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Scott Webb: With things changing on an almost daily basis regarding COVID- 19 at Salinas Valley Memorial Hospital and the region. It's a great time to catch up with Carla Spencer, Registered Nurse and Director of Emergency Services at SVMH. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Thanks again for being on today, Carla. We spoke last in March. So how are things going? I want to talk about the advances and things and we're going to get the testing later, but just generally speaking, what's new at SVMH regarding COVID-19?

Carla Spencer: Even though we talked in March, there's so many new things, but I have to say that at the hospital, you know, we're doing really, really good. Our, you know, processes are up and running and you know, back in March we were kind of brand new at this and really learning so much. But right now you know, our processes are up and running. We have good process through the emergency department and then the testing, you know, the testing. As you know, at the beginning there were very strict guidelines around testing. And now with the availability of testing, it's so much better and we're able to test, you know, more freely without having so much restriction on the testing. So I would say high level, it's, you know, good process where we had the luxury of time to be able to sharpen our process here in the hospital, make sure we're doing things in a safe manner and that people feel comfortable and you know, and then also having more resources at our fingertips, you know, testing the support from the Monterey County Health Department. So I would say high level, that's really what's been going on.

Host: That's really great to hear that everybody's still working together. So Carla, tell us now about the AG worker education program and how the hospital is assisting with it.

Carla Spencer: Yes, this is really great. And it's just a, you know one example of how this community really banded together to try and fight COVID-19, you know, as you know, in the Salinas Valley, Ag is a big part of our Valley. You know, we have lots of people here that work endless hours in the fields to take all of our produce and grow our produce that goes out to the entire country. And so with that comes a lot of people. And then more vulnerability for COVID-19 right. You have a lot of people in a smaller area and so early on the hospital had a task force that went out and is since been working with all the Ag companies. So our medical surgical director, Agnes Lolita is leading that charge. And some of her nurses have gone out to several Ag companies and they have taken the time out in the field all day to educate Ag workers on, you know, proper social distancing masking, you know, just the down and dirty of COVID-19 right.

And a lot of these people just don't know. So what it's done is it's able to bring that education out to the field and they feel supported. The Ag companies feel supported and you know, at the end of the day, the medical community, you know, we're the experts at this. And so it's one of our duties to get out there. Not only taking care of the patients that come to the hospital and educating, but to get out into our community. So it's really nice to see, and we've provided educations for hundreds, if not thousands of field workers on, you know, what to look for, what are the symptoms masking, washing their hands, you know, just all of those things that really make a difference in the spread.

Host: That is amazing. And I know that Ag is so huge in Salinas Valley and so as you say, of course the hospital is where it is. The hospital can't move and people can come to the hospital if they need to. But bringing education out into the fields is really amazing and a Testament to the work that SVMH is doing and everybody else in the area. That's so cool. So let's talk again about the importance of not delaying care. We've been over this before, but this trend hasn't changed. People are afraid to go to the hospital because of COVID-19 and they're staying at home when they're having heart attacks and strokes and other emergent conditions. Tell them again Carla in your own words as a registered nurse, why we need them to go to the hospital.

Carla Spencer: It's something that really concerns all of us, especially in the emergency department is that when this whole thing started, we had some messaging about staying home if you didn't need medical care. But what we weren't saying was that to stay home if you do need medical care, right. And what we've seen, and this is not just in our emergency department but emergency departments, you know, emergency departments in our County emergency departments around the country is that some emergency departments are seeing a 50% decrease in volume. And that's a lot. And so I can tell you presently what we're seeing is that when patients come in, they have been sitting on symptoms for, you know, five days a week and then by the time they get to the emergency department, they're very critical in nature. And so we've had many more code blues.

And so what we would say is that we have very sophisticated processes in the ER to separate, you know, coded related patients from the rest of the ER population. And what I would say is that it is so important that if you're having chest pain or you're, you know, you have a chronic medical condition that's getting worse and you're having trouble breathing and things like that, that you don't delay coming to the hospital because what's happening is we're seeing patients at a lot less volume but much sicker than we've ever seen. And so it's really important that people know that if they feel that they need medical care, that you're safe to come to the hospital. We have very sophisticated processes. All of our staff has been trained. They know what to do, they know how to recognize things, they know how to separate the patient populations as well as our providers. And so don't delay. You have to come, you have to get that medical care because sometimes it's too late. If you wait.

