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Thank you for trusting Alhambra Hospital Medical Center with your medical care. We care deeply about your health, and are committed to keeping you safe while striving to provide the best possible care.

Los Angeles County is experiencing an exponential surge in Covid-19 cases that is severely impacting the availability of key medical resources. As a result, we are extraordinarily vigilant of how we utilize resources like essential equipment, supplies, and staff in order to ensure our hospital's ability to serve our entire community, including those with injuries or illnesses unrelated to COVID-19.

In the event that medical resources reach a severely low level, it may be necessary for the Hospital to implement Crisis Care. We have convened a triage team of multi-disciplinary professionals to review the cases of all critically-ill patients at Alhambra Hospital Medical Center. This team will make the difficult, but necessary decisions about allocating limited resources based on the best medical information available, following the California SARS-CoV-2 Pandemic Crisis Care Guidelines. The guidelines are anchored on nationally recognized best practices, and ethical principles including equity.

What This Means for Patients and Families

• In order to provide the most effective care to every patient when resources are limited, it is very important for a patient to tell family members (or their representative) as well as hospital staff of the following:

- Current medical conditions
- An advance healthcare directive (or a desire to establish one)
- A "Do Not Attempt Resuscitation" (DNR) order
- No desire for blood products or life-saving treatments, such as mechanical ventilation, dialysis, or a surgical procedure that may prolong their life
- A single representative who is to make medical decisions for the patient should the patient be unable to communicate.

• If a patient becomes ill and their doctor believes that the patient needs ICU care or mechanical ventilation (i.e., a breathing machine), their case will be reviewed by our triage team as described above to equitably distribute these limited resources.

• If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources currently limited in availability, such as ICU care or a ventilator, may be given to another patient who is more likely to survive. If a ventilator or ICU care is not offered or is stopped, the patient has the right to ask their doctor for further detail regarding this decision, and will receive everything needed to ensure that they are free of pain or discomfort.

• Importantly, the status of all critically ill patients will be reevaluated regularly by the triage team in order to ensure equitable distribution and best possible use of limited resources. In other words, if an ICU bed or ventilator is not available at first, such resources could become available to the patient at a later date.

Please be assured that crisis care will be implemented only when all other avenues have been exhausted.

This is an extremely challenging time for our entire community. Know that everyone at Alhambra Hospital Medical Center is working tirelessly to provide the best care possible. And please feel free to ask your physician or nurse about any questions you might have.