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Life in the ER in the Time of COVID-19

Life in the ER in the Time of COVID-19
Jul 21 2020

By Dr. Brandon Lew, Medical Director, Emergency Department

Every day, emergency physicians and staff members assess patients and make split second, critical decisions based on a limited amount of information in a time-sensitive environment. We are accustomed to unpredictability, and often work outside our comfort zone.

COVID-19 added layers of complexity to an already challenging work environment. We saw the need to quickly adapt to this health crisis and safely treat patients who required emergency care during the pandemic. We adopted additional protective and preventive measures for both staff and patient safety.

The first response was implementing the use of personal protective equipment (PPE). While this is imperative, it makes performing complex procedures much more cumbersome and time consuming. Wearing white plastic respirator suits makes it difficult to hear. Goggles and uncomfortable face masks worn for hours on end create pressure sores on noses and cheeks.  Our ED staff is often the first point of contact for potential COVID-19 patients. With this comes great obligation to maintain strict infection prevention measures for our patients and ourselves. In addition, not only are we caring for our community, but we have a persistent worry of bringing the virus home to our loved ones. This is a very real fear for caregivers all around the world.

Our entire hospital shifted when COVID-19 came along. A novel virus and the strain a pandemic can place on a medical system created an urgent need to mount an effective response that included a multi-disciplinary task force of experts. Led by our President & CEO, Dr. Lori Morgan, the team collaborated to ensure adaptability to challenges we faced, which included limited testing and myriad logistics.  Initially, we were – alongside so many healthcare institutions – in disaster mode, dealing with tough questions and few certain answers.

Countless meetings were devoted to adjusting policies, testing and staffing, and addressing resources and ventilators. We created alternative care site teams and frontline triage tents outside the hospital and trained physicians to practice in a new environment under unusual circumstances. The team implemented new protocols and procedures for the ED and admissions like PPE, testing and resuscitation. Adjustments were made for everyone’s safety, including policies for visitors, donations, telecommuting and meetings.

We needed a holistic view to battle the pandemic – operationally as a whole, inside and out. Each department’s workflow impacted the emergency and trauma operations and vice versa. From well-being support to community engagement, every resource was leveraged. Our team was involved in facilitating this synergy with our amazing nursing and administrative leadership, the frontline physicians and nurses, technicians, and additional hospital staff members.  The ED was fortunate to be supported by decades-long working relationships with the outpatient and hospital-based physicians.  Everyone was especially grateful for our community, who stepped up to help us through donations of supplies and an outpouring of support. The City of Pasadena leadership and the City of Pasadena Fire Department were also incredibly collaborative.

Very little was known about this virus in the beginning. Our dedication to providing excellent service and compassionate care to our community was the impetus to helping us understand so much more today to share our response now and into the future. The virus remains prevalent  and an ongoing threat to the well-being of our community. Huntington Hospital stands ready to serve as we face the ups and downs of this virus together. I urge everyone to remain very cautious and vigilant about practicing behaviors that help prevent the spread, including masking, social distancing, limiting gatherings and hand-washing. We will get through this time together.

Dr. Brandon Lew
Dr. Brandon Lew

Brandon Lew, DO, FACEP, is the Medical Director of Huntington Hospital’s Emergency Department and President-Elect of the Medical Staff.