Crisis standards of care now in place across all of Idaho. What does that mean?

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Less than two weeks after crisis standards of care were activated in two North Idaho health districts, the Idaho Department of Health and Welfare announced Thursday that they have been activated statewide.

The rationing comes as COVID-19 cases and hospitalizations have continued to rise, filling hospital beds and creating the situation that health officials have been warning about for weeks and desperately hoping to avoid.

“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Health and Welfare Director Dave Jeppesen said in a news release.

Crisis standards involve rationing health care resources when hospitals become overwhelmed. Patients may be prioritized differently, with treatment given first to those considered most likely to survive.

Here’s what you need to know about crisis standards of care.

How did we get here?

The expansion Thursday came after St. Luke’s Health System, Idaho’s largest hospital system, requested the standards be activated.

A combination of Idaho’s low vaccination rate and a highly contagious delta variant of COVID-19 brought cases raging again, more acutely and in a younger population.

Patients infected by the delta variant are filling emergency rooms and ICU beds. If Idaho continues on its current path, the state could see 30,000 COVID-19 cases a week by mid-October, according to the Department of Health and Welfare.

With schools opening, many with mask-optional policies, health officials have also warned about the potential for rampant spread within the classroom. Now, children under 12 are ineligible to get vaccinated against the virus. Even though kids are more rarely hospitalized with the virus, they could spread it to friends and family who are more vulnerable and not vaccinated.

There has been an uptick in some age groups — those 12 to 17, 35 to 44, and 65 to 74 — getting a COVID-19 vaccine. But only about 56% of Idaho’s eligible population had received at least one dose in Idaho as of Thursday, Health and Welfare reports, far lower than the national average of 70%.

What is ‘crisis standard of care?’

A committee of medical administrators, doctors and legal and public health professionals, as part of the state’s Disaster Medical Advisory Committee, wrote a plan in June 2020 for what to do when there is a limited supply of health care resources. The framework is intended to be used when “a disaster event overwhelms usual health and medical capabilities and capacities, resulting in an inability of the health care system to provide the standard levels of care to patients,” according to the document.

Idaho’s crisis standards of care plan is 48 pages long, with an additional 41-page guide and a 42-page set of checklists. You can download the documents by visiting the Idaho Department of Health and Welfare’s Emergency Preparedness page.

The goal is to “save as many lives as possible,” Health and Welfare said.

The state also created guidelines for nursing homes, should they need crisis standards of care.

Crisis standards won’t just apply to people with COVID-19. They will apply to patients who need medical care for any reason, such as car crashes, heart attacks, strokes and influenza.

Will hospitals turn patients away?

Regardless of diagnosis, patients would likely face significantly longer wait times for care. They could also have to be moved to another hospital, potentially out of state.

Hospital beds might not be open and people could end up being put in rooms not traditionally used for care, such as repurposed conference rooms.

“Someone who is otherwise healthy and would recover more rapidly may get treated or have access to a ventilator before someone who is not likely to recover,” Health and Welfare said in Thursday’s news release.

Hospital officials say they will provide as much care as they can and provide treatments to keep patients comfortable, even if they’re denied a resource.

Activating the Crisis Standards of Care Plan may not mean shutting down a certain kind of treatment or service. Depending on the situation, the standards may apply to just one health care resource — such as oxygen or ventilators — once hospitals begin to run short.

Hospitals will implement crisis standards of care only as needed.

Rural hospitals especially would suffer, the department said.

“Rural hospitals would likely need to care for higher-complexity patients than they are used to during crisis standards of care and would likely struggle to even transfer traumas, strokes, or heart attacks,” Health and Welfare said.

Small hospitals may not be able to accept transfers from outside hospitals, according to Health and Welfare.

Who will be first, who will be last in line?

According to the plan, priority would go in order of:

  1. Children up through 17 years old.

  2. Pregnant women with a viable pregnancy, at more than 28 weeks of gestation.

  3. Adults by age, from younger to older: age 18-40, age 41-60, age 61-75 and 76 and older.

  4. Patients who “perform tasks that are vital to the public health response of the crisis at hand, including, but not limited to, those whose work directly supports the provision of acute care to others.”

  5. A lottery, or “random allocation,” if there is still a tie after going through the first four priority criteria.

The crisis standards of care may give Idaho hospitals a defense in lawsuits against them over patient care during the pandemic, Jeppesen told the Statesman in 2020.

They could point to the crisis standards of care activation and say, “we essentially were operating under unique circumstances that required us to depart from the usual standard of care, given the level of resources that were in the community,” Jeppesen said.

How long will crisis standards of care remain in effect?

The standards will remain in effect until there are “sufficient resources to provide the usual standard of care to all patients,” the department said.

Health care officials continue to urge people to get vaccinated and to wear a mask indoors to reduce the strain on health care systems.

“The best way to end crisis standards of care is for more people to get vaccinated,” Jeppesen said. “It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19.”

Will people who didn’t follow COVID-19 guidelines be denied?

No. They will be prioritized the same way as people who faithfully followed the guidelines.

It is against the law and against medical ethics for Idaho’s health care system to triage patients based on things like politics, where they live or whether they obeyed mask mandates.

Has this happened in Idaho before?

The standards were activated for the first time less than two weeks ago in two North Idaho districts, the Panhandle Health District and the Idaho North Central District.

Hospitals were close to implementing the standards last fall, but COVID-19 cases dipped just in time to avoid them.

The use of crisis standards is extremely rare in the U.S. In July 2020, Arizona became the first state to activate crisis standards. Several cities in Texas came close but were able to avoid that decision.

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