Emergency Response Plan for Coronavirus COVID-19 at SVMH

Robert Ferris, DM discusses SVMH's emergency response plan for COVID-19.
Emergency Response Plan for Coronavirus COVID-19 at SVMH
Robert Ferris, DM, MS, CHEP
Robert Ferris, DM, MS, CHEP is certified by the International Board of Safety Engineers as a Certified Healthcare Emergency Professional (CHEP). He is a Doctor of Management in Homeland Security. His dissertation was related to all hazard mass casualty standards of care related to overwhelming surge events. Specifically, Crisis Standards of Care implementation strategies. His work is published by ProQuest and recorded in the Libray of Congress.

Scott Webb: Though you might think that hospitals have been playing catch up with COVID-19, many have had emergency response plans in place to deal with an outbreak like this for some time, including Salinas Valley Memorial Hospital. Let's talk with Dr. Robert Ferris, the Emergency Preparedness Manager at SVMH about developing and executing the plan and what patients can expect. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So Rob, thanks for being on. I know that preparation is key when dealing with events like COVID-19, so take us through the emergency response planning at SVMH. What kinds of exercises have been done with hospital staffs security, other agencies?

Dr. Ferris: The first part of that, you know, is the preparedness for SVMH or Salinas Valley Memorial Healthcare System. So you know, I've been here for about a year and a half and when I got here I was really pleasantly surprised as to how well prepared they were with a warehouse full of PPE, and a risk assessment that identified pandemic, you know, and those types of things and tents and negative air pressure and things like that. 

Host: How have you been doing it with the folks that work there, hospital staff, security, other agencies? How have you been kind of putting people through their paces in preparation for this or in dealing with this?

Dr. Ferris: Well we have a couple of things that happen on a day to day in a hospital preparedness program where we have, you know, an emergency management committee that, you know, basically reviews our, as a vulnerability assessments based on our risk and projected impacts. And then we take that and translate that into training and education for our staff that comes through annual and new hire onboarding education on a hospital preparedness initiatives. And it really is an all hazards program. So pandemic is just one slice of that pie. I mean we live in earthquake country, so we have a lot of different things, wildfires, public safety, power shut off and all kinds of things. So our preparedness training and education with security, environmental services, it's really a team sport and it has been all along engineering administration, nursing leadership.

Long before COVID, our organization was all in on preparedness from multiple hazards and threats that could happen internally and externally. I mean we could have broken pipes or power outages or circuit breakers that go bad, having an operating room go dark, for example, versus having a pandemic, whatever it is that we identify is a potential vulnerability to our normal service to Liberty. You know, we practice that, security is engaged, and I'll give you a really good case in point. We're in an agricultural community that feeds 70% of the country's produce needs, you know? And so what does that translate into emergency preparedness is, you know, I have pesticides, fertilizers, and other things in bulk quantities and I have to train the hazardous materials team to decontaminate potentially contaminated patients.

Working with security and how we control perimeter access and patient access so that we don't become cross-contaminated is something that's really a part of our daily culture. So we just expanded on that concept for COVID where we have security and security checkpoints and perimeter, and access controls, and a flow to manage patients that are coming in for screening and testing so that our staff and our security and our contractors are safe as they can be. And we give the patients a safe environment, in a fairly less intimidating situation. It's got to be terrifying for a patient to come to a hospital this past few months and you know, but we also have to protect our hospitals. So it's kind of a balancing act of how can we improve the patient experience and the quality of care that they get, with also protecting our staff and our interest.

I'm just really impressed by how our staff, our security and other key stakeholders, like our environmental services folks have really stood up and just been adaptable. And now that we have mask on, it's really hard to see the smiles. But these folks smile all day long. We're really blessed to have this team of people because they it much more welcoming given the circumstances. And we know that we are delivering the highest quality care that you can get. And it's a total team effort and it goes back to that previous actual planning and preparedness that we do. I'm just really blessed, I guess to be part of it and to be conducting this orchestra of these musicians that are just playing the perfect tune.

Host: Great explanation and really well said. And I love the analogy that you're the conductor and they are the orchestra and great that you could identify there the key players and everything that's being done, it really is a, we're mixing our metaphors here, but it really is a team sport and you guys are on your game. So when folks come to the hospital and they see these tents to deal with potential COVID-19 patients, what's that all about? How did that come to be? How quickly were able to put that in place? And then lastly, why don't we want people going into the emergency department? I mean, I think that's obvious, but maybe you can take us through that

Dr. Ferris: First to clarify. We do want people to come into the emergency department, but we want the right patient populations come into the emergency department and we want the potential COVID patients go into the tents. We separate that out and people are still going to have, you know, heart attacks, chest pain, diabetic emergencies, and all the normal life happenings in healthcare. And we got to be really cognizant of that because we don't want somebody to be afraid to come to the emergency department and really prolong a needed checkup on their cardiac condition or some other underlying health problems. So the way that the tent set up works, and it's worked really well for us here is have a couple of different things that are a catalyst to support that where we have the community hotline and our nursing approach to this has been really well dialed in, where early on we established a hotline where concerned citizens could call and basically do kind of a telephone triage kind of thing.

