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Buffalo quarterback Josh Allen throws over Kansas City's Derrick Nnadi during their game Sunday night in Kansas City, Mo.

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Several Wyoming hospitals have utilized crisis standards of care as staffing shortages and high patient volume strains system
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Four Wyoming hospitals have recently utilized crisis standards of care, and more than half a dozen have sought information on those standards from the state health department, though no hospital was actively in crisis care as of Tuesday afternoon, health department spokesperson Kim Deti said via email.

Twelve hospitals Tuesday reported a critical staffing shortage to the U.S. Department of Health and Human Services. Thirteen anticipate such a shortage within the week. Tens of thousands of traveling nurse positions are vacant nationwide, making it more difficult for hospitals to attract those workers to Wyoming.

More than 220 COVID-19 patients are hospitalized across Wyoming. The state’s virus hospitalizations have hovered at or above 200 patients since early September, creating a sustained burden unlike the last surge. Hospitals including the state’s largest are caring for the highest number of patients, virus-related and otherwise, they’ve seen in years.

State and local officials say this surge — driven almost entirely by the unvaccinated — is pushing hospitals to the brink.

What are crisis standards of care?

Crisis standards of care, or crisis care, is used when hospitals don’t have what they need to serve every patient as well as they normally would. The standards dictate how a hospital uses scarce resources.

In extreme situations, this can mean hospitals having to decide who gets a life-saving treatment and who doesn’t.

WDH crisis standards of care guidelines

The Wyoming Department of Health has guidelines for hospitals that utilize crisis standards, but transitioning to crisis care is up to each hospital’s leadership.

When a facility is under crisis care, they must notify the department of health, which is involved in trying to get the hospital back to a less severe position. On Tuesday, Deti said four facilities had at some point this surge been under crisis care but none were actively in that position Tuesday afternoon.

“It is something that is extremely fluid,” Deti said via email. “Hospital status is highly situational and dependent on several factors such as the ability to transfer or obtain resources quickly within the community.”

The health department’s guidelines outline in detail when a hospital can engage crisis care and how to decide which patients receive certain treatments. Crisis care could be necessary in the case of natural disasters or a mass casualty event like a plane crash, or in the case of a pandemic.

“In an important ethical sense, entering a crisis standard of care mode is not optional — it is a forced choice, based on the emerging situation,” reads the state guidelines.

Those guidelines provide detailed criteria for when a facility would shift into crisis care, but stresses the final decision is up to leaders of individual facilities. The state guidelines also stress that choosing not to shift into crisis care if a situation calls for it “is very likely to result in greater death, injury or illness.”

In severe situations, the guidelines provide a point system for determining what patients get certain care. They also outline the ethics behind these decisions, focusing on “doing the greatest good for the greatest number.”

Officials at Wyoming Medical Center, the largest hospital in the state, said they are not at the point of needing crisis standards. That hospital does, however, have a record patient load, with 196 people admitted as of Tuesday. Sixty-four of those patients are being treated for COVID-19 or virus-related illness, Dr. Mark Dowell said in a video message Tuesday — more than 30% of all admitted patients.

So many beds are occupied that the hospital is keeping would-be patients in the emergency room until space opens up for them, Dowell said, adding that some elective procedures at the hospital may have been halted.

Dowell said this is the highest patient total at Casper’s hospital at least since he arrived in the early 1990s.

Wyoming Medical Center officials have declined to answer questions about the facility’s needs with specific details. When asked how many patients an ICU nurse is treating now versus what is typical, spokesperson Mandy Cepeda demurred.

When asked how many patient transfer requests Wyoming’s largest facility has declined in recent weeks, she demurred again, confirming only that the number of denials is on the rise.

Twice last week the facility reported zero available intensive care unit beds.

Alleviating the staffing strain

In Casper and all other Wyoming hospitals, staffing has been a primary problem.

“We hear overwhelmingly staffing is an issue across all our facilities,” Josh Hannes, vice president of the Wyoming Hospital Association, said. “Not even just clinical staff, which is certainly the biggest part of it. But the housekeeping, environmental services staff, dietary staff, food service staff ... I mean all positions. They’re really struggling to have enough people to do the work they need to do.”

The hospital association is coordinating two different efforts to address the staffing problem, but they each have their own challenges.

