Rural Idaho hospitals are beginning to face potentially devastating decisions as COVID patients fill up hospital beds in the north and central parts of the state.

The current COVID surge is hitting rural hospitals in Idaho just as hard as in Coeur d’Alene or Boise, just at a different scale. If a region confirms about 100 new cases, that could translate to a handful of hospitalizations. The difference in rural hospitals is that 10 more patients might be more than half of a hospital’s staffed bed capacity.

Last week, St. Mary’s Health in Cottonwood went into crisis standards of care when providers realized they needed to decide who got a ventilator and who did not.

The hospital has a multidisciplinary ethics committee that works with the triage team to determine who gets prioritized for care under the state’s crisis standards, which emphasize saving the most lives.

Luckily, the crisis was averted due to the facility’s proximity to its sister hospital in Orofino, Clearwater Valley Health, and staff brought equipment from Orofino to the Cottonwood hospital an hour south.

“That’s a scary place to be for these little communities,” said Kim Johnson, communications director at St. Mary’s Health. “And in our small communities, chances are you will know these people.”

With larger hospitals like Kootenai Health full of COVID patients and largely unable to accept transfers, rural hospitals are caring for COVID patients on their own and struggling to transfer patients who need critical care.

St. Mary’s and Clearwater Valley are not in crisis standards of care anymore, but that status can change with the arrival of just a patient or two.

St. Mary’s Health is located in Idaho County, the least vaccinated county in the state, with a vaccination rate that is about equal to the percent of people who get tested and receive a positive result in the region: 30%.

Both hospitals have COVID wards, and, at one point recently, Clearwater Valley had nine COVID patients, which is more than a third of its licensed beds.

Between the two hospitals, there are five BiPap units, used to administer high-flow oxygen, and four ventilators.

Equipment, much like staff, is not an unlimited resource, particularly in smaller hospitals.

Both St. Mary’s and Clearwater Valley will receive support for their weary staff from the National Guard, or in some cases, allow staff to shift back from COVID care to their primary jobs.

This is the case at Shoshone Medical Center in Kellogg, where CEO Paul Lewis requested National Guard support this week to help his staff with things like screening people for COVID symptoms at the doors or collecting COVID testing materials.

Currently, nurses or nursing assistants might be doing these jobs, when they could be on the floor caring for patients.

“If we can get support for those (positions), we can free those medical professionals up to do patient care,” Lewis said.

Shoshone Medical Center is not in crisis standards of care , but its COVID unit was full earlier this week.

In Moscow, Gritman Medical Center is facing scenarios similar to larger hospitals.

People are waiting just to get into beds in the emergency rooms, COVID patients are continuing to seek care and transferring patients is becoming even more challenging.

Providers have had to transfer local patients as far as Reno, Nevada, or Sacramento, California, said Peter Mundt, spokesman at Gritman.

People who need to be transferred are not necessarily COVID patients.

Patients who need critical or intensive care for a stroke or a heart attack, which is usually beyond the scope of practice for rural hospitals, are normally transferred to larger hospitals in Spokane, Coeur d’Alene or Boise.

But with Kootenai Health at crisis standards of care and Spokane hospitals using transfer wait lists, the wait times are lengthening as rural Idaho hospitals are making calls farther and farther out of state.

“That could be life or death for someone,” Johnson said. “And that’s the message we’ve been trying to preach to everybody: It’s not just COVID; if you have a stroke or heart attack, we might not be able to take care of you.”

Rural providers stressed that their emergency rooms remain open for medical emergencies, but leaders are pleading with their communities to get vaccinated to help stop the delta surge.

Some rural hospitals are preparing for things to get worse before they get better.

Projections at St. Mary’s Health show COVID cases are not projected to peak until October, Johnson said.

“In a smaller system we rely on every single staff member, particularly when demands are significant,” Mundt said. “We’re trying to manage it as best we can, so we are able to continue to provide care to all people, especially in emergency situations.”