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（SACBEE）L.A. is overwhelmed. How Sacramento hospitals are trying to avoid their own COVID crisis
洛杉矶人满为患。萨克拉门托的医院应该如何避免自己的危机呢
Dr. Rob Azevedo, Kaiser’s chief physician in Sacramento, speaks Monday, Jan. 11, 2021, in front of the Morse Avenue hospital about preparations for a surge in COVID-19 cases and the 'way out' of the pandemic to return to normalcy. BY RENÉE C. BYER
2021年1月11日，周一，凯撒医院在萨克拉门托的首席医生罗布·阿泽维多(Rob Azevedo)在莫尔斯大道医院(Morse Avenue hospital)前就COVID-19病例激增的准备工作和让疫情恢复正常的“出路”发表讲话。
Southern California hospitals are in crisis mode, overwhelmed with COVID-19 cases and, in some cases, rationing care. Are Sacramento County hospitals next?
南加州的医院正处于危机模式，因COVID-19病例而人满为患，在某些情况下，还实行了护理配给制。萨克拉门托县医院是下一个吗?
Intensive care unit space at Sacramento hospitals has dropped to 10%, and officials say they are now girding for a potential “surge upon a surge” stemming from infections likely spread during Christmas and New Year’s gatherings.
萨克拉门托医院的重症监护病房面积已降至10%，官员们表示，他们正在为可能在圣诞节和新年聚会期间传播的感染病毒“激增”做准备。
In the last week, the November/December surge of new hospital cases has plateaued. But, “resources are stressed,” said Edmundo Castañeda, president of Mercy General and Woodland Memorial hospitals for Dignity Health, which has six local hospitals. “We are concerned about what is going to happen in the next week or two.”
在过去一周，11月/ 12月医院新增病例的激增已趋于平稳。但是，“资源紧张，”仁慈总医院(Mercy General)和伍德兰尊严健康纪念医院(Woodland Memorial hospitals for Dignity Health)的主席埃德蒙多·卡斯塔内达(Edmundo Castaneda)说。该医院在当地有六家医院。“我们对未来一两周内将发生的事情感到担忧。”
Here is an overview of issues facing Sacramento hospitals based on interviews with three of the region’s largest entities: Kaiser Permanente, Dignity Health and Sutter Health. UC Davis Medical Center declined to make an official available to answer questions for this article, telling The Sacramento Bee in an email, “our team feels it is prepared to care for increased numbers of patients.”
以下是对萨克拉门托医院面临的问题的概述，这是基于对该地区三个最大医院的访谈:凯撒永久医疗机构、尊严健康和萨特健康。加州大学戴维斯分校医学中心拒绝为本文提供官方回答，在一封电子邮件中告诉《蜂报》:“我们的团队认为他们已经准备好照顾越来越多的病人。”
Hospital leaders say they have not yet hit the crisis level seen in Southern California. And they hope not to. But they are in surge mode, which means they have expanded ICU beds, added and reassigned staff, and stocked up on equipment and drug therapies.
医院领导表示，他们还没有达到南加州的危机水平。他们不希望这样。但他们正处于增兵模式，这意味着他们扩大了重症监护室床位，增加并重新分配了工作人员，储备了设备和药物疗法。
“If the surge is bigger than projected, it could outstrip our resources,” said Dr. Rob Azevedo, Kaiser’s chief physician in Sacramento. “That is when you make difficult choices. That is what we want to avoid.”
“如果激增的人数超过预期，可能会超出我们的资源，”凯撒在萨克拉门托的首席医生罗布·阿泽维多(Rob Azevedo)博士说。这时你就要做出艰难的选择。这是我们想要避免的。”
LACK OF OXYGEN SUPPLIES FOR RESPIRATORY PATIENTS
呼吸系统病人缺氧
In Southern California, hospitals have been running low on oxygen, which is typically provided to most COVID-19 patients from oxygen tanks and ventilators. The state is attempting to send oxygen supplies to the south state.
在南加州，医院的氧气一直不足，通常是通过氧气罐和呼吸机向大多数COVID-19患者提供氧气。该州正试图向南部州输送氧气。
In Sacramento, Kaiser Permanente officials say they already have begun “managing” their oxygen supplies, but not withholding them from patients who need help breathing. Instead, they are taking better care to give patients the correct amount, they say, and not more.
在萨克拉门托，凯撒医疗机构的官员说，他们已经开始“管理”氧气供应，但不会阻止需要帮助呼吸的病人接受氧气供应。相反，他们说，他们正在更好地照顾病人，给他们正确的剂量，而不是更多。
Dignity Health officials say they are not in that position, but are sending oxygen and other COVID-19 resources back and forth among six facilities in the Sacramento region, depending on which ones need more supplies.