Host: That is so well said. And as we know, Carla, time is brain time is heart, right? And every minute that someone who is experiencing a stroke or a heart condition, right, every minute that is wasted is delayed by not calling 911, not going to the hospital can be the different strokes can be reversed. The effects of strokes can be undone if you get to the hospital in time and it's so key and so well said Carla. We've got a lot to unpack here when it comes to testing, right? There's so much going on and so much has changed and I wanted to have you take us through that but specifically too, talk about the new Abbott testing machines. How do they work? And let's unpack all this for people.

Carla Spencer: Perfect. Yeah, so you know, the Abbott machine was a true game changer for us here at the hospital. And so you know, just to kind of go over the different types of testing. So the Abbot ID Now machine is what we call a rapid test. And this is a test, a point of care test that utilizes the same method that we send when we send the swabs to the Monarch County Health Department. This machine, however, gives you a turnaround time of 15 minutes. And so you can just imagine when, you know, at the beginning of this whole thing, we had the Monterey County health department and we were sending tests there and although they're probably one of the best labs in the State, you know, in terms of turnaround time where we get results within 18 to 24 hours. You know, when we have patients that come into the hospital and we have to admit them and we would send a test to the County, we would have to place that patient on our COVID unit as what we call a rule out patient.

Right? Cause we don't know, we don't have a test result back, so we don't know whether they're positive or negative. So we would have that patient upstairs in our COVID unit and the staff, we would have to utilize a personal protective equipment, you know, for that 24 hours until the test came back. So with the rapid tests, now the patients come into the emergency department and we can do that test and have a result in 15 minutes. So I'll tell you the benefits of it. Number one is exposure, right? Because when patients come into the ER, the worry right off the bat is that, you know, we don't know what's going on with those patients. You know, we're going into this blind. Sometimes we don't have a lot of information. Let's say the patient was critical on the scene and the ambulance is bringing them in.

So not only for the hospital workers in the emergency, but for our first responders that when those patients are brought in and we're able to take that test and get a result within 15 minutes, you know, we all know as providers care providers off the bat, okay, this patient's negative. So we know you can kind of breathe a sigh of relief. We can care for the patient, can conserve our PPE. So the same thing is that we have this test result back in 15 minutes. If the patient's negative, then the patient doesn't have to go to that COVID unit and we don't have to utilize that PPE and thus saving it. And so it was a true game changer for us. So at this point, you know, like I said, when we talked back in March, we had one, you know, one ability to test and that was that we were sending all of our swabs to the Monterey County Health Department. So we're still doing that because it is such a great asset for us. So we have that mechanism. So all of our outpatient testing, we're still going through the Monterey County Health Department and they're doing a fabulous job. And then all of our inpatients.

So we're utilizing the Abbot ID Now, the rapid test for all of the patients that are being admitted. And then all patients that come into the emergency department that are critical care patients maybe that, you know, we're doing CPR on or you know, and anybody that we're having to resuscitate, we do that swab right up front so we know what we're dealing with. And then they just opened the Monterey County and then the State of California just opened these alternate testing sites. And this is new as of this week. And so that's the third mechanism of testing. And so this doesn't have anything to do with the hospital. It is something that the state, it's their initiative. There are 80 testing sites across the State of California. And the goal for the State of California is to do 10,000, 500 tests per day. And you know, at the beginning you heard several experts talk about that we have to have wide availability of testing, we have to have a mechanism to test whoever comes to be tested.

And so this is what's going to help that. So we have two locations around Monterey County, one at Alice L. High school, the other at Greenfield Library. And so essentially if you, whether you have symptoms or not, you can go to one of these testing sites and they do testing and they do the swab testing. So this is not antibody testing. This is testing to see if you actually have COVID-19 presently. So it's the same swab that we do here. And so that's available for the community now as well. They prioritize healthcare workers and first responders and then the general public after that.

Host: Wow. Carla, I mean this is jaw dropping. I'm just listening to you and I'm going, okay, wait, from 18 to 24 hours to 15 minutes as you said in your words, what a game changer for everybody, for the patients, for the hospital workers to know what you're dealing with within 15 minutes, to save the PPE when possible, to save them from having to go on through the, you know, the COVID protocol, if you will. Truly amazing work that you folks are doing at SVMH and how everybody in the community and the County is collaborating and working together. I know I'm going to get to talk to you again, so I'll look forward to that, but keep up the great work. Carla, thank you so much. For more information on the Coronavirus, please visit SVMH.com/Coronavirus. We hope you found this podcast to be helpful and informative. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.