To proactively engage LTCFs, health systems and PHSKC developed strike teams to provide them with on-site support. "Our geriatrics and post-acute care physicians have had longstanding relationships with many of the skilled nursing facilities, and each healthcare system has a group of LTCFs that they routinely work with for patient discharges, so they organized these strike teams to support these facilities," Dr. Bulger said. That on-site support includes COVID-19 testing for residents and staff and training for personal protective equipment and effective isolation and quarantine. "We were able to keep many of these patients in the nursing facilities and not overwhelm the hospitals by evacuating entire facilities," she said.
In addition to people in LTCFs, the response identified other vulnerable populations: minority and immigrant communities and non-English speakers; the homeless; and people in jails and prisons. PHSKC has convened nine task forces and community advisory groups to engage diverse populations. To service the homeless, King County added shelter space, hand-washing stations, and a call center along with locations where they can access isolation and quarantine services.
The WRC, Dr. Bulger noted, is built on the RMOC model first established in Texas and since promoted by the ACS Committee on Trauma to support disaster response. "The RMOC structure is a vital resource that I believe needs to be established in every community in the United States," Dr. Bulger said. The Department of Health and Human Services office of Assistant Secretary for Preparedness and Response (ASPR), which provides funding for regional coalitions, has promoted this approach as "Medical Operations Coordination Cells."
"Each region should begin to organize itself in this way because whether it's a pandemic or other type of large-scale disaster that occurs, it's critical for regions to prepare to develop communication structures that support situational awareness and patient distribution strategies," Dr. Mitchell said. "Otherwise, facilities get overwhelmed and patients suffer."
The authors proposed these "lessons learned" as a roadmap for preparation for future outbreaks, as well as establishing a lasting infrastructure which will strengthen the health systems response to all future mass casualty events and save lives.
The authors have no relevant disclosures.
Coauthors are senior author John B. Lynch, MD, MPH, of the Division of Allergy and Infectious Diseases at the University of Washington, Seattle; Herbert C. Duber, MD, MPH; and Vicki L. Sakata, MD, of the Northwest Healthcare Response Network, Tukwilla, Wash.; James Lewis, MD, and Jeffrey S. Duchin, MD, of Public Health – Seattle and King County; Keith R. Jerome, MD, PhD, of the University of Washington and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle; and Alexander L. Greninger, MD, PhD, MS, MPhil, Thuan D. Ong, MD, MPH, Stephen C. Morris, MD, MPH, Lisa D. Chew, MD, MPH, Tom M. Haffner, BS, Geoffrey S. Baird, MD, PhD, Susan A. Stern, MD, Timothy H. Dellit, MD, Louise Simpson, MHA, Onora Lien, MA, Nancy K. Sugg, MD, Meagan Kay, DVM, Benjamin Sanders, MD, MPH, Margaret D. Lukoff, MD, Sabine von Preyss-Friedman, MD, Matias Valenzuela, PhD, Chloe Bryson-Cahn, MD1, Vanessa A. Makarewicz, MN, and Hanh Pan, MHA, all of the University of Washington.
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Western Washington State's COVID-19 Experience: The Keys to Flattening the Curve & An Effective Health System Response. Journal of American College of Surgeons. DOI: https://doi.org/10.1016/j.jamcollsurg.2020.06.006.
