Establishment of an Alternate Care Site (ACS) in Imperial County During COVID-19

Abstract

Imperial County is in southern California, one of the state’s two counties at the international United States-Mexico border. The county is one of the most resource-limited in the state, with only two hospitals serving its 180,000 citizens, and no tertiary care centers. A significant portion of the population cared for at the local hospitals commutes from Mexicali, a large city of 1.2 million persons, just south of Imperial County’s ports of entry. Since May 2020, following an outbreak in Mexicali, Imperial County has seen a significant increase in the number of COVID-19 patients, quickly outpacing its local resources. In response to this surge an alternate care site (ACS) was created as part of a collaboration between the California State Emergency Medical Service Authority (EMSA) and the county. In the first month of operations (May 26–June 26, 2020) the ACS received 106 patients with an average length of stay of 3.6 days. The average patient age was 55.5 years old with a range of 19–95 years. Disposition of patients included 25.5% sent to the emergency department for acute care needs, 1.8% who left against medical advice, and 72.7% who were discharged home or to a skilled nursing facility. There were no deaths on site. This study shares early experiences, challenges, and innovations created with the implementation of this ACS. Improving communication with local partners was the single most significant step in overcoming initial barriers.

Crisis Standards of Care and COVID-19: What Did We Learn? How Do We Ensure Equity? What Should We Do?

“…Staffi ng was a pervasive problem for these facilities, and most of the larger facilities were staff ed with federal resources, which is not an option for a majority of jurisdictions in most disasters. Often, successful ACS were in jurisdictions that did not have robust inpatient resources or were geographically isolated Published August 30, 2021 [35]. ACS may also be helpful in specifi c types of events when local health care infrastructure is damaged or insuffi cient, and COVID-19 signifi cantly advanced this planning.…”

Reduction in Hospital Transfers at a US COVID-19 Alternate Care Site: Maintaining Surge Capacity Support in Imperial County, California

“…This is especially important for small community hospitals in remote areas such as those in Imperial County, where each of the hospitals are licensed for less than 200 beds and there are no tertiary care centers in the county. 3 Kadri et al found that hospitals experiencing surges were associated with higher mortality rates. 8 COVID-19 pneumonia is characterized by a variable clinical course with few reliable predictors of subsequent deterioration.…”

“…2 The team initially established an acute care ACS in the gymnasium of Imperial Valley College in Imperial County, California, in June 2020 during the first surge of COVID-19 cases. 3 Imperial County is a resource-limited area in southern California, bordering Mexico, with a population of approximately 180,000 people. Over 25% of persons live below the poverty line in Imperial County, 4 and the county leads the state of California in rates of asthma-related hospitalizations, diabetes-related deaths, and tuberculosis.…”

“…Adults with moderate to severe COVID-19 disease (Table 1) requiring supplemental oxygen by non-high flow nasal cannula and who were unable to be discharged home were considered for admission. 3,6,7 Clinical care was provided in line with published standards of clinical practice for the care of COVID-19 patients, including the use of remdesivir and dexamethasone. 7 ACS-IVC2 received its first patient on November 19, 2020.…”

Oxygen and Ventilator Logistics During California’s COVID-19 Surge: When Oxygen Becomes a Scarce Resource

“…). 13 In the event of power failure, E-cylinders were placed at the foot of each bed and daisy-chained oxygen ports from H-tanks with mass casualty manifolds were strategically located to quickly connect patients. Circuit breakers required active monitoring due to overheating, and clinicians were advised to position patients according to electricity load required by oxygen flow rates.…”