County begins preparing community center, ice arena for patients as part of hospital surge plan
STEAMBOAT SPRINGS — At least two locations have been identified to house patients in the event UCHealth Yampa Valley Medical Center in Steamboat Springs reaches capacity due to the COVID-19 pandemic.
Those sites — the Steamboat Springs Community Center and Howelsen Ice Arena — would not house critically ill patients or intensive care unit beds, according to Routt County Emergency Operations Director David “Mo” DeMorat. And they would not house patients requiring a ventilator.
The hospital has its own plan within the UCHealth system to transport patients to locations that can provide additional ICU beds if needed.
The ice rink and community center would be used to house Tier 3 or Tier 4 patients, DeMorat said. Tier 3 patients require some level of medical care and monitoring, like oxygen or IV support. Tier 4 patients need very minimal — or no — medical care, but need a place to recover and don’t have adequate self-isolation options, so as not to put others at risk.
While the hope is for the community to flatten the curve enough to not need the additional facilities, the goal is to make them available as soon as the hospital communicates the need.
“The hospital will contact us when their capacity is being approached,” DeMorat said. “At that point they identify what level of care their patients need, and we make sure the facility is ready.”
The ice has already been removed at the rink, and DeMorat said they will begin furnishing both locations this week.
The idea is to “decompress” the hospital capacity by taking their Tier 3 and 4 patients and allowing them to focus on the Tier 1 and Tier 2 patients who require more critical medical care, DeMorat said.
“It’s a matter of planning ahead, so we are not caught by surprise,” said Steamboat Springs City Manager Gary Suiter. “Hopefully we don’t need to use any of these, and everything is handled by YVMC, but we need to be prepared.”
A third option on the table is the Tennis Center at Steamboat Springs.
On Monday, DeMorat said the ice rink moved to the top of the list because there are several things logistically easier about the rink over the tennis center — like backup power and climate control. Other factors that went into the decision-making process were things like having a commercial kitchen on site, laundry and housecleaning.
The goal is to use the two facilities simultaneously to keep positive COVID-19 patients separate from those without the virus, DeMorat said. However, because it is impossible to predict the numbers for either potential group, they also have plans in place to isolate COVID-19 patients within the facilities.
“We believe both could house both negative and positive,” DeMorat said, of the two locations, though that is not ideal and would only be required in an emergency.
The Steamboat Springs City Council will vote Tuesday to approve the emergency ordinances detailing the lease agreement between the city and the county.
Under those agreements, the city continues to bear responsibility for maintenance and utilities, while everything in terms of operating the locations as overflow medical facilities falls on the county. Under the terms, the county will reimburse the city to their “best effort,” depending on federal and state reimbursements.
The county also would be responsible for cleaning and sanitizing the facilities before returning them to the city.
While it is a lease, there is no rent payment involved.
DeMorat said they’ve already ordered 25 hospital beds and will be making another order soon. They are also working to borrow or buy additional supplies, like linens, blankets, pillows and IV stands.
The county has some medical equipment in its mass casualty trailer, he said.
DeMorat acknowledged the surge plan requires additional personal protective equipment, for which the county is working to determine a specific quantity and inquiring about getting at least some of that from the national strategic stockpile.
For current PPE needs, DeMorat describes the supply as yellow — sufficient for now — but at a “cautionary” level. DeMorat said the county is always working to order more supplies and receive deliveries from the state.
The county is also working on agreements with other locations — including the STARS Ranch and several local hotels — to potentially house Tier 4 patients, DeMorat said. Hotels also have offered rooms for health care workers and frontline responders so they can limit their exposure by not being at home.
At the Tennis Center, Loretta Conway said they have always known the city may need the courts in the event of an emergency. Conway and her husband run the center under a concessionaire agreement with the city, which owns the property.
“We are here to do our part; we just hope it’s not needed,” she said.
Like nearly all other small businesses, Conway said it’s financially hard for the center to be closed.
“As soon as we closed our doors, all revenue stopped,” Conway said.
They had to lay off 25 people but are working to apply for a loan program that would allow them to rehire their employees.
One of their biggest expenses is the center’s utility bill, which runs as high as $5,000 or $6,000 in the winter.
Conway said the three nonprofits that are part of the tennis center have played a huge part in stepping up to help.
Modeling from various academic sources led the Routt County Board of Health to estimate the county will reach its highest number of infected patients around April 19.
No new COVID-19 cases were reported Sunday or Monday in Routt County. The positive COVID-19 count remains at 29, with 22 listed as recovered and 343 people tested. There have been 150 deaths due to COVID-19 across the state, but none at this time in Routt County. Hospital officials confirmed last week there have been COVID-19 patients admitted at YVMC.
State updates crisis standards of care
On Sunday, Colorado Governor Jared Polis’ Expert Emergency Epidemic Response Committee voted to update the crisis standards of care guidelines, which are “recommendations for how the medical community should allocate scarce resources, such as ventilators and intensive care unit beds, in the extreme case when patient needs exceed available resources.”
Dr. Eric France, chief medical officer at the Colorado Department of Public Health and Environment, described how it works during a press conference on Monday.
There are four tiers of decision-making. First, a patient is given a score based on the severity of their illness, their chance of survival and any chronic medical conditions that may be life limiting in the near future.
If there is a tie between two patients, the medical team moves to Tier 2, which takes into consideration pediatric patients and health care workers and frontline responders. If there is another tie, the team moves to tier 3, which takes into consideration things like pregnancy and how many years left a patient has to live (i.e. 27 years old versus 72 years old).
A tie at Tier 4 results in random allocation.
“This conversation is not easy,” France acknowledged. “But it is important that it happens now and not in the midst of the pandemic.”
Before immediately heading to the hospital, people who are exhibiting symptoms of COVID-19 have several resources, including:
- The Colorado Department of Public Health and Environment is providing a phone line to answer questions from the public about COVID-19. Call CO-Help at 303-389-1687 or 877-462-2911 or email email@example.com for answers in English and Spanish, Mandarin and more.
- UCHealth Yampa Valley Medical Center offers Ask-A-Nurse, a 24/7 call line staffed by registered nurses who can assess symptoms and provide advice on seeking care. In Routt County, Ask-A-Nurse can be reached by calling 970-871-7878.
- Virtual Visits can be done from the comfort of your home and only require a computer or tablet with a working webcam, speakers and microphone, or a smartphone.
- If patients are experiencing severe symptoms or having difficulty breathing, they should visit the hospital’s emergency department.
Take precautions in everyday life:
- Frequently and thoroughly wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer with at least 60% alcohol.
- Cover coughs and sneezes with a tissue, then throw the tissue in the trash, or use your inner elbow or sleeve.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Stay home if you’re sick and keep your children home if they are sick.
- Clean surfaces in your home and personal items such as cell phones, using regular household products.
- Be calm but be prepared.
- Employees at businesses and customers are required to wear a mask, according to a statewide public health order.
- Limit distance between non-household members to 6 feet when indoors and outdoors.
- The maximum group size for indoor activities is 10.
To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.
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STEAMBOAT SPRINGS — Routt County will write its own version of a COVID-19 dial governing local restrictions when the state dial is expected to end Friday.