Bozeman Health Deaconess Hospital

Bozeman Health Deaconess Hospital is pictured on Thursday, August 12, 2021.

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Bozeman Health Deaconess Hospital’s critical care unit is at 100% capacity and the health system is planning to implement portions of its surge plan, including using unlicensed beds, hiring emergency staff and redistributing health care workers.

The health system is not yet implementing a crisis of care standard — which rations care for some patients — but is preparing for the possibility if COVID-19 volumes don’t decline, COVID-19 Incident Command Lead for Bozeman Health Kallie Kujawa said Wednesday during a press conference.

As of Wednesday, Deaconess Hospital had 16 COVID-19 patients, six of which were in the critical care unit. Big Sky Medical Center had two COVID patients.

The critical care unit was at 100% capacity, the medical unit at 95% and the surgical unit at 114% capacity, Kujawa said.

Only portions of the surge plan will be immediately implemented, Kujawa said, but that that could change if the situation deteriorates.

The surge plan includes preparing to use unlicensed beds in the post-anesthesia care unit, in procedural areas like radiology and in the emergency department, halting non-essential services and opening the opportunity for the hospital to request help from the Montana National Guard.

“We are preparing (unlicensed beds) to be used in the coming hours as we anticipate we will see continued increases in patients with inability to transfer patients to other hospitals,” she said.

The hospital has hired about 40 emergency staff members to fill positions left by quarantined and isolating staff, Kujawa said. Part of the surge plan could include bringing in quarantined staff, regardless of whether they’ve tested positive for the coronavirus.

The hospital is still caring for those with heart attacks, strokes, traumas and other medical needs, Kujawa said, saying it wanted to prevent disrupting non-essential services as much as possible.

This is the first time in the pandemic that the hospital has implemented portions of its surge plan, she said.

“We’ve known it was a potential all along, but this is the first time we’ve prepared a surge unit and experienced this amount of diversion in neighboring hospitals,” she said.

Many of the states’ larger hospitals being on divert is having a “domino effect” on Bozeman Health, she said, as the hospital is no longer able to transfer or accept patients from other hospitals.

“Hospitals across the state are full, and it’s an incredibly difficult position to be in right now,” Kujawa said. “We have been coordinating with other hospitals to assess whether patients can be transferred or taken into other areas and we are meeting major challenges with a majority of other hospitals being on divert.”

Nine out of 10 of Montana’s largest hospitals were at 90% bed capacity, according to a weekly report from the Department of Public Health and Human Services, although bed capacity fluctuates hourly and the snapshot does not represent a current status of hospital capacity in the state.

In Missoula, St. Patrick’s Hospital said Tuesday that COVID-19 patients were being triaged in the ambulance bay amid a record-breaking number of county hospitalizations there.

Billings Clinic announced Wednesday it was preparing for crisis standards of care, saying it may be needed as early as this week.

Crisis standards of care — typically implemented during a disaster or an emergency — means the health system can no longer deliver normal standards of care to all patients. That means patients may find that hospital beds aren’t available, or are in repurposed areas and that some equipment is not available.

Billings Clinic said it also meant making hard decisions about when resuscitation efforts are appropriate.

Kujawa said Bozeman Health was not in crisis standards of care at this point. The state provides framework for crisis of care and the decision would require approval from Bozeman Health executives, physician leaders and the incident command, she said.

“If we were into a surge mode we would absolutely be looking at when we would need to be using those crisis standards of care,” she said.

A majority of people who have been hospitalized are unvaccinated, Kujawa said. In Gallatin County, nine out of ten hospitalized with COVID-19 in the summer were not vaccinated.

“We are pleading with every person to get vaccinated,” Kujawa said. Roughly 59% of those eligible — everyone 12 years and older — in Gallatin County had been fully vaccinated, according to DPHHS.

Gallatin City-County Public Health Officer Lori Christenson said Wednesday the hospital news was concerning coupled with the county’s high community transmission.

“We stand alongside all medical professionals working tirelessly to urge our community to plan to get a vaccine and to wear a mask,” she said.

Last week the county health department announced it could no longer keep up with the volume of case investigations needed and would be prioritizing certain cases.

This comes as the county, Montana and the U.S. has seen an exponential increase in COVID-19 cases.

In Gallatin County, cases rose 182% from August to September. The county had more than 600 active cases as of Wednesday and transmission rates were five times higher than they were this time last year.

Statewide, Montana is seeing case counts that mirror the winter surge in cases, consistently adding more than 1,000 cases a day in recent weeks, according to information provided by DPHHS. From mid-August to mid-September, COVID-19 cases rose more than 200%.

As of Wednesday, Montana had 8,670 active cases, 364 hospitalizations and 1,858 people had died due to COVID-19.

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Juliana Sukut can be reached at 582-2630 or jsukut@dailychronicle.com

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