Preparing at a sprint for wave of patients

Authorities using ‘calm before the storm’ to reorganize, coordinate health system

Medical authorities are rapidly reorganizing Ottawa-area hospitals — emptying beds, expanding capacity and coordinating services — in preparation for a wave of COVID -19 patients that’s expected to severely test the region’s healthcare system.

The Champlain region’s 20 hospitals, from Cornwall to Deep River, will work together to manage the crisis.

Triaged COVID-19 patients will be sent by a central command centre to the hospital best able to meet their needs. Eight hospitals have been designated as critical care sites: The Ottawa Hospital (Civic and General campuses), the Queensway-Carleton, Montfort, CHEO, the University of Ottawa Heart Institute, Pembroke Regional Hospital and Cornwall Regional Hospital.

Unprecedented measures are being discussed, including field hospitals, as part of a complex planning process that encompasses a wide range of pandemic scenarios.

“We’re sprinting toward preparedness and we’re not going to stop,” said Dr. Andrew Willmore, medical director of emergency management at The Ottawa Hospital, and incident commander for the Champlain health region.

Willmore said “absolutely anything” is on the table as officials contemplate how to move patients to alternative care settings outside the hospital while also expanding the number of intensive-care beds.

“Certainly field hospitals have been discussed for some time now,” he said.

Health-care officials are also making visits to local hotels, hockey arenas, community centres and convention facilities to assess them as possible sites for patients who require post-hospital care.

Moving recovered patients safely out of hospital is a critical part of ensuring space remains available for incoming patients.

“We will use all available sites,” Willmore vowed. “It’s a very interesting time in that a lot of the rules — a lot of the things we normally have to go through to make these kind of changes — have been accelerated to an unprecedented degree.”

At The Ottawa Hospital, for instance, part of the cafeteria was remade into a negative pressure room — an isolation room that does not allow airborne particles to escape — when COVID -19 patients started to present themselves in the emergency department. It was closed once the Brewer Park testing centre opened.

The region has more than doubled the number of intensive-care beds available to patients. There are now 343 ICU beds fully equipped with ventilators, and officials are actively looking at adding more.

Hospitals have access to hundreds of emergency ventilators that can be used for up to 30 days.

Willmore warned, however, that no amount of preparation will be enough if members of the public fail to do their part to flatten the COVID-19 curve — and moderate the pandemic’s effect on the health-care system.

“Irrespective of any preparations that we do, irrespective of the amount of surge capacity we can ramp up, it will not be enough if the public does not adhere to guidelines about physical distancing and self-isolation when sick.”

Hospital officials have completely reshaped the region’s healthcare system in one month.

Pressure on emergency departments has been relieved by the Brewer Park assessment centre, and the community care clinics opened by both the Queensway-Carleton and Montfort hospitals. The clinics treat people with fever and other respiratory illness symptoms that can’t be managed at home.

Meanwhile, hospitals across the region have established specialized

COVID is not SARS and it’s not H1N1 — it is its own thing, and that requires a bit of a tune up to what was already a complex system.

units to treat COVID-19 in an effort to limit the spread of the disease inside hospitals. The region now has a total of 3,400 hospital beds available to it.

Earlier this week, the Champlain region also launched a pandemic command centre, which gives hospital officials a single phone number to call when a patient with COVID-19 has to be admitted.

The command centre will control the flow of patients across the region, and ensure each is sent to the hospital that can best meet the individual’s care requirements.

Patients in respiratory distress will be stabilized then transported to one of the eight hospitals with the ability to offer critical care.

The University of Ottawa Heart Institute, for example, has postponed surgeries not considered urgent, and opened beds for critical care during the pandemic.

The pandemic plan has several response levels based on the number of patients that move into hospital. An upper tier envisages the possibility of designating entire hospitals as COVID-19 centres to keep other hospitals “clean” of the virus, and able to safely treat patients with other ailments.

The plan was based on a flu pandemic model, but it has been adapted to COVID -19, which presents unique health-care challenges, including much higher rates of infection and death.

“COVID is not SARS and it’s not H1N1 — it is its own thing, and that requires a bit of a tune up to what was already a complex system,” said Willmore.

Planning has been complicated by the worldwide shortage of personal protective equipment (PPE). A regional stockpile of PPE has been created, Willmore said, and will be shared with hospitals if they experience a critical shortage.

“Running out of protective equipment would lead to a significant problem for the health-care system to continue operation: It would be a critical point of failure.”

Hospital corridors are now largely quiet, but that’s expected to change dramatically in the coming weeks. At The Ottawa Hospital, the occupancy rate is just below 70 per cent. “It’s the calm before the storm,” said Willmore.

An emergency doctor who specializes in disaster management, Willmore was seconded to help direct the region’s COVID-19 response. He said all of the decisions made to date have taken into account the needs of front-line doctors and nurses — and how they can best deliver care in difficult circumstances.

“The urgency of this has really helped us move the levers of power to align and make some really positive changes to the system that, honestly, I think are going to persist long after COVID.”