COVID Crisis Surge Planning

This is an open letter to our community to comply with a California State Public Health Officer Order dated January 5, 2021 requiring hospitals to implement COVID surge plans.  For 120 years, our community has trusted Community Memorial Health System (CMHS) with its care.  We thank you for your continued trust and support as we face the pandemic together.  Our doctors, nurses, and other staff care deeply about your family’s health.  We are committed to being here when you need us.

Surging COVID-19 patient volumes have stretched healthcare resources in California and elsewhere.  State public health officials have ordered all hospitals to implement surge plans to potentially receive even more COVID patients, including those who may be transferred from outside the area.  We have been asked to describe how we will alter conventional ways of providing care with contingency methods, and how we would provide crisis levels of care should resources become severely stretched.  Some elements of our care move fluidly from conventional care to contingency care on an as-needed basis.  For example, to decompress census in the new Ocean Tower, we may reopen floors in the Mountain Tower.  CMHS has prepared, and will implement, its plan in response to a growing number of patients.

Here’s What We Want You to Know:

  • Our physicians and nurses are experienced in providing optimal care for patients with COVID in the outpatient and inpatient settings.  However, the number of COVID patients continues to rise, with further increases expected to stretch our resources beyond conventional levels.   If this happens, we will need to alter how and where we provide care, always with patient safety and optimal outcomes in mind.
  • To respond to a projected surge of COVID hospitalizations, we will augment staffing, facility and equipment resources to safely care for an increasing number of patients.  How will we do it?
    • Staffing
      • Staffing is our most vital resource.  We will expand our nursing staff by adding nurse techs, medical assistants, lift teams and a personnel pool to help wherever needed. 
      • Adequate Personal Protective Equipment has been secured for our staff, and the majority of our caregivers have received the COVID vaccine.
    • Facilities
      • Intensive care may be provided in not only our 28-bed ICU, but also in an adjacent 15-bed unit called the Progressive Care Unit.  It is equipped and ready to go. 
      • Parts of the Mountain Tower have been renovated and may be reopened for lower-acuity patients to increase the number of available beds. 
    • Equipment
      • Additional ventilators and high-flow oxygen delivery systems have been acquired in case we need them.
    • Operational Decisions
      • Most elective surgical procedures have been suspended so staffing resources can be preserved for surge care (this is an example of contingency care).
      • If patient volume overwhelms staffing, equipment or facility resources, we, and all the other hospitals in the area, will implement crisis levels of care.

What Does Crisis Care Mean?

If CMHS implements its Crisis Care Plan, it means we are facing shortages in staff, medical supplies (such as ventilators/breathing machines), or physical capacity that affect our ability to care for all patients.  Developed in collaboration with clinical and medical leadership, our Crisis Care Plan:

  • Guides the allocation of limited resources based on the best medical information possible, as well as national and statewide standards.
  • Empowers an unbiased team of physicians and Bioethicists (with expertise in ethical issues related to healthcare) to evaluate patient cases and implement the “Ethical Allocation of Scarce Healthcare Resources in the COVID-19 Pandemic” policy and process.
  • Allows for, and outlines, the use of alternative staffing models and ratios to accommodate critical patient volume and compensate for staff shortages.  Alternative staffing models may include the CMHS Team Nursing Plan. 
  • Allows for, and outlines, the use of alternative spaces throughout our acute care facilities for the boarding and treatment of critical patients, COVID-19 patients, and patients with needs unrelated to COVID-19.
  • Limits surgical services to urgent/emergent cases only, evaluated on a case by case basis.

How Crisis Care Impacts Our Patients

  1. Patients may not have option to receive the levels of conventional care during this public health crisis, but it is still important for patients to talks to their family/representative and notify hospital staff if they:
    1. Have any current medical conditions;
    2. Have an advance healthcare directive or would like to complete one;
    3. Have a Do Not Resuscitate (DNR) order;
    4. Do not want blood products or other live-saving treatments, such as mechanical ventilation, dialysis, or surgeries to prolong their life.
  2. If a patient becomes ill and the doctor believes the patient needs extra care in an ICU or needs mechanical ventilation (breathing machine), their case will be reviewed, along with other patient cases, to determine how these resources should be shared throughout the hospital.
  3. If a patient becomes extremely ill and is unlikely to survive, even with life-saving treatment, our limited medical resources may be allocated to other patients who are more likely to survive.  If a ventilator or ICU care is not offered or is stopped, the patient has the right to ask their doctor for further detail or request an appeal concerning this decision. We will continue to provide everything they need to ensure they are comfortable and free of pain or discomfort.

This is an extremely difficult time for our entire community.  Community Memorial Health System’s physicians, nurses, staff and leadership appreciate your understanding as we work tirelessly to deliver the best possible care amidst these unprecedented circumstances. 

Should you have any questions or concerns, please call 805-948-5350

Approved by Gary Wilde, President/CEO, Community Memorial Health System