Gallup Indian Medical Center adopts crisis standards

The Gallup Indian Medical Center implemented its Crisis Standards of Care in late December due to a spike in COVID-19 cases. That was two weeks before the first case of omicron had even surfaced on Navajo Nation. 

Within the Gallup Service Unit health care facilities, the Tohatchi Health Center reported it is also receiving an influx of patients infected with coronavirus. Since there is a strain on resources, the Crisis Standards of Care are meant to prioritize patients in the most precarity.

“There’s certain guidelines and how to do it,” said Dr. Kevin Gaines, acting chief medical officer at GIMC. “It is individualized to the facility based on the facility’s resources and the abilities that they have to change operations to best meet the needs of the patients that they serve.” 

Gallup leadership and staff got together to develop a plan around the standards and started using it Dec. 23, Gaines confirmed.

Trying to find beds for patients

This Crisis Standards of Care means medical staff prioritize the sickest patients first. This could cause non-emergency patient care to be delayed, and some appointments for routine health services may be canceled. Wait times for appointments might also grow longer. 

GIMC has 99 beds, and six of those are ICU beds, according to its website. But Gaines said the staff is struggling to find available beds for patients in other hospitals.

Hospitals serving the Navajo Nation adjust as beds keep filling up

“There are extended periods of time, sometimes a day or more, to find a bed for a patient that needs a bed that we can’t provide,” Gaines said. “And that’s part of the reason that Gallup declared Crisis Standards of Care.” 

It could take as many as 40 to 50 calls to various hospitals to ask if there are any available beds, he said, and these hospitals could be in different parts of the country such as Kansas, Texas, California. This adds hardships for families and takes time away from providers as they search for a bed for their patients.

“We always try to find the closest bed possible but right now those beds are very, very limited,” said Gaines. “And so unfortunately, we’re having to send our patients at times farther away from home to get the care that they need.”

Staffing shortages and more PPE

GIMC has also been experiencing nurse shortages like the rest of the country. But Gaines said they have had a bit more success recently in acquiring additional nursing staff through contracting, as well as hiring some more permanent nurses. 

As the more contagious omicron virus starts coming into the facility, GIMC has improved its PPE game, Gaines said.

“The big thing that we’ve been able to do so far is step up our level of PPE required due to the higher infectious nature of the omicron variant,” he said. “So our staff are now utilizing more N-95 respirators and face shields.”

GIMC continues to provide between 15 and 18 patients a day with antibody monoclonal treatments. But Gaines said some scheduled patients don’t always show up for this infusion, so they’re not actually infusing that many people most days.

The onslaught of omicron

Omicron has quickly become the dominant variant in the county. Near the Navajo Nation, the first case in Utah was confirmed on Dec. 3, in Arizona on Dec. 8 and in New Mexico on Dec. 13. 

Navajo Nation had been keeping vigilant and worked to prevent this virus from reaching Navajo for as long as possible. But, on Jan. 3, it was reported that the first case of omicron was found in the Utah Navajo Health Care Service Unit. 

The Navajo Department of Health reported that as of Wednesday, Jan. 5, delta was still the dominant variant with 1,107 identified cases so far. 

“We did our very best,” said Navajo Nation President Jonathan Nez. “We did extremely well pushing this variant off the Navajo Nation. But it’s all around us. It’s everywhere. It’s contagious.”

The number of COVID-19 cases grew from double digits to triple in recent days. As of Sunday, Jan. 9, there were a reported 242 new COVID-19 cases for the Navajo Nation and no deaths. 

The Navajo Nation continues its mask mandates, which have been in place since April 2020, and will continue to make vaccines and boosters available at Navajo health care systems. 

“We encourage people to get tested,” Nez said. “If you’re sick, don’t go to work. If you’re sick, don’t go to school. Let’s protect our Navajo citizens.”