First, the association is coordinating the release of $20 million, allocated by Gov. Mark Gordon, to help hospitals and other facilities keep existing staff and recruit people to vacant positions. That money can also be used for vaccine incentive programs for hospital employees.

The other project has $10 million to hire traveling nurses. But having that money does not guarantee Wyoming will get those professionals.

“It’s been more difficult now than when we did the same thing in the November to March time frame,” Hannes said. “One is because people are just leaving the industry.”

During the last surge, Wyoming worked with the traveling nurse contractor Medical Solutions and brought in about 300 temporary workers to Wyoming facilities.

That company today lists more than 50 unfilled temporary positions across the state. In surrounding areas, the need is even greater. Idaho and Montana both have openings for more than 100 hospital positions.

Another firm contracting traveling nurses, Aya, lists more than 59,000 openings nationwide.

“Part of the problem now is just the need versus the number of bodies that exist out there to fill spots. They’re just not out there,” Hannes said.

Those who are out there cost a lot more than they used to. In August, the average traveling ICU nurse coming to Wyoming would make $85 an hour. In September, they were paid $150 per hour.

That difference is being felt across all nursing positions. With so many openings at such competitive rates nationwide, Hannes said it’s unlikely Wyoming will have the same success filling positions as it did in November.

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Lawmakers clear first hurdle toward holding special legislative session
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The Wyoming Legislature completed the first major step toward holding a special session intended to fight back against a recent federal COVID-19 vaccine mandate.

For the Legislature to call itself into a special session, two rounds of votes are needed: One that surpasses 35% of both the House of Representatives and the Senate to decide whether a formal vote should take place. That second vote requires a majority of both chambers.

As of Tuesday, the Legislature had attained the necessary votes for the first round of voting.

Roughly 50% of each chamber voted for the special session. No Democrats voted in favor of it.

Members have until 5 p.m. Thursday to vote in the poll. If a special session is approved by a majority of both chambers — which is 30 representatives and 16 senators right now — the session would “likely start on Oct. 26,” Dockstader and Barlow said in a Tuesday press release from the Legislative Service Office.

It remains undetermined whether or not the session will be held virtually or in person.

The first order of business at a special session will be holding a vote on the rules of the session. To adopt them, lawmakers need two-thirds of the membership of both the House and the Senate.

If the two-thirds supermajority is not achieved, legislative leadership “will ask the respective majority floor leader to move for an immediate adjournment of the special session without considering any legislation,” Barlow and Docskstader said in a Tuesday memo.

Technically, if they were not to achieve the two-thirds, lawmakers could use the rules of the 66th Legislature, but that would allow the special session to go on for several days and allow legislators to introduce topics that do not have to do with federal COVID vaccine mandates.

“No, I don’t want to go on for several days and no, I don’t want to consider multiple topics,” Dockstader said.

The rules as now proposed would limit the special session to COVID-19 vaccine mandates, allow members to appear remotely (which would save on costs) and require any bill eligible for introduction to be posted five days prior to the session.

If the lawmakers do reach the majority threshold in the second vote and the supermajority threshold in the vote on the rules, it remains unclear exactly how they will fight the mandate with legislation.

The Biden Administration issued an executive order in early September that mandates employees at private companies with over 100 workers get vaccinated or be tested weekly for COVID-19. In Wyoming, that order would potentially apply to more than 300 companies, according to the governor’s office.

The federal mandate is not yet in effect, and must still go through the federal rule-making process. In practice, this means that it’s next to impossible to know exactly how to fight back against the vaccine mandate until those details are released, multiple lawmakers have previously told the Star-Tribune.

“I think there’s a legal fix in the courts,” Sen. Cale Case, R-Lander, said at a recent committee meeting. “But I don’t see a way the Legislature can fix this,” he later added.

Final forms of bills must be submitted to the Legislative Service Office by noon on Oct. 21 for posting on the legislative website.

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Sage grouse hunting and species conservation can coexist, studies find
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Sage grouse conservation is a balancing act.

With the birds’ numbers still dwindling, wildlife managers responsible for setting annual grouse hunting guidelines must account for a range of threats, from human-caused habitat loss to the droughts and wildfires made worse by climate change.

Wyoming is home to roughly 37% of the world’s greater sage grouse, the more widespread of the two sage grouse species. The birds thrive in “big, flat, rolling landscapes of sagebrush,” which are abundant across the central part of the state, said Jeff Beck, a professor of wildlife habitat restoration ecology at the University of Wyoming.

