American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Messages from the Frontlines

Today, Dr. Anthony Vine of Mount Sinai Health System and ACS Governor for Manhattan sent along his personal early experience being a member of Team 6. He reports on his system’s experience over the last two days. Note: These messages have not undergone traditional peer review, but we feel will be of interest to our readers.

Mount Sinai Health System:
COVID-19 Health System Updates, March 30

Dr. Vine Reports

“ ….There were over 500 deaths in the country yesterday—138 of them in NYC alone, so the situation is getting worse here.

Just some personal background—

While I am a “voluntary” (not paid by the hospital) surgeon—of whom there are very few left, I am a more senior surgeon at sinai. We have equal stature in the department, as we are instrumental in the training of residents and fellows, since we still receive a majority of the complex cases. As you can see, I am just as—or more—“academic” than many of my Full time colleagues. I have been at Sinai now for 30 years, over half my life. I hope to turn 58 on the “old” tax day, April 15.

While not doing any elective cases, I still feel a dedication to this institution that trained me and has helped foster my surgical career, so of course, I have volunteered to help in any way I can.

The next attachment I send will explain what we are doing specifically in the Dept of Surgery.

Most sincerely,

Tony

Anthony J. Vine, MD, FACS
Asst. Clinical Professor of Surgery,
Icahn School of Medicine at Mount Sinai Hospital, NY, NY
Member, Board of Governors, American College of Surgeons
Manhattan Council, American College of Surgeons

Daily Memo

TO: All Faculty, Staff, and Trainees
FROM: Vicki R. LoPachin, MD, MBA
Senior Vice President
Chief Medical Officer
Mount Sinai Health System

DATE: March 30, 2020
RE: COVID-19 Health System Updates, March 30

I want to give you an update on our Personal Protective Equipment. As I mentioned last week, we are meeting with success in getting more of it. It is a 24/7 relentless effort. Some of what we are getting in will look unfamiliar to you because we are sourcing from multiple manufacturers. In order to make sure that what we put in the field is safe, we need to send it for testing at certified laboratories. Just yesterday, one of your colleagues dropped everything he was doing to drive out to the laboratory in Ohio in order to bring samples of the recent mask arrivals there for expedited testing. He didn’t want to risk late arrival by the mail system or the possibility of a lost package. Behind the scenes there are so many similar stories of people going above and beyond to support our front-line teams. It is important that you know that.

And on those front-lines, the work has only been getting harder. My heart breaks for everyone struggling to keep up with the volume of critically ill, and near-critically ill patients. This week you will see others joining the fight. We are meeting with success in sourcing additional clinical and support staff and will be deploying them where needed most. I hope you will welcome your new colleagues as members of our family and let them take as much of the burden as they can.

As of yesterday afternoon, we had 1,249 COVID-19 positive patients in our hospitals. That included 233 patients in our ICUs. We had another 135 inpatients under investigation (PUIs).

Last week, we mentioned a treatment that we are spearheading—called human convalescent plasma—and we told you about the extraordinary response when hundreds of you stepped forward to help. As you know, the cutting-edge approach transfuses antibodies from those who were previously infected to those COVID-19 patients who are sick. You can read more about Mount Sinai’s leading role in this here.

Keeping Your Loved Ones Safe
If you have questions about how to protect your families from COVID-19, and what proper practices to employ when you return home after treating patients, we have a new resource, which can be found here.

Information About New Ventilators
We continue to make progress in securing the tools we need to win the fight against COVID-19, including many new respiratory devices and ventilators. They won’t all look familiar so, in addition to training and orientation to the new devices, we have posted a reference sheet and an education packet on our resources site here, under the “Information about Ventilators” tab.

Statewide “PAUSE”
With the pandemic continuing to escalate, Governor Cuomo announced this weekend that the statewide “PAUSE” currently in place, which directs all nonessential workers to work from home, will be extended to April 15.

Your Commute
The MTA has implemented the “NY Essential Service Plan” so that essential personnel like you have the transportation you need at critical times. But changes in public ridership may trigger the MTA to reduce schedules on some subway, bus, and rail service. Please be aware that the MTA may make continuous adjustments to its service, and any service reductions could potentially affect and lengthen your commute. If you need more information, please click here.