And okay. Yeah. You answered yes to some of our screening questions. We'd like you to come in the evaluated and then when they get here, either whether it's through the phone or they just drive up, there's a screening tent for a quick look Tent is what we call it. And that, you know, everybody including ambulance patients, everybody gets screened through there before they come in to the hospital or go to the ER. If you sprained your ankle playing soccer, you're going to go in to the ER, as long as you and said some of our other screening questions, cause we were not going to get tunnel vision on your sprained ankle, we're going to make sure that you're not in a house that's got a confirmed potential COVID patient and things like that. So we really screen all that out and then we'll determine, okay, we're going to bring this patient into the ER versus we're going to send this patient over to the tents because they have upper respiratory signs and symptoms or they have been exposed to unknown COVID patient or whatever it is that triggered something on our screening.

We're going to send you for further evaluation. So we have the quick look tent and then we have this COVID further screening evaluation kind of tent. So we can separate it out and kind of keep that separated. And then if somebody's obviously really sick, then we have a plan in our emergency department with some isolation areas that are for those more acute patients. So typically our low acuity patients who will go to the COVID screening tents, if it's a high acuity, we have some rooms inside the hospital that are built out for them and then they have other areas in the hospital that are for the non COVID kind of related things. And then there's some things that may require some diagnostics and we have all that worked out. For instance, our, you know, screening tents and basic low acuity tents have diagnostic imaging, chest X-ray, some lab capabilities and some basic pharmacy components in there.

So we can basically have a one stop shop outside in that area. And then discharge, you know, almost all of those patients will go home from those tents with instructions and public health follow-up. And you know, all those kinds of things. So, and then a very small percentage would go into the hospital for further care. And then we have the immediate ability to bring in high acuity patient that needs more immediate advance intervention. We have that all factored into our planning, but it all starts with that quick look area and then triage nurses are very well trained and very well versed and they can point all those things in the appropriate direction based on the plans that the emergency department has put in place early on for this. So it's working very well. Then we have drive-thru testing capabilities, so we may not even need to bring you into the tent or bring you into the hospital. We can just have you pull your car over to a curbside spot and our team will come out and test you right in your car, give you some paperwork, you know a number and you'll head home straight from there, and they'll actually never even have to get out of their vehicle. So there's lots of different layers to it and it's all synchronized very well. It's working very well for us.

Host: It sure does sound like it and pretty amazing. I mean, everything you're doing in the parking lot from, you know, you're doing drive-up testing and the quick tent, you identify patients who maybe would go on, you know, to the next tent or maybe go directly into the emergency department, if they're not having any symptoms, if they pass the screening and you're doing all this in the parking lot, it's really amazing. I wanted to ask you though. I have heard about these pressurized tents, you know, what does that mean exactly? And you know how many patients can be in there, like take us through that. What's the difference between a regular tent and a pressurized tent?

Dr. Ferris: These tents that you refer to as pressurized, it's negative pressure. So they're actually depressurized rather than as if you think about negative pressure versus positive pressure. So what we do with these tents, and there's three of them connected together there, 19 feet by 35 feet and they have an eight foot connecting vestibule. So you can go from one tent to the next tent, to the next step. Each tent has its own self contained climate control system and negative pressure unit built into it. So it's kind of a self contained biocontainment system. Right now we have chairs set up in there and you go through basically like a normal ER visit where you know you have a waiting room and then you see the doctor. 

Host: I know we've covered so much today and this is also fascinating, Doctor. Anything else we can share with the community?

Dr. Ferris: Whether you have COVID or you know you have a sprained ankle or your banged your finger with a hammer, you know, hanging up a new family picture, you can come to the hospital. We have a plan and we can take care of anybody and everybody, whether it's COVID or chest pain, you know, we really want people to come to the hospital for their healthcare needs. We have you covered and it's safe to do so.

Host: Definitely. I love the way you said that. Anybody and everybody, and then when you're sick, where's the best place to go? The hospital. But when you go to that hospital in this case, you know, Salinas Valley Memorial Hospital, you want to know that there's a plan in place and it's being executed. Thank you so much for your expertise and insight today. Really awesome having you on. Thank you. For more information, visit svmh.com/coronavirus. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.