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Seeking Emergency Care During COVID-19
Dr. Stephen Miller explains the extra protocols that are in place to help keep non-COVID-19 patients safe, and why you shouldn't wait to go to the hospital if you have an emergency.
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learn more about Stephen Miller, DO
Stephen Miller, DO
Stephen Miller, DO is a Professor of Emergency Medicine.learn more about Stephen Miller, DO
Transcription:
Seeking Emergency Care During COVID-19
Scott Webb: We are hearing stories from across the country that people are not going to the hospital when they have an emergent condition due to COVID-19 concerns and though COVID-19 is concerning, hospitals in general including VCU Health are open and safe with well-protected medical staff waiting to help you. Here to emphasize this point today is Dr. Stephen Miller, an Assistant Professor of Emergency Medicine at VCU Health. This is Healthy with VCU Health. I'm Scott Webb. So Dr. Miller, thanks for joining me today. We know that VCU is open and safe, but I want to hear some things in your words today. Why should people call 911 or go directly to the hospital if they are experiencing an emergency?
Dr. Miller: Obviously COVID pandemic is very real. It's very out there. People are afraid and it's completely understandable and as we kind of move into an environment of trying to get some resemblance of normalcy and kind of demonstrate to people that yes, we are open. I think it's a good idea as you brought up to kind of remember that. Anybody that's experiencing kind of worrying symptoms, whether we're talking stroke, like symptoms, which is degree of weakness or speech deficits having chest pain that's new or not normal for the individual. Anything that's really concerned, those are certainly indications and things that we want people to come and see us about. And we want to make sure that people feel assured that they're going to be treated timely and that they're going to be safe and that we're taking all the precautions to make sure that they feel comfortable. You know, following those directions that have been out there to seek medical care when you have these worrisome symptoms and come in and get evaluated.
Host: Definitely. I mean that's the message today, right? Cause we're hearing that people are delaying care all across the country. Do you believe it's just because of COVID-19?
Dr. Miller: I definitely think that's a big, big factor for it. And you know, I think any time this kind of unprecedented type situation where we're really kind of stuck in our homes and away from friends and family. And kind of our normal day in and day out, whether it's work or anything, that's just kind of a sense of normalcy that has all been taken away and you know, appropriately to where we're trying to reduce spread and flatten that curve. And people have done such an incredible job across the country, particularly here in Virginia and in Richmond and around area. But we definitely want people to realize that at a stage that they should be feeling safe and feeling comfortable with coming in and seeking care. You know, I think that is going to be a discussion for a long time of why numbers in these areas have dropped so much. But I do think that COVID has absolutely kind of been at the forefront of why people aren't seeking the care that they once were.
Host: Yeah, I agree. That seems to be the case and the trend, and it's not like people are choosing one hospital over another. I'm sure you're speaking with friends and colleagues across the country and they're all probably reporting the same thing, right?
Dr. Miller: Correct. Yeah. I think numbers down. There's not a place out there that hasn't been impacted and seeing just the overall reduction in volume.
Host: Well let's hope, especially if people are experiencing these emergency urgent conditions like strokes and heart attacks, that they really get this message today. I want to talk about, since we're framing this as a sort of a byproduct or an unintended consequence of COVID-19, let's talk about how VCU is handling screening and testing. What can people expect when they arrive?
Dr. Miller: So, you know, as you come in, whether it's through the emergency department or to the main hospital itself, we have taken a big priority to make sure that we are screening at the doors. And so for my environment in the emergency department, either be walking in through our triage area or coming in by the ambulance, and you're coming in through the triage area. We have a screener nurse who's masked, and all of our providers are, will be wearing a mask. So you can expect to see that and that's to take precautions. You know, I think that the message has been pretty clear and put out there that wearing a mask, particularly in public, but certainly in the hospital environment is needed to keep people safe and so our providers will be masked. You'll be asked a series of questions that kind of fit along CDC guidelines and state and our local and VCU epidemiology department as far as some screening questions.