For more than a decade, the state has also seen the region’s highest annual sage grouse harvest, with the total estimated take hovering around 10,000 birds per year.

Of Wyoming’s four sage grouse hunt areas, two — those in the southeastern and far western parts of the state — are closed. The northeastern hunt area opened for three days in mid-September. And the biggest hunt area, stretching from Colorado to Montana and encompassing the central and southwestern parts of the state, offered a 13-day grouse season this year. Restrictions for both open areas were the same: a two-bird daily limit and a four-bird possession limit.

According to Beck, it’s a pretty good system.

Beck is the co-author of two recent studies on sage grouse management. The first compiled grouse hunting regulations, dating as far back as 1870, from 11 Western states and two Canadian provinces. The other analyzed the impacts of hunting regulations on grouse population growth, with mixed results.

Hunting isn’t a big sage grouse research topic. Most recent studies have focused on habitat loss, habitat selection, monitoring techniques and disease, Beck said.

“But hunting was kind of going on in the background,” he said. “And maybe even because it was usually done in populations that were larger, not the smallest ones necessarily, people, maybe, were more confident that it wasn’t having a big impact.”

Of the 11 states with sage grouse populations, seven currently hunt the birds, but hunting data from those states hadn’t been consolidated. “We have a history of that information and it wasn’t really put together in one place, and we saw that as a real need,” Beck said.

In general, the researchers found, declining sage grouse numbers have been driven primarily by habitat fragmentation and loss. Because the birds tend to avoid human disturbances, energy development infrastructure like roads and power lines bisects their existing habitat, while wildfires, drought-driven food scarcity and the incursion of invasive plants also push them into smaller areas. Hunting, though still impactful, has had a less marked effect on populations.

While sage grouse hunting regulations and closures have been in use for more than a century, they became more refined as data collection improved. State wildlife agencies have been particularly responsive to the birds’ declining numbers over the last 25 years, including by reducing bag limits, delaying the grouse hunting season and limiting open areas, Beck said.

“At some level of hunting sage grouse, we can influence their growth rates, and that can be really impactful on the population,” he said. The researchers found that states’ proactive strategies have largely prevented excessive population impacts from hunting, though the efficacy depends, in part, on population size.

Smaller sage grouse populations, like those in Wyoming’s two closed hunting areas, are especially vulnerable to environmental disturbance. The studies found that many small populations continued to struggle even after hunting closures — though the restrictions alleviated added mortality from hunting, Beck said.

But according to Beck, among larger and more stable populations, effective management can still allow for modest sage grouse hunting. And so far, he said, Wyoming’s conservation practices seem to be working.

“If we hunt the birds, then we’ve got people that are more interested in them,” he said. “And if there’s a problem, then the state can — that’s the first thing they can do — is restrict hunting season, to limit any chance that there’s going to be additive mortality.”

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Casper police employee involved in fight; DCI investigating
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A fight involving an off-duty Casper Police Department employee in north Casper on Oct. 1 is being investigated by the Wyoming Division of Criminal Investigation, a CPD spokesperson said Tuesday.

According to police, a report of a fight near Seton House on North Durbin Street came in around 1:30 p.m. on Oct. 1. The officer responding reported the off-duty CPD employee appeared to be fighting with a citizen.

CPD spokesperson Rebekah Ladd could not confirm whether the employee is a sworn officer with the department or one of its civilian employees, citing the ongoing DCI investigation.

“The altercation was unrelated to the involved employee’s employment at the Casper Police Department,” Ladd said in a statement to the Star-Tribune.

The employee is on administrative leave at least until the investigation is completed. From there, Ladd said, the department will review any possible internal policy violations before deciding whether to reinstate the employee to their position or not.

Ladd said Casper police made no arrests at the scene. She declined to give any information on the citizen involved in the fight or any injuries they may have sustained.

Gloria Perez, manager of the St. Vincent de Paul Thrift Store near the scene of the fight, said that store employees had heard a commotion outside and locked their doors for fear of their safety.

Perez said when she left the store around 3:30 p.m. that afternoon, there were still around five police cars blocking off the intersection with H Street.

DCI Commander Matt Waldock declined to comment on the investigation Tuesday. The report, once completed, will go to District Attorney Dan Itzen, who will decide whether to bring charges in the case.