Staff at Landmark ready and waiting
Virus won’t catch City medical facility off guard
WOONSOCKET — The moment when the first coronavirus patient shows up at Landmark Medical Center has not arrived yet, but the clinical staff here is reasonably certain it’s coming.
And they’re ready for it – whether the first coronavirus patient is the only one or the first of many, the hospital says.
Following directives spilling down from state and federal health authorities, Northern Rhode Island’s only hospital has built up its reserves of medical supplies and trained the staff in preparation for a possible outbreak in the region. It’s held multiple meetings with members of the Woonsocket Fire Department to bone up on protocols for the transfer of patients and it’s converted an idle, third-floor wing of the Cass Avenue facility to a surge unit, with up to 22 beds to accommodate a potential influx of admissions.
“We prepare for all scenarios,” said Landmark CEO Michael Souza. “Over the last several months, we’ve been preparing to make sure that we’re ready in case we see one patient, three patients or 20 patients.”
So far, the state’s outbreak appears to be limited to a group of teachers and students associated
with a trip to Italy in mid-February that was organized by St. Raphael’s Academy in Pawtucket. There are three cases of coronavirus – either presumed or confirmed – stemming from the trip, but as of yesterday, some 200 people who had direct contact with the SRA group are presently home-quarantined while they self-monitor for symptoms.
And health officials are still hunting for more people who may have had direct contact with the overseas travelers.
The broad strokes of the hospital’s response to coronavirus emphasize providing patients with quality care and minimizing the risk to healthy people, including hospital staffers and the EMS workers who, in many cases, will be the frontline first-responders who bring patients from their homes to the hospital.
With the containment of coronavirus a paramount concern, the protocols established between the hospital and EMS providers stress an open, active dialogue between the two parties. The hospital doesn’t want to be surprised by having patients who may be infected with coronavirus, or COVID-19, without advance notice, since medical personnel will need sufficient time to don the necessary protective gear and get their teams in place.
The prevailing guidelines now require hospital personnel to wear, at a minimum, a gown, latex gloves, a special face mask and a plastic face shield to keep their eyes, nose and mouth protected from a patient’s coughing or sneezing.
The dialogue is two-way. If the hospital has information about a coronavirus patient that may be headed for a rescue squad, it will pass the information along to EMS.
“What we don’t want is for all of a sudden a patient to show up and we don’t know about it and they don’t know about it,” said Chief Medical Officer Glen Fort, an expert in infectious disease. “So if we get word there might be a possible person under suspicion of having coronavirus then they’ll contact us, we’ll contact them and we can all be prepared in terms of personal protective equipment and what to wear and where that patient will go and how that patient will be treated.”
Patients who present symptoms of coronavirus will invariably be transferred to a special room that’s built for containing contagious pathogens. It’s a “negative pressure” room that is essentially an environmental bubble.
As nurses and other direct-care clinical staff deal with patients in a hands-on way, much will be going on behind the scenes that most people in the hospital won’t even see.
Whenever a coronavirus patient arrives, the hospital will declare a “code purple” emergency, triggering the assembly of a six-member “incident command” team. Code purple is nothing new – it’s a standard emergency response condition observed in jurisdictions all over the country, much like “code red” stands for a fire-related emergency. Except code purple means the hospital is dealing with an infectious disease threat.
The incident command team meets in a room on the second floor equipped with autonomously-powered computer and telecommunications equipment which allows members to transmit to the state health department, in real time, information on the status of the patient that caused them to trigger the alert, according to Landmark’s Director of Infection Control Marla Goulart, a member of the team.
The incident command team represents a cross section of the core operational tasks of the hospital. Even the hospital’s public information officer, like other members of the team, will be summoned from home to assemble in the incident command center to monitor the path of a COVID-19 patient’s arrival at the hospital.
The incident command team has been meeting regularly already for weeks.