That would put us a little bit more concerned that people might have the symptoms of COVID, and if that was the case then you'd be sent to a second triage area, which is tailored more to dive a little bit deeper. And so evaluating any of these concerns for the potential of having COVID, anybody that comes into the hospital, again, whether it's through the emergency department or through the main hospital, will be given a mask if you don't already have one. And that is again a precautionary measure to keep people safe for us in the emergency department. If you don't have any of those concerning symptoms and you are there for something that we see every day. Again, as we mentioned, the chest pain, the weakness or stroke like symptoms, any pains that are new or different for you. We put you into our regular triage area and we get you screened and brought into the back and evaluated.
Host: That's awesome to hear. And you mentioned the PPE for medical staff and I'm guessing there's different levels of protection for staff depending on whether they're at the front door or wherever they might be. But I want to let everybody know that the VCU Medical staff is fully, you have all the PPE you need, right?
Dr. Miller: Correct. We have a wonderful working team from hospital leadership on down our supply, and folks that have just done an incredible job of keeping our staff supplied with appropriate PPE. We have plenty of N95 masks. We have a wonderful division that has actually worked on using a reuse capability of N95 masks, to get them cleaned and back to providers, with just amazing technology what they've been able to do. That I think has been shared and put out with other health systems that has allowed us to keep our supply on a very sustainable numbers by being able to utilize some of that for our equipment. But you're right in that there are different degrees of it, so everybody, as I mentioned will have a mask. They'll likely be wearing some sort of face protection. Our eye protection goggles or a short face mask, and then oftentimes, particularly if someone is coming in with symptoms of COVID-19 than we would be wearing a gown and gloves. Sometimes we keep people in a kind of an isolation room that has some negative pressure or some techniques that allow for that. Again, that continued safe environment so that we're able to keep folks with those symptoms isolated from folks that don't have those symptoms. So it's an addition to protecting the patient, protecting our staff, but anybody that's coming into our environment, we take high priority making that everybody's safe on both sides.
Host: I'm glad to hear you say that, and say it that way because I think sometimes lost in this is that, you know, both sides of the equation. Obviously VCU and every other hospital wants the patients to be safe. But we also need the frontline workers, the essential healthcare workers to also be safe. Otherwise they won't be there, you know, to help the potential patients. So glad to hear and I didn't know that about the N95s could be cleaned if you will and reused. That's really awesome to hear that you guys are well situated. I want to ask your thoughts about telemedicine. You know, this has been something that's been kind of like inching along here in healthcare for a while, but it has been totally optional. And now for nonemergency situations it seems to be the norm and maybe it's the new norm and maybe that's a good thing that, you know, sort of come out of COVID-19. What are your thoughts about that?
Dr. Miller: I agree. And it speaks to just an amazing ability for folks to be innovative and to really put priority to make sure that we are, while you know, limiting contact and making sure that people are staying separated and isolated but yet still able to reach out and, and talk to their physicians and get questions answered and get evaluated. The telemedicine thing has been just an amazing innovation to see because you're right, you know, we're doing things, and that old traditional way and it was effective and there was some push for the telemedicine and this has really kind of brought it to the forefront. And I think the future probably holds a very much keeping us up. I think the people enjoy it because they can get direct links into talking with their doctor from home. I think we can do and utilize it in a way of evaluating people to make sure that they're getting good follow-up, that they're able to be checked on, that they can get all their questions answered. They're taking new medications and those types of things.
To give us an opportunity to evaluate somebody and see if they can need to come into the clinic or if they need to actually come into the emergency department. And so I think it's the utilization of it really. How we can put it into place is, are just kind of endless possibilities. So it's an exciting field. VCU has stood it up very, very quickly, so much to other places. We have clinics utilizing it, we have follow up urgent care appointments. All those types of things are being done by it. We've even been able to utilize it in some cases for folks in the hospital or in the emergency department where we can talk via kind of a telemedicine link so that it limits exposure risk and keeps people distancing as well as not having to over-utilize PPE. And as well as, you know, we have had maintain a no visitor policy, some of the other places to limit exposure. But utilizing some of the similar technology we've been able to get our patients linked up and talking to their loved ones. And so that they're not, I'm having to go through these things alone while we're having to kind of keep these restrictions in place, until those policies are able to be changed. But, you know, I think the technology is amazing, and I only see it being used more and more after we get through this.
