A Reflection on the Initial Experience
Though the future impact from the coronavirus outbreak is still uncertain, many Carson City emergency physicians believe our facility may have been spared the devastation of COVID-19 seen elsewhere. The exact reasons remain unclear. Perhaps luck or maybe a life-saving combination of a low population density, and citizens truly heeding the recommendation to stay home. Either way, we have not been hit by the pandemic like some of our comrades. Initially, local physicians feared the worst as the pandemic spread, knowing our particular patient demographic to be elderly and chronically ill. Thankfully, we have not seen a vast outbreak. Benjamin Franklin said, “By failing to prepare, you are preparing to fail.” At Carson Tahoe Regional Medical Center, we anticipated a surge of critically ill COVID-19 patients and prepared fully to that end, an opportunity of time that colleagues elsewhere were not so fortunate to have.
In the beginning, our initial objective was to “Conserve PPE while maintaining the safety of staff, patients, and visitors.” Out of an abundance of precaution, an Incident Command Team was established, and strategies implemented to decrease PPE use while providing the same level of safety and care.
As the probability of caring for COVID patients at our hospital became almost certain, our focus transitioned to tactics needed to maintain as safe of an environment for our patients, staff, and visitors while caring for COVID positive patients. We controlled access to our hospital, limited visitors, and placed screeners at the two entrances that remained open to the public.
As the situation progressed, we continued to further plan for a surge in COVID patients. We established biocontainment units in our ED, ICU, and Medical Floor, which included negative pressure rooms and additional air scrubbers. Patients who were admitted with COVID symptoms were immediately given a mask and placed in these units.
Keeping staff informed and empowered was another goal we aspired to. We know that when staff is fully aware of the situation, they are more likely to take ownership and provide better care to their patients. To keep the channels of communications open, we implemented the distribution of a daily email update to all staff, developed a “COVID” section on our home intranet page containing all the communications surrounding COVID, and established a COVID email address for staff to send questions or concerns.
As things evolved, we requested a mobile hospital tent from the state and set it up near our ED entrance. Almost immediately, we began utilizing the tent for assessment of low acuity patients with COVID concerning symptoms. A rapid response/code blue plan was created and practiced, which involved safely moving an ill patient from the tent to the ED BCU. This ensured the safety of our other patients seeking emergency care.
A multi-stage surge plan was then created, in which we identified possible areas for expanding bed capacity, “alternative vents,” including anesthesia and BiPAP machines, and additional staffing needs. Our Respiratory Therapy made “COVID BiPAP” bags with all of the necessary equipment and a COVID-specific education packet for staff caring for critical patients. We also started cross-training as many nurses as possible on ventilator management and critical care.
Comparatively speaking, our community has not been affected as much as other areas in the United States. Still, the intense planning and preparation from our administration team and community and state partners have been nothing short of amazing. The lasting memories from this pandemic will surely include the unwavering community support felt by all Carson Tahoe clinicians, particularly those of us on the front lines. Handmade masks were abundant; local restaurants supplied round the clock meals for the emergency department staff, school children painted inspiring and delightful artwork that was hung thoughtfully throughout the emergency department. Baked goods from community members became the norm, as well a new sense of gratitude from emergency department patients, who never balked at the new stringent visitor policies or their ER doc who suddenly maintained a 6 ft distance during the evaluation.
The future is still uncertain; we are cautiously optimistic and taking small steps to resume some of our canceled services. For the time being, rural northern Nevada physicians are poised for a huge sigh of relief.
Kathleen OBrien MD, MPH, RDMS Carson Tahoe Emergency Physicians
James Freed Carson Tahoe Emergency Preparedness Coordinator