care, the decision to treat someone “should be based on an individualized assessment of the patient based on the best available objective medical evidence.”

ICU/ventilator care, for example, would be focused on those more likely to benefit from it. While patients who have certain underlying conditions would receive “non-ICU care, including comfort care.”

“It’s important for people to not think of crisis standards of care as some sort of death panel, where we’re just sitting around thinking of who we can avoid treating,” Shah said. “It’s really the opposite. It’s really trying to figure out ways where we can treat everybody.”

In these uncertain times, Shah said health officials and hospitals are collaborating more than ever to be prepared. But he said the burden also falls on everyone to do all they can to avoid getting COVID-19 and overwhelming hospitals.

“It is a wake-up call for us all to be doing what we can to slow the spread of coronavirus,” Shah said. “And if we all do our part then I am very optimistic that we will not enter a situation in which we need to make these difficult decisions.”