“We looked at our readiness, our staff, the education, the protective equipment that we had on hand for the supplies to have available for one patient or 20 patients, or whatever may be in between or for whoever comes in the door,” said Goulart. “We educated our triage staff on the questions to ask and educated the staff in the emergency department on what to do, what protective equipment to put in place and the process as the patient comes in the door and making sure your leadership and everyone was working together.”
Even weeks ago, said Dr. Fort, Landmark began stocking up on gloves, masks and other essentials. “We feel like we have an adequate supply,” he says, adding that there may be enough to share with municipal EMS partners if it turns out they’’re short.
NOT EVERY PATIENT suspected of having contracted COVID-19 will be admitted to the hospital, or even taken there.
For those who call a rescue squad, the chores of preliminarily screening patients to determine the severity of their symptoms will fall to the municipal EMS personnel, according to Woonsocket Fire Chief Paul Shatraw.
Dispatchers have a “screening tool” – basically a set of assessment questions – that they will pose to COVID-19 callers to see what type of medical response is required.
“They will ask a certain number of questions so our first responders will hopefully know what they’re responding to,” said Shatraw. “At that point we would...evaluate, we would be in constant communication with the Rhode Island Department of Health, who will give guidance based upon the criteria as to whether they should be self-quarantined or transported to the emergency room.”
Landmark’s security and medical personnel have already held a number of meetings with the WFD and the Woonsocket Police Department, and a full-on training session was held for EMS providers at the hospital on Thursday night.
“Together, with EMS, Landmark Medical Center and community stake holders, the city is taking every precaution to assure our community members are safe and informed about COVID-19, Mayor Lisa Baldelli-Hunt said.
The handoff of COVID-19 patients from EMS to the hospital will be a carefully-coordinated operation designed to protect the patient and staff, according to Landmark’s Director of Security Gino Olaes.
“If a positive screening comes back, then we ask that the rescue, when they arrive, to shelter in place and they will be met by the clinical people in the appropriate gear to look at the patient and escort into the emergency department and make sure we have a direct path to a room where we can mitigate exposures...”
Dr. Fort, however, says many patients will never see the inside of the hospital.
All indications are that COVID-19 poses the greatest risk to the elderly, particularly those with immune systems already compromised by some underlying medical condition.
Some younger patients may endure a few sniffles and get healthy again, completely unaware that the cause of their illness was COVID-19, he says.
“There will be a lot of people who are exposed to this virus and they may not even realize it,” said Dr. Fort. “Eighty percent who have this infection will have a mild illness. It feels like a cold to them and they don’t even realize they’ve been infected.” p
But COVID-19 can also hit hard with a high fever and respiratory complications that can become life-threatening for older people, much in the same way as influenza. b
The precautions under way now, not just at Landmark, but hospitals throughout the country, are similar to those that were in place during past outbreaks of exotic viruses, including H1N1, a severe, flu-like illness, and Ebola, an aggressive, blood-attacking virus that left victims with a 5050 chance of survival.
“I think certainly Ebola was a lot more worrisome several years ago when we had that,” said Dr. Fort.
Because of the uncertainty posed by COVID-19, a new virus for which a vaccine may be up to two years away, the nation’s healthcare infrastructure has little choice by to mount an allhands-on-deck approach to reining in the spreadb of the disease. The potential for calamity is certainly there, since COVID-19 appears to be fatal in 1-2 percent of those who contract the virus.
Although that’s 10 to 20 times the usual mortality rate of seasonal flu, it remains to be seen whether the domestic death toll associated with COVID-19 even approaches that of this year’s installment of influenza.
Given influenza’s record as a grim reaper, Dr. Fort finds it somewhat intriguing that folks don’t take the familiar killer as seriously as they should.
“We have had 100 pediatric deaths in this country from regular influenza this year, yet no one is really up in arms or alarmed by it,” he says.p “There have been over 20,000 deaths from it, but nobody seems concerned about it because it’s expected.”
No one quite yet knows how COVID-19 will play out domestically, however, so the hospital has to be prepared for the worst.
“Our goal is to provide quality care and makep sure we minimize the risk,” said Souza.