Host: Yeah. And I'm glad to hear that VCU is doing that. And I was telling you before we got started here today, I had a video visit with my doctor the other day and it was just the coolest thing. It's like, right, why do I have to drive over there, put her at risk, me at risk, waste all that PPE just so we can sit and talk for five or 10 minutes. Like why not do it on your phone? It's really cool. And I just amazed at how creative we can all be and how collaborative the healthcare medical profession can be under these conditions with this tremendous, you know, stress and everything weighing on people and yet some, some real good can come out of this. So lastly here, Doctor, our premise has been today that COVID-19 is the reason why people aren't going to the hospital, or seeing their doctors and we want to just kind of put a period at the end of the sentence, tell us again why all hospitals, but VCU in particular is the best and safest place to be if you're having an emergency or experiencing symptoms that are unfamiliar to you. Let me hear it in words
Dr. Miller: And I appreciate this cause I really want people to understand that you know, if there are concerns, if you're experiencing something as you mentioned that is new, different, that you're worried about this being an emergent condition, then please do not be afraid to come in, seek care. Call 911 if needed. Call your doctor's office if you have questions and they can link in and help you through the process. Or come in and get evaluated. We have set up systems in place to keep you safe. We have set up systems in place to keep our staff safe. We absolutely do not want you to delay seeking care. If you have any concerns come in, we're going to take good care of you. We're going to keep you safe. COVID-19 again, while extremely scary and very understandable, but I don't want it keeping people from seeking care when they otherwise would have because we have set it up so that we at VCU have the ability to keep you safe in your environment and still take care of you for any of your symptoms and complaints. So please do, please reach out and please come see us.
Host: Dr. Miller, thanks so much for your time today. Great thoughts, great advice. Of course there's every reason to be concerned about COVID-19 but the hospital and VCU is open, it's safe, people are protected and you all are just there waiting, you know, to help people, whether it's, as you say, an emergent condition or COVID-19 or anything else, go to the hospital. Thanks again, Dr. Miller. Great having you on. For more information, call (800) 762-6161 or check out our website at vcuhealth.org. And thanks for checking out this episode of Healthy with VCU Health. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library at VCUhealth.org/podcast for topics of interest to you. Thanks, and we'll talk again next time.
Seeking Emergency Care During COVID-19
Scott Webb: We are hearing stories from across the country that people are not going to the hospital when they have an emergent condition due to COVID-19 concerns and though COVID-19 is concerning, hospitals in general including VCU Health are open and safe with well-protected medical staff waiting to help you. Here to emphasize this point today is Dr. Stephen Miller, an Assistant Professor of Emergency Medicine at VCU Health. This is Healthy with VCU Health. I'm Scott Webb. So Dr. Miller, thanks for joining me today. We know that VCU is open and safe, but I want to hear some things in your words today. Why should people call 911 or go directly to the hospital if they are experiencing an emergency?
Dr. Miller: Obviously COVID pandemic is very real. It's very out there. People are afraid and it's completely understandable and as we kind of move into an environment of trying to get some resemblance of normalcy and kind of demonstrate to people that yes, we are open. I think it's a good idea as you brought up to kind of remember that. Anybody that's experiencing kind of worrying symptoms, whether we're talking stroke, like symptoms, which is degree of weakness or speech deficits having chest pain that's new or not normal for the individual. Anything that's really concerned, those are certainly indications and things that we want people to come and see us about. And we want to make sure that people feel assured that they're going to be treated timely and that they're going to be safe and that we're taking all the precautions to make sure that they feel comfortable. You know, following those directions that have been out there to seek medical care when you have these worrisome symptoms and come in and get evaluated.
Host: Definitely. I mean that's the message today, right? Cause we're hearing that people are delaying care all across the country. Do you believe it's just because of COVID-19?
Dr. Miller: I definitely think that's a big, big factor for it. And you know, I think any time this kind of unprecedented type situation where we're really kind of stuck in our homes and away from friends and family. And kind of our normal day in and day out, whether it's work or anything, that's just kind of a sense of normalcy that has all been taken away and you know, appropriately to where we're trying to reduce spread and flatten that curve. And people have done such an incredible job across the country, particularly here in Virginia and in Richmond and around area. But we definitely want people to realize that at a stage that they should be feeling safe and feeling comfortable with coming in and seeking care. You know, I think that is going to be a discussion for a long time of why numbers in these areas have dropped so much. But I do think that COVID has absolutely kind of been at the forefront of why people aren't seeking the care that they once were.
Host: Yeah, I agree. That seems to be the case and the trend, and it's not like people are choosing one hospital over another. I'm sure you're speaking with friends and colleagues across the country and they're all probably reporting the same thing, right?
Dr. Miller: Correct. Yeah. I think numbers down. There's not a place out there that hasn't been impacted and seeing just the overall reduction in volume.
Host: Well let's hope, especially if people are experiencing these emergency urgent conditions like strokes and heart attacks, that they really get this message today. I want to talk about, since we're framing this as a sort of a byproduct or an unintended consequence of COVID-19, let's talk about how VCU is handling screening and testing. What can people expect when they arrive?
Dr. Miller: So, you know, as you come in, whether it's through the emergency department or to the main hospital itself, we have taken a big priority to make sure that we are screening at the doors. And so for my environment in the emergency department, either be walking in through our triage area or coming in by the ambulance, and you're coming in through the triage area. We have a screener nurse who's masked, and all of our providers are, will be wearing a mask. So you can expect to see that and that's to take precautions. You know, I think that the message has been pretty clear and put out there that wearing a mask, particularly in public, but certainly in the hospital environment is needed to keep people safe and so our providers will be masked. You'll be asked a series of questions that kind of fit along CDC guidelines and state and our local and VCU epidemiology department as far as some screening questions.
That would put us a little bit more concerned that people might have the symptoms of COVID, and if that was the case then you'd be sent to a second triage area, which is tailored more to dive a little bit deeper. And so evaluating any of these concerns for the potential of having COVID, anybody that comes into the hospital, again, whether it's through the emergency department or through the main hospital, will be given a mask if you don't already have one. And that is again a precautionary measure to keep people safe for us in the emergency department. If you don't have any of those concerning symptoms and you are there for something that we see every day. Again, as we mentioned, the chest pain, the weakness or stroke like symptoms, any pains that are new or different for you. We put you into our regular triage area and we get you screened and brought into the back and evaluated.
Host: That's awesome to hear. And you mentioned the PPE for medical staff and I'm guessing there's different levels of protection for staff depending on whether they're at the front door or wherever they might be. But I want to let everybody know that the VCU Medical staff is fully, you have all the PPE you need, right?
Dr. Miller: Correct. We have a wonderful working team from hospital leadership on down our supply, and folks that have just done an incredible job of keeping our staff supplied with appropriate PPE. We have plenty of N95 masks. We have a wonderful division that has actually worked on using a reuse capability of N95 masks, to get them cleaned and back to providers, with just amazing technology what they've been able to do. That I think has been shared and put out with other health systems that has allowed us to keep our supply on a very sustainable numbers by being able to utilize some of that for our equipment. But you're right in that there are different degrees of it, so everybody, as I mentioned will have a mask. They'll likely be wearing some sort of face protection. Our eye protection goggles or a short face mask, and then oftentimes, particularly if someone is coming in with symptoms of COVID-19 than we would be wearing a gown and gloves. Sometimes we keep people in a kind of an isolation room that has some negative pressure or some techniques that allow for that. Again, that continued safe environment so that we're able to keep folks with those symptoms isolated from folks that don't have those symptoms. So it's an addition to protecting the patient, protecting our staff, but anybody that's coming into our environment, we take high priority making that everybody's safe on both sides.
Host: I'm glad to hear you say that, and say it that way because I think sometimes lost in this is that, you know, both sides of the equation. Obviously VCU and every other hospital wants the patients to be safe. But we also need the frontline workers, the essential healthcare workers to also be safe. Otherwise they won't be there, you know, to help the potential patients. So glad to hear and I didn't know that about the N95s could be cleaned if you will and reused. That's really awesome to hear that you guys are well situated. I want to ask your thoughts about telemedicine. You know, this has been something that's been kind of like inching along here in healthcare for a while, but it has been totally optional. And now for nonemergency situations it seems to be the norm and maybe it's the new norm and maybe that's a good thing that, you know, sort of come out of COVID-19. What are your thoughts about that?
