Health care workers during a shift at St. Luke’s Boise Medical Center on Aug. 30, 2021. (Photo courtesy of St. Luke’s Health System)

BOISE - The week after North Idaho hospitals reached a breaking point and were forced to enter “crisis standards of care,” Idaho has activated the care-rationing protocol for the entire state.

Treasure Valley and Magic Valley hospitals are overburdened to a point where they must now begin to triage patients. East Idaho hospitals are similarly buckling under the strain from COVID-19 patients.

Idaho’s largest hospitals take patients from small community hospitals. They also have traditionally taken in patients from other states.

Idaho Health and Welfare Director Dave Jeppesen said in a telephone town hall, just before 1 p.m. Wednesday, he believed a request for crisis standards was “imminent” from Treasure Valley and Magic Valley hospitals.

Such a request would require documentation that hospitals are using every possible resource — even their “contingency” resources — and still cannot manage all the patients coming through their doors.

“We will wait to see if and when a hospital makes that request,” Jeppesen said during the town hall.

That day, Idaho’s crisis standards of care committee convened, reviewed all the information and recommended to Jeppesen that he activate crisis standards.

This will have a ripple effect, because smaller hospitals may be unable to transfer critically ill or injured patients to larger medical centers in Idaho.

There is no step beyond crisis standards of care — just degrees of crisis. Hospitals may have to ration or delay certain types of medical care; or if the crisis worsens, they may have to triage patients according to their likelihood of survival.

The official declaration that Idaho is at “crisis standards” helps to protect doctors, nurses and hospitals from liability when they can’t respond as well to patients or have to make tough decisions about which patient is most likely to survive.

It allows them to follow guidelines to determine how to most effectively use scarce resources.

A state committee last year developed an in-depth plan for health care providers to follow.

“As a public health emergency moves along the continuum of care (i.e., from conventional, to contingency, to crisis), normal operating conditions will give way to extreme operating conditions,” the plan says, explaining how Idaho would arrive at crisis standards. “Health care resources, including space, staff, and supplies, will become increasingly scarce.”

The state has provided guides and checklists to help hospitals, doctors and nurses — who want to give all patients the best care possible — most effectively use the resources they have, to help as many people as they can.

Idaho officials have urged Idahoans to get vaccinated for the past nine months.

It is rare for a vaccinated person to need hospital care if they get infected with the coronavirus, and even more rare for them to end up in the ICU.

But even vaccinated people may now be at risk of not getting life-saving medical care. If hospitals have just one ICU bed, and two critically ill patients arrive, the person deemed more likely to survive will get that bed. (The other patient would likely still receive some medical care, or at least medication to keep them comfortable, until an ICU bed opens for them.)

Jeppesen and other public health officials have urged all Idahoans to be careful, avoid risky activities and take medications as prescribed.

During an AARP Idaho town hall meeting with Gov. Brad Little and Jeppesen, a resident asked about crisis standards of care and how hospitals will determine who receives care, especially those from outlying rural areas. 

“If you have a medical emergency, do what you would normally do,” Idaho Health and Welfare Director Dave Jeppesen told the caller. “If it was something you would normally go into the emergency room for, you should do that. Some of those wait times and even locations where you may be seen will be different, but the hospitals haven’t locked their doors. If you have a true need for medical care, seek medical care.”

Jeppesen added anyone who needs a COVID test and is not in immediate need of medical care should not go to the emergency room for a test. A list of testing sites can be found on the Idaho Department of Health and Welfare website.

Another individual asked whether vaccination status could be a factor when hospitals using crisis standards are determining who receives care. Jeppesen said just like if someone is in a car crash and not wearing a seatbelt, they wouldn’t receive a different standard of care than someone who was wearing a seatbelt.

“The hospital will make a holistic decision for each person and then act accordingly,” Jeppesen said. “… While we strongly encourage people to get vaccinated, it is not a determining factor in how care is given.”

This story is republished with permission from Idaho Capital Sun, part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Contact Editor Christine Lords for questions: [email protected]