Adult Surviving Sepis Campaign Guidelines (Hour-1 Bundle)
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Management of Adults with COVID-19
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For hospitals in surge cities, novel coronavirus 2019 (COVID-19) was a disaster such as they had never seen before. Most disasters—natural, nuclear, mass shootings, and other forms of terrorism—are one-time events that quickly overwhelm intensive care units (ICUs) and then ease within a few days. COVID-19 was a “mass casualty in reverse,” said Richard H. Savel, MD, CPE, FCCM, director of adult critical care services and vice-chair for inpatient clinical services in the Department of Surgery at Maimonides Medical Center in Brooklyn, New York, a hotbed of the COVID-19 outbreak. ICU needs grew steadily—rather than all at once—and then remained at high levels for weeks without a break. Between its first COVID-19 case on March 9 and the peak on April 21, Maimonides transformed from a 700-bed hospital with one 20-bed medical ICU and 57 ICU beds, to a hospital with 10 ICUs and 140 ICU beds.
While no hospital was truly prepared for COVID-19, Dr. Savel said that, because he had taken the Society of Critical Care Medicine’s Fundamental Disaster Management (FDM) course twice and taught it twice during the past decade, Maimonides was in a far better position. “Our COVID-19 cases are dropping and, while we’re still addressing the pandemic, to the extent that we got through the worst of it, it was due to this course,” said Dr. Savel. “I remain eternally grateful for every drop of information I gleaned from it.”
The FDM course focuses on the role of the critical care specialist in managing disasters. Dr. Savel recommends that all attending physicians and fellows take the course. During the New York City outbreak, Dr. Savel’s role at Maimonides was as the “boundary spanner,” meaning that he acted as the interface between critical care clinicians and operational leadership. Constant communication was of the utmost importance, and he rounded with those groups twice daily. Ultimately, he was part of the team responsible for ensuring that the hospital had enough staff, equipment, and rooms to treat COVID-19 patients. There was no time to employ normal protocols, and decisions that normally took months were made in minutes, by necessity. Through it all, he was impressed with the dedication of the staff, all of whom faced daunting experiences every day. “I’ve never been prouder to be part of a critical care community,” he said.
He noted a number of important take-aways from the FDM course that applied to the pandemic, beginning with having a disaster plan in place, employing rules that have been agreed upon in advance and must be adhered to. He said five key lessons learned from FDM apply directly to pandemic management: