Facing the Pandemic with Preparation and Perseverance

Salinas Valley Memorial Hospital Emergency Department nurses, physicians and staff played critical roles in the hospital’s COVID-19 response.

Fortune favors those who are prepared. At least that’s how it turned out for Salinas Valley Memorial Hospital Emergency Department nurses Naomi Arrey, RN, CEN, and Kerry Kantmann, BSN, RN, CEN, who participated in advanced, all-hazards training and received a certification as Hospital Emergency Response Team Trainers at FEMA’s Center for Domestic Preparedness in the fall of 2019.

“I remember in the bioterrorism lecture, the instructor was saying how a pandemic usually erupts, on average, every hundred years. He said we needed to be prepared because it was not a matter of ‘if’ but ‘when,’” Arrey says. “He referenced the last one, which was the 1918 influenza pandemic. Little did we know then that two months later, we would begin to hear of this novel deadly virus erupting out of China.”

With that training accomplished, Arrey and Kantmann became the hospital’s nurse leaders on decontamination and personal protective equipment (PPE) protocols. By February 2020, it was clear the coronavirus pandemic was heading toward Salinas Valley, and the two nurses began to prepare for the worst.

“We began conducting PPE training for Emergency Department staff based on the latest recommendations,” Kantmann says. “Then we started getting requests to train staff in other units, and we launched our ‘PPE Roadshow.’”

Soon, SVMH leadership requested that the nurses create mandatory PPE training videos for every hospital employee.

“We couldn’t have done it without our training and the disaster planning here at the hospital, by hospital leaders who made sure we had a stockpile of PPE,” Kantmann says.

Streamlining Patient Assessment and Care

Next, they had to figure out a way to isolate patients with COVID-19 to prevent unnecessary exposures.

“We had to completely restructure our use of patient rooms inside the department, as well as incorporate tents as new patient areas,” Arrey says. “We presented our plan to the physician group and administrators, and the support we received from everyone was incredible.”

Arrey and Kantmann were instrumental in launching the patient care tents that the hospital had on hand for disasters.

“We looked at what hospitals on the East Coast were doing and implemented what we thought were best practices, and they worked! It’s a testament to how adaptive our hospital can be when the need arises!”

Nikolas Greenson, MD
Emergency Medicine Physician

“We had a ‘quick-look’ tent and care tents for treating low-acuity isolation patients,” Arrey says. “In the quick-look tent, we determined if patients required isolation and how acute their illness was. Kerry and I reached out to a colleague who worked at a Bay Area hospital that was already seeing COVID patients to see how they screened their patients on entry. He told us about an algorithm-based screening tool they developed, which aligned with our practice of following algorithm-based protocols.”

Together, Arrey and Kantmann drafted their own screening algorithm. In collaboration with physicians, they implemented it to determine which patients could be treated and monitored in the care tents versus which ones would need to be admitted to the hospital.

“We collaborated with everyone – physicians, respiratory therapy, infection prevention, engineering, materials management, environmental services, registration, radiology, IT and others. It was a group effort, and EVERYONE stepped up, worked together and made it happen,” Arrey says.

Demonstrating Innovation and Resilience

Even in the face of so much uncertainty and fear surrounding the new virus, the Emergency Department and other SVMH staff forged ahead to protect their patients and each other in incredible ways.

“A lot of us were bracing for the worst,” says Nikolas Greenson, MD, an emergency medicine physician at SVMH. “We knew very little about how the virus spread or if the N95 respirators were going to be very effective. We worried that people from our own department would end up in the ICU or worse. And our department, specifically our physician assistants [PAs], really carried the burden for the whole community as the first point of care for patients coming in with COVID.”

An emergency department nurse enters patient information into a computer in the COVID-19 patient care tent .

Staff physicians went to Home Depot and bought hardware to craft their own patient barriers. Cristina Martinez, MD, Vice Director/Chair, Salinas Valley Emergency Medical Group, bought equipment to create individual tents that could be placed over patients during intubation to contain the viral plume.

“We looked at what hospitals on the East Coast were doing and implemented what we thought were best practices, and they worked! It’s a testament to how adaptive our hospital can be when the need arises!” Dr. Greenson says.

Emergency Department staff created communication protocols that allowed them to minimize staff in COVID patients’ rooms. They trialed ways to filter and contain the movement of air and the virus, ultimately resulting in the ability to ventilate patients safely in controlled negative-pressure environments, says Jeremy Hadland, BSN, RN, CEN, Clinical Nurse Manager. They also developed Code Blue Plus, a signal to the whole team that a resuscitation attempt was COVID-related.

“By using our skills and leveraging the information about the virus as it developed, our whole staff stepped up to make it through to the other side,” he says.

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