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Prakash Chandran: This Healthy Conversations COVID-19 Podcast was recorded on July 31st, 2020. There may be uncertainty with dialing emergency services when there is fear of COVID-19 in the medical centers themselves. Although the pandemic continues through the season, it's important to know that emergency services are practicing safe and quality care for all patients. We're going to talk about it today with Director of Emergency Services, Float Pool, and House Supervision Bridgette Bateman, I'm Prakash Chandran. So Bridgette, it's great to have you here. My first question is really around how has the emergency department changed since COVID began?

Bridgette Bateman: Oh, the emergency department has changed quite a bit since this pandemic first came around. To start with, we have set up different screening areas when people access into the facility, we've limited the amount of access points. So that way we're able to monitor more who's actually coming into the facility. As those screening locations, we are actually doing a series of things to make sure that we're protecting both the staff and the patients that are coming through the doors. We are asking again, the questions in regards to any type of symptoms that you might have that would be either COVID related or, or close to those types of symptoms. We are also taking temperatures and this is for both staff and for, as well as our pre EMS and our paramedics and police officers, anybody coming into the facility as being screened through those specific areas. And then once they are actually, if they do happen to screen positive after that series of questions and the temperature, we're actually putting them in a separate location.

So, trying to kind of segregate the areas in which we have patients who are under investigation or PUI or positive COVID type patients, we're separating them even within the facility and within the emergency department, even in how we care for those patients. Along with having the designated areas for those, it's also limiting visitors coming in. That's probably been one of the most challenging for many of the staff, as well as for the patients coming in and their loved ones. The fact that they are unable to be with their loved ones during the time that they are either positive COVID patients or PUIs is a very difficult thing. How, as a provider, as you know, as nursing and anybody who works in the medical field, we're here because we care about the patients. And how do you maintain that when you're wearing your PPE or your personal protective equipment and gown and gloves and mask and goggles, and how do you maintain that personal touch with your patients and personal caring when you're in all of that? And how do they deal with not being with their loved ones?

Host: Yeah, you're dealing with a couple of things there. One, is not only trying to maintain that human connection through the PPE, but also dealing with the fact that you just can't have as many visitors anymore. So beyond those things, how else has COVID changed your daily work life?

Bridgette Bateman: I think the daily work life has changed in regards to just being heightened to, as emergency nurses specifically, we're always worried about infection and viruses and how things can be transmitted from person to person. So we've heightened that a little bit, but when you start thinking about that actually going home and how as providers do we protect those, those family members that are at home as well as our patients within the facilities and make sure that we're not transmitting from person to person. So again, we're wearing all of the personal protective equipment, and then once we, actually, many of us are we're changing into hospital scrubs when we're here in the facility. And then we're changing into our personal clothing before leaving, taking showers. Before we go home, you're not wearing your shoes into your car, you're not wearing your shoes home.

All of that kind of comes into play because on top of the fact that you're worried about what's out in the environment, you're worried that you're not taking something home to your family and to your loved ones, because then we know that from there it's transmitted to somebody else. So I think it's just heightened and everybody is on edge with everything we do. I will say that from the perspective of being a healthcare provider, I feel safer at work than I do, honestly, going into a grocery store. At least when I'm here, I know that the cleaning is occurring. I know that I am in personal protective equipment. I know hand-washing is happening. I know everybody's wearing their mask and we are doing everything we can to keep things from spreading. I can't say that when I go out in public. So when I'm here at work, I feel safe. It's when you go out in public just as everybody else's and what does that look like? And how do we keep that from our families?

Host: Yeah, I mean, I think that really says something about the processes that you all have put in place, because you know, you are effectively a first responder seeing this constantly. So if you have methods in which you are doing things in the safest way possible, and you feel more comfortable at the hospital, I think the rest of the public should feel comfortable going into the emergency department. So, you know, that kind of brings me to the question. I mean, I think we all know the answer, given what you've just said, but is it safe to go to the emergency department if you feel like you need to in today's world?