Final Thought
I have been receiving a lot of inspiring emails from members of our Mount Sinai family. This one arrived yesterday from Joseph Uhl, who normally works in our planning and development office but has been deployed to an engineering role at one of our hospitals to help in this fight.


Dr. Vine’s Second Installment

For our “Disaster Protocol,” the Chairman of Surgery has set up approximately 30 “teams” of providers (I hate that word), comprised of two surgeons, one senior/chief resident, one nurse practitioner/PA, and two medical assistants to be deployed at hospitals/ICUs in our Sinai system that are in need or understaffed. While my primary workplace is Mount Sinai proper (upper east side, main facility), I have been assigned to Mount Sinai of Brooklyn as “team 6.”  The first two teams are already there working alternating 12 hour shifts 3 days a week, and as they get tired and the place gets overwhelmed, we will come in.

Interestingly, I called the Navy recruiter in NYC to see if they needed any very experienced civilian Surgeons, but she said no, and only suggested I sign up for the reserves, if I so desired.

All of our senior surgical residents are excellent, and I have one of the best, most skillful and organized ones, Dr. Chris LaChapelle. When we get notified, he is the one who will receive the call and will be in charge of notifying the team and the possessor of a duffle bag of our own PPE, if the hospital is in short supply.

All of the surgical attendings have been required to do refresher ICU and ventilator courses with the depts of Anesthesia and Critical Care.

I am rereading my ACLS protocols.

Of note, I also am on the Mount Sinai Ethics Committee for the whole hospital, so we may very well be called as consultants for those horrible situations that we hope will never occur:  the allocation of scarce resources, ventilators, life and death.

I will keep you posted.

Daily Memo

TO: All Faculty, Staff, and Trainees
FROM: Vicki R. LoPachin, MD, MBA
Senior Vice President
Chief Medical Officer
Mount Sinai Health System

DATE: March 31, 2020
RE: COVID-19 Health System Updates, March 31

Every day presents new challenges in our fight against COVID-19, and I know that each day feels harder than the last. But as our fight intensifies, I am deeply heartened by how all of us are coming together to tackle this crisis head on.

As of yesterday afternoon we had 1,360 COVID-19-positive patients in our hospitals. That included 248 patients in our ICUs. We had another 112 inpatients under investigation (PUIs).

We are currently at 67 percent ventilator utilization and more vents are on the way. The Governor has requested that all hospitals become familiar with protocols for using one vent on two patients at a time should the supply not prove adequate for the need. This is something we would normally never attempt. But these extraordinary times might require it. So, we are developing that capability.

Our biggest collective challenge so far is having enough clinical staffing to meet the growing need. This work is physically and emotionally exhausting—and all the more so as staff-to-patient ratios get stretched to accommodate the growing volumes. We need to do better and are working every angle. In a positive development, Governor Cuomo announced yesterday that staff from upstate hospitals would be coming to our region to join in the fight with us. We are very grateful to the Governor and the Mayor, and to everyone who comes to fight by our side. We are also sourcing extra staff from many other places as well. We welcome them all with open arms. Likewise, many of you are floating from your regular Mount Sinai hospitals to other ones within our system to provide much-needed help. This is never easy, and we are beyond grateful to you.

Also, yesterday, the USNS Comfort—a Navy hospital ship with 1,000 beds and 12 operating rooms—arrived in New York harbor. It could be ready to serve patients as soon as today. These extra beds will help free up space for the battle ahead.

As of this past weekend, our convalescent plasma transfusions have begun. One patient was treated on Saturday and two were treated on Sunday. There is more information about Mount Sinai’s work in this New York Times article.

Some more good news: So far, a total of 4,204 COVID-19 patients have been successfully treated and subsequently discharged from New York State hospitals. Many lives are indeed being saved.

If you have any questions, ideas, or concerns, you can always email CovidQuestions@mountsinai.org and we will be sure to follow up. And the COVID-19 employee resource website is constantly being updated with new information.

Your heroic efforts in this humanitarian mission of our lifetime are making all the difference. This is what I find myself reflecting on when I take my Mount Sinai minute at 12 pm each day. I have never been prouder to be your colleague or to wear the Mount Sinai badge.