Dr. Miller: I agree. And it speaks to just an amazing ability for folks to be innovative and to really put priority to make sure that we are, while you know, limiting contact and making sure that people are staying separated and isolated but yet still able to reach out and, and talk to their physicians and get questions answered and get evaluated. The telemedicine thing has been just an amazing innovation to see because you're right, you know, we're doing things, and that old traditional way and it was effective and there was some push for the telemedicine and this has really kind of brought it to the forefront. And I think the future probably holds a very much keeping us up. I think the people enjoy it because they can get direct links into talking with their doctor from home. I think we can do and utilize it in a way of evaluating people to make sure that they're getting good follow-up, that they're able to be checked on, that they can get all their questions answered. They're taking new medications and those types of things.
To give us an opportunity to evaluate somebody and see if they can need to come into the clinic or if they need to actually come into the emergency department. And so I think it's the utilization of it really. How we can put it into place is, are just kind of endless possibilities. So it's an exciting field. VCU has stood it up very, very quickly, so much to other places. We have clinics utilizing it, we have follow up urgent care appointments. All those types of things are being done by it. We've even been able to utilize it in some cases for folks in the hospital or in the emergency department where we can talk via kind of a telemedicine link so that it limits exposure risk and keeps people distancing as well as not having to over-utilize PPE. And as well as, you know, we have had maintain a no visitor policy, some of the other places to limit exposure. But utilizing some of the similar technology we've been able to get our patients linked up and talking to their loved ones. And so that they're not, I'm having to go through these things alone while we're having to kind of keep these restrictions in place, until those policies are able to be changed. But, you know, I think the technology is amazing, and I only see it being used more and more after we get through this.
Host: Yeah. And I'm glad to hear that VCU is doing that. And I was telling you before we got started here today, I had a video visit with my doctor the other day and it was just the coolest thing. It's like, right, why do I have to drive over there, put her at risk, me at risk, waste all that PPE just so we can sit and talk for five or 10 minutes. Like why not do it on your phone? It's really cool. And I just amazed at how creative we can all be and how collaborative the healthcare medical profession can be under these conditions with this tremendous, you know, stress and everything weighing on people and yet some, some real good can come out of this. So lastly here, Doctor, our premise has been today that COVID-19 is the reason why people aren't going to the hospital, or seeing their doctors and we want to just kind of put a period at the end of the sentence, tell us again why all hospitals, but VCU in particular is the best and safest place to be if you're having an emergency or experiencing symptoms that are unfamiliar to you. Let me hear it in words
Dr. Miller: And I appreciate this cause I really want people to understand that you know, if there are concerns, if you're experiencing something as you mentioned that is new, different, that you're worried about this being an emergent condition, then please do not be afraid to come in, seek care. Call 911 if needed. Call your doctor's office if you have questions and they can link in and help you through the process. Or come in and get evaluated. We have set up systems in place to keep you safe. We have set up systems in place to keep our staff safe. We absolutely do not want you to delay seeking care. If you have any concerns come in, we're going to take good care of you. We're going to keep you safe. COVID-19 again, while extremely scary and very understandable, but I don't want it keeping people from seeking care when they otherwise would have because we have set it up so that we at VCU have the ability to keep you safe in your environment and still take care of you for any of your symptoms and complaints. So please do, please reach out and please come see us.
Host: Dr. Miller, thanks so much for your time today. Great thoughts, great advice. Of course there's every reason to be concerned about COVID-19 but the hospital and VCU is open, it's safe, people are protected and you all are just there waiting, you know, to help people, whether it's, as you say, an emergent condition or COVID-19 or anything else, go to the hospital. Thanks again, Dr. Miller. Great having you on. For more information, call (800) 762-6161 or check out our website at vcuhealth.org. And thanks for checking out this episode of Healthy with VCU Health. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library at VCUhealth.org/podcast for topics of interest to you. Thanks, and we'll talk again next time.