Bridgette Bateman: It's absolutely safe. Again, I think initially when this very first started, there was definitely a fear of coming to the emergency department and it has still continued. Initially we were seeing less than 50% of the amount of patients that we normally would. And then what we began to see is that the patients that were coming in were sicker, meaning they're staying home and they're not coming in when they should be coming in because of the fear of possibly catching COVID. Again, as I had said, we've really done a good job of segregating, how we have patients in here and in minimizing that transmission and using the correct PPE with those patients when they do come in, it is a safe place to come. And if anybody does have any type of emergency that they need to come in for, they definitely should feel safe coming in. The other aspect of this is one of the things that we have here on the central coast kind of started recently is our tele-ED, which is something we believe is new to the actually one of the newest things that we've been able to do. And I think we're one of the first in which you can actually call in and speak to a board certified emergency physician.

There is a nurse that actually takes those phone calls. And oftentimes that's probably one of the most rewarding is when you receive a phone call from somebody who says, I don't know if I should come in. I don't know if this is something serious enough that I need to come in, because there's also that thought process by patients that Hey, they're dealing with very sick patients. Maybe I'm not sick enough to go in, not even just the fear of the COVID, but are we taking away from somebody else who is sick? So to be able to talk to a nurse and say, you know what you are spot on, this is something you need to come to the emergency department for, or this is something we think we can handle through a telehealth visit, and we can put the emergency physician on with you. And they're able to talk through the process and say, okay, this is something we can handle and not have you come into the emergency department. So it's been hugely beneficial. And I can't tell you how rewarding it is as a nurse to hear a patient on the other end. Go, thank you. I wasn't sure. And now I feel confident coming in. So it's a good thing. There's a lot of good things that have come out of this.

Host: Yeah, that's amazing. You know, I haven't actually heard of this before and this tele-ED, which I'm assuming that stands for the virtual emergency department. You know, this concept is actually really good, even outside of COVID pandemic times, you know, just having the assurance to talk to someone to say, Hey, you know, is this, should I come in for what I'm experiencing? And as you correctly said, maybe some good will come out of this in terms of process, in terms of the way you interact with patients. So moving on, I wanted to ask you about the different types of patients that you're seeing in the emergency department. Can you talk a little bit about that?

Bridgette Bateman: It will be sides are COVID positive or our respiratory patients that we're seeing. One thing that I will say is that our trauma patients are still very much active, meaning we are the only trauma center for this San Luis Obispo County. And as part of we are still having the same amount of traumas they have changed. However, initially we would normally have quite a bit of trauma coming from the dunes at this time. But with those being closed down, we're not seeing quite as many of those, but what we are seeing is an increase of our mental health patients, meaning our patients who are at risk of depression and an increase in suicidal tendencies from patients. Mental health during this time period is very important and is something that I would ask anybody who is having issues with, to seek help immediately and to not wait. That would be probably one of the biggest messages or the types of patients we're seeing that we normally do see, but it's definitely at a higher rate now than it ever has been.

Host: Yeah, absolutely. I'm glad you touched on that. Are there any resources that you can give to people that might feel isolated or uncertain during this time?

Bridgette Bateman: I think at this point again, if you are having any thoughts of suicidal ideation or depression, I would recommend that you call the National Hotline, which would be the +1 800-273-8255, and not to wait to reach out and know that everybody is experiencing some hardship right now. And that sooner than later is always a better call.

Host: You know with all that we've discussed here, as we close, they're still going to be individuals who have some apprehension about coming into the emergency department, even if they need to. So what might you like to communicate to those that are experiencing that fear or apprehension around it?

Bridgette Bateman: I think one of the biggest things is if you feel sick, you have a couple of different avenues now to go through. The first one is, is, as I said, you can access us through the telehealth number, which is on our landing page, as well as if you just happen to Google emergency department, you'll come up with that number. And that will get you in connection with a live person to be able to say, yay or nay, we agree, or this is something we might be able to handle through a virtual visit. The other aspect is don't wait too long. The last thing we want is for somebody to sit home and think that either we're completely impacted here. We are very fortunate here in San Luis Obispo County that we are not experiencing the numbers that the rest of the country is at this time. So please feel comfortable and know that we've put precautions into place to be able to take care of you and your loved ones. And we are more than happy to take care of you.

Host: Well, thank you so much for your time today. I certainly feel reassured with all of the information that you shared. That's director of emergency services, float pool, and house supervision Bridgette Bateman. Thanks for checking out this episode of Healthy Conversations. If you found this podcast helpful, please make sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, thanks and we'll see you next time.

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