尊严卫生官员表示，他们并不处于这种情况，但正在萨克拉门托地区的六个设施之间来回运送氧气和其他COVID-19资源，具体取决于哪些设施需要更多供应。
AMBULANCES BACKED UP OUTSIDE OVERCROWDED ERS
救护车停在拥挤的人群外
In Los Angeles, ambulances are waiting in line for hours at times to be allowed to transfer patients into overcrowded hospitals. There was one report of an ambulance waiting eight hours. In some cases, first responders are told not to bring patients to the hospital if that person has lost vital signs and cannot be resuscitated by EMTs.
在洛杉矶，救护车要排上好几个小时的队才能把病人送到拥挤的医院。有报告说一辆救护车等了8个小时。在某些情况下，急救人员被告知，如果病人失去了生命体征，急救人员无法救活他，就不要把他送到医院。
In Sacramento, ambulance officials report “wall time” is increasing. “Ambulances are tied up (waiting to drop patients off) at hospitals,” said Roberto Padilla, spokesman for the firefighters union. That means ambulances may have to come from longer distances when called to someone’s house or an injury scene.
在萨克拉门托，救护官员报告说“等待时间”正在增加。消防队员联盟的发言人罗伯特·帕迪拉说:“救护车被困在医院里等着病人下车。”这意味着，当救护车被呼叫到某人的家中或受伤现场时，可能不得不从较远的地方赶来。
LACK OF REFRIGERATED SPACE TO STORE THE DECEASED
没有足够的冷藏空间存放死者
Some hospitals in California have run out of refrigerated space to hold the bodies of patients who have died from COVID-19. The governor last week announced that the state has obtained 88 refrigerated corpse storage trailers and has already sent some to Southern California medical centers.
加州的一些医院已经没有足够的冷藏空间来存放COVID-19死亡患者的遗体。州长上周宣布，加州已经获得了88辆冷藏尸体拖车，并已将一些拖车送往南加州医疗中心。
In Sacramento, the county coroner told The Bee its facility already has two extra refrigerated units ready to help hospitals. Dignity Health officials acknowledged they could see themselves calling on the state for one of the refrigerated trailers.
在萨克拉门托，县验尸官告诉蜂报，他们的设施已经有两个额外的冷藏设备准备帮助医院。尊严卫生官员承认，他们可能会要求政府提供一辆冷藏拖车。
“That is something that is on our mind as the surge continues,” said Dignity’s Castañeda, who oversees Mercy General and Woodland Memorial hospitals.
“这是我们一直在考虑的问题，”尊严医院的卡斯塔涅达说，他负责监督仁慈总医院和伍德兰纪念医院。
LACK OF BEDS AND HOSPITAL STAFF
缺乏床位和医务人员
Most Sacramento-area hospitals have expanded their ICU units, moving some patients into the post-operation rooms or turning other areas of the hospital into an ICU.
大多数萨克拉门托地区的医院都扩大了他们的重症监护病房，将一些病人转移到术后病房，或将医院的其他区域变成重症监护病房。
California Hospital Association CEO Carmela Coyle said that COVID-19 patients require a specific type of acute care.
加州医院协会首席执行官卡梅拉·科伊尔(Carmela Coyle)表示，COVID-19患者需要特定类型的急性护理。
“When people show up at the hospital, they need two things — either high-flow oxygenation which requires them to be put in a medical surgical unit with special equipment or ventilator care or ECMO (extracorporeal membrane oxygenation) which requires intensive care unit capacity,” Coyle said, “and so while hospitals are often big places, the kind of care needed by COVID-19 patients is very specific, very acute.”
“当人们出现在医院,他们需要两件事情——无论是高速流氧化需要他们在医疗手术单位有特殊设备或呼吸机护理或医学界(体外膜肺氧合)需要重症监护室能力,”Coyle说,“所以,医院通常是大地方,COVID-19病人的护理需要非常具体,非常严重。”
SENDING PATIENTS HOME EARLY
提前送病人回家
Sutter Health a few weeks ago changed protocols to allow less ill patients to remain at home, with oxygen support, who previously would have been admitted to the hospital. Adventist Health has been taking this approach for some months now, using home monitoring technology. Similarly, some people who in other times might be admitted to the ICU are being treated in other areas of hospitals.
萨特健康公司几周前改变了治疗方案，允许病情较轻的患者留在家里，使用氧气支持，而这些患者以前应该被送进医院。基督复临安息日会健康中心利用家庭监测技术已经采用这种方法几个月了。同样，一些在其他时候可能会被送进重症监护室的人正在医院的其他地方接受治疗。
The biggest problem, as the expected peak surge approaches, is staffing. Hospitals uniformly report staffers are overworked and stressed. Kaiser officials say they are looking to hire nurses and respiratory therapists, but are competing with hospitals nationally for those employees.
