LOS ANGELES (NewsNation Now) —  The agency that oversees emergency medical services in Los Angeles County has issued new directives for paramedics transporting patients in ambulances as the coronavirus pandemic places increasing pressure on Southern California hospitals’ ICU capacity.

The Los Angeles County Emergency Medical Services Agency issued multiple directives Monday, telling paramedics to stop transporting patients if they have virtually no chance of surviving, including those whose hearts and breathing have stopped and who couldn’t be resuscitated.

One directive told paramedics to not transfer patients in cardiac arrest to the hospital unless spontaneous circulation can be successfully performed in the field. Meaning, if the patient does not respond within 10 minutes of on-scene interventions, paramedics must determine them dead on the scene and not transport them to the hospital. This applies to blunt traumatic and nontraumatic cardiac arrest.

Another directive ordered ambulance crews to conserve oxygen, effective immediately. Ambulance crews will now only administer oxygen to patients whose oxygen saturation levels are below 90%. Supplies have been strained because of the pandemic.

Some older hospitals in Southern California have oxygen systems that can’t handle the demand, and the state is contracting with the Army Corps of Engineers to upgrade the systems. Giant oxygen containers may also be placed in hospital parking lots as back ups.

County health officials have expressed worry over a possible incoming surge from the Christmas and New Year’s holidays. The additional Thanksgiving cases have swamped hospitals, forcing them to treat patients in hallways, ambulances and even gift shops, and forced an oxygen shortage. The California National Guard is contributing freezer trucks to help store bodies as hospitals run out of space.

More than 22,000 were hospitalized across the state, setting another record, according to the COVID Tracking Project. California’s Department of Public Health reported that of those hospitalized, nearly 4,700 were in intensive care units.

Most of the state’s population remains under a broad stay-at-home order as ICU capacity dwindles. In hard-hit Los Angeles County, the total COVID-19 death toll has reached 10,850, and confirmed cases topped 818,000. The county reported more than 7,700 people hospitalized, including 21% in ICUs.

This comes as the state is trying to execute the massive immunization campaign “with a sense of urgency that is required of this moment and the urgency that people demand,” but so far only about 1% of California’s 40 million residents have been vaccinated, Gov. Gavin Newsom said.

The 454,000 doses of vaccine that have been administered in California represent just a third of the more than nearly 1.3 million received in the state so far, according to the California Department of Public Health.

Across the country, the pace of immunizations has gone slower than planned due to logistical hurdles and differing approaches across states and counties. On Monday, the U.S. Centers for Disease Control and Prevention said nearly 4.6 million shots have been dispensed.

While the state wants to make sure no one is jumping ahead in the line, Newsom said he wants to give providers the flexibility to distribute doses to people not on the priority list if doses are at risk of going to waste.

“We are working hard to make sure that 100% of what we get, we get out as quickly as possible,” Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said.

Overall, California has more than 2.45 million confirmed coronavirus cases and almost 27,000 deaths, according to data complied by Johns Hopkins University.