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With intensive care units full and projections showing big increases in hospitalizations through New Year’s Day, Southern California’s medical system is faced with the prospect of not being able to provide critical medical care to everyone who needs it, which would significantly increase the chances of patients dying as they wait for help.

Already, hospitals are juggling resources to keep up, placing the overflow of ICU patients in other parts of hospitals not designed for them, clearing out critical care wards of patients who can survive elsewhere and in some cases keeping patients on ambulances for as long as eight hours until space is available.

But much more wrenching choices could be ahead as the COVID-19 surge shows no signs of slowing down, and there is little hope for the arrival of an army of additional medical professionals who can greatly expand intensive care unit availability through the end of the year.

Many hospitals are preparing for the possibility of rationing care in the coming weeks as the number of patients exceeds their staffs’ abilities to care for them. A document obtained by The Times outlining how to allocate resources in a crisis situation was recently circulated among doctors at the four hospitals run by Los Angeles County.

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