随着预计的高峰逼近，最大的问题是人员配备问题。医院一致报告员工工作过度，压力很大。凯撒医院的官员说，他们正在寻找护士和呼吸治疗师，但正在与全国各地的医院竞争这些员工。
Coyle said hospitals need to expand cross-training of nursing staff.
科伊尔说，医院需要扩大护理人员的交叉培训。
“If we don’t have enough nurses for the intensive care unit, as an example, how can we take one of those critical care nurses and partner him or her with other nurses throughout the hospital?” she asked. “They’re all practicing at their level but working as a team, and will allow us to care for more Californians.”
“举个例子，如果重症监护病房没有足够的护士，我们怎么能让其中一位重症监护护士与医院其他护士合作呢?””她问道。“他们都在以自己的水平练习，但都是团队合作，这将使我们能够照顾更多的加州人。”
SOME COUNTIES BLOCK PATIENT TRANSFERS TO SKILLED CARE
一些县不允许将病人转移到专业医疗机构
Hospital leaders say a breakdown in the normal patient flow to skilled-care facilities means they have no room for patients coming to them for treatment for illnesses other than COVID-19.
医院领导表示，进入专业医疗机构的正常病人数量减少，意味着除了COVID-19以外，他们没有地方让病人来医院治疗其他疾病。
“We have challenges discharging patients to other parts of the health care system when they are no longer in need of that acute care,” said California Hospital Association CEO Coyle. “It is creating a bottleneck within our hospital setting.”
加州医院协会首席执行官科伊尔说:“当病人不再需要紧急护理时，我们很难让他们转到医疗系统的其他部门。”“这在我们的医院环境中造成了瓶颈。”
Coyle said many of these policies are holdovers from when medical professionals knew far less about the COVID-19 disease, how to separate patients who have it from those who don’t and how to safely manage the care for both populations.
科伊尔表示，这些政策中的许多都是医疗专业人员对COVID-19疾病、如何区分患有COVID-19的患者和不患有COVID-19的患者以及如何安全管理两种人群的护理的遗留问题。
Months ago, there was concern about whether transfers added to a spread of the disease, Coyle said, but that has been addressed by the state with a much more thoughtful review of patients and increased testing capabilities.
科伊尔说，几个月前，人们担心转移是否会加剧疾病的传播，但该州已经通过对患者进行更仔细的审查和提高检测能力来解决这一问题。
GOOD NEWS: SEASONAL FLU NUMBERS LOW
好消息:季节性流感的数量很低
Hospital officials report that flu season appears to be mild, so far. The COVID-19 pandemic may, in fact, have helped reduce flu infections because many people have been wearing masks, social distancing, washing hands and often avoiding contact with others.
医院官员报告说，到目前为止，流感季节似乎比较温和。事实上，COVID-19大流行可能有助于减少流感感染，因为许多人一直戴着口罩、保持社交距离、洗手并经常避免与他人接触。
“We still have a little to go to see what the flu season is like,” Kaiser doctor Azevedo said. “We are all wearing masks, social distancing. Those are the same measures that reduce the flu.”
凯撒医生阿泽维多说:“我们还需要一点时间来看看流感季节是什么样的。”“我们都戴着口罩，保持社交距离。这些都是减少流感的相同措施。”
BOTTOM LINE: HOSPITALS MAY SEE RELIEF SOON
结论:医院可能很快就会看到好转
Vaccinations are well underway in hospitals throughout the region. When those are done, more hospital workers will be available for shifts, because fewer will be quarantined for exposure to the virus or because they have tested positive.
在整个区域的医院里，疫苗接种工作正在顺利进行。这些工作完成后，将有更多的医务人员轮班工作，因为将有更少的人因接触病毒或检测呈阳性而被隔离。
“It was a very emotional day when I got mine,” Kaiser’s Azevedo said. “I now feel like I have been given an incredible opportunity to stay healthy to keep our community healthy. We see this as the way out of this pandemic.”
Kaiser的Azevedo说:“当我得知这一消息时，是非常激动的一天。”“我现在觉得我得到了一个难以置信的机会来保持健康，以保持我们社区的健康。我们认为这是摆脱这场大流行的途径。”
That alone has cheered up hospital workers as they head into the second year of dealing with the pandemic.
仅这一点就足以让医护人员振奋起来，因为他们已经进入了应对疫情的第二年。
“There is hope. There is light at the end of the tunnel,” said Castañeda of Dignity Health.
“有希望。光明就在隧道的尽头，”Dignity Health组织的卡斯塔涅达说。
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发表于 2021-1-12 14:14:30
发表于 2023-1-